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SUPPLEMENTAL OWNERSHIP & CONTROLLING INTEREST DISCLOSURE FORM To supplement applications for SD Medicaid Tribal/IHS Enrollment Types Provider Name: Provider NPI (only 1 per form): Page of The online

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What is tribal ihs ownership amp?

Tribal IHS Ownership AMP stands for Tribal Indian Health Service Ownership Annual Mandatory Provider Agreement.

Who is required to file tribal ihs ownership amp?

Tribal health service providers who have agreements with Indian Health Service are required to file Tribal IHS Ownership AMP.

How to fill out tribal ihs ownership amp?

To fill out Tribal IHS Ownership AMP, providers must include information about ownership, services provided, and compliance with regulations.

What is the purpose of tribal ihs ownership amp?

The purpose of Tribal IHS Ownership AMP is to ensure compliance with Indian Health Service regulations and track ownership of tribal health service providers.

What information must be reported on tribal ihs ownership amp?

Information such as ownership details, services provided, and compliance with regulations must be reported on Tribal IHS Ownership AMP.

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