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Form 3254 November 2020EHealth and Human Services CommissionCommunity Services Contract Provider Agreement I. Contractor Information 1.1 Name of LegalMagnolia Primary Care LLC 1.2 Doing Business As

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How to fill out hhs000004901872-provisional contract-magnolia primary care

01

Obtain the hhs000004901872-provisional contract from Magnolia Primary Care.

02

Read through the contract carefully, paying attention to all sections and clauses.

03

Fill in all required fields with accurate information.

04

Sign and date the contract where indicated.

05

Submit the completed contract to the appropriate party at Magnolia Primary Care.

Who needs hhs000004901872-provisional contract-magnolia primary care?

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Individuals or organizations seeking to establish a contractual agreement with Magnolia Primary Care would need the hhs000004901872-provisional contract.

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What is hhs000004901872-provisional contract-magnolia primary care?

hhs000004901872-provisional contract-magnolia primary care refers to a contractual agreement between Magnolia Primary Care and a healthcare provider for provisional services.

Who is required to file hhs000004901872-provisional contract-magnolia primary care?

Healthcare providers who have a contractual agreement with Magnolia Primary Care are required to file hhs000004901872-provisional contract-magnolia primary care.

How to fill out hhs000004901872-provisional contract-magnolia primary care?

To fill out hhs000004901872-provisional contract-magnolia primary care, healthcare providers need to provide accurate information about the services provided, fees, and terms of the contract.

What is the purpose of hhs000004901872-provisional contract-magnolia primary care?

The purpose of hhs000004901872-provisional contract-magnolia primary care is to establish a formal agreement between Magnolia Primary Care and healthcare providers for provisional services.

What information must be reported on hhs000004901872-provisional contract-magnolia primary care?

hhs000004901872-provisional contract-magnolia primary care must include details about the services provided, fees charged, duration of the contract, and any other relevant terms.

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