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... SUD) Services Enrollment Criteria and Forms , specifically: DHS-4138-ENG (MA and MCO In-Network providers or ...
Date: June 26, 2026
... these settings. Legislative Director Ari Didion 651-431-4138 ariana.c.didion@state.mn.us Legislature Government ...
Description: This page has DHS contacts for the Minnesota Legislature.
Date: June 26, 2026
Renew my coverage A5 Handout Позаботьтесь о своей медицинской страховке Медицинскую страховку необходимо периодически обновлять. Информацию о том, как сохранить ...
Date: December 30, 2022
2017 Collaborative Report Infographic 2017 Collaborative Report Infographic In 2017, there were 90 Children's Mental Health & Family Services Collaboratives ...
Date: September 02, 2021
... Care Programs Provider Agreement means the form DHS-4138 agreement, as amended, between the STATE and a ...
Description: 2026 IHP RFP - Appendix G - Sample Contract
Date: June 05, 2026
... Minnesota Health Care Programs (MHCP) Provider Agreement (DHS-4138) (PDF) • EIDBI Assurance Statement for Comprehensive Multi-Disciplinary ... Application (DHS-4016A) (PDF) • MHCP Provider Agreement (DHS-4138) (PDF) • Disclosure of Ownership and Control Interest (DHS- ...
... Application (DHS-4016) (PDF) • MHCP Provider Agreement (DHS-4138) (PDF) • MHCP Limited Authorization Dental Hygienists Assurance Statement ( ...
... signed and completed forms: • MHCP Provider Agreement (DHS-4138) (PDF) • MHCP Enrollment Application (DHS-4016) (PDF) • MHCP ...
... Enrollment Application (DHS-4015) • MHCP Provider Agreement (DHS-4138) • Disclosure of Ownership and Control Interest (DHS-5259) • ...
... MHCP services for you • MHCP Provider Agreement (DHS-4138) (PDF) • Copy of all applicable licenses and your ...