Attachment C-Medicare-Medicaid Acknowledgement.docx

This is a Medicare-Medicaid Acknowledgement certification document required as part of a state and local contract opportunity. The document serves as a compliance attestation in which the contractor certifies that both the contractor and any dietician provided for services under the contract are not currently excluded from Medicare and Medicaid provider programs and will not become excluded during the contract period. The certification requires the contractor to provide a signature, date, printed name, and title/position of the authorized representative executing the document.

No additional information regarding pricing terms, contract duration, scope of services, deliverables, or other substantive contract requirements is contained within this attachment. This document functions solely as a compliance verification mechanism to ensure contractor eligibility to participate in federally funded healthcare programs.