Managed Care Program

Addendum to the Provider Agreement

Medical assistance providers who anticipate participating in the South Dakota Medical Assistance PRIME Program may use this Addendum to the Provider Agreement to enroll as a Primary Care Provider (PCP) in the Managed Care Program.

This addendum establishes contractual relations with the provider to ensure the provider adheres to rules and regulations established by South Dakota administrative rule and codified law.

• Addendum to the Provider Agreement

Mail document to the following address:

• South Dakota Department of Social Services
  Division of Medical Services
  Provider Enrollment
  700 Governors Drive
  Pierre, SD 57501