Fee For Service| Primary Care Provider | Specialty Type | Start Date | End Date | State Wide Coverage | Status | |
|---|---|---|---|---|---|---|
| [A. Name] | [field-value] | [Date] | [Date] | [True] | [Active] |  |
Fee For Service Primary Care Provider
| Primary Care Provider | Specialty Type | Start Date | End Date | State Wide Coverage | Status | |
|---|---|---|---|---|---|---|
| [A. Name] | [field-value] | [Date] | [Date] | [True] | [Active] | |