New York State Medicaid Program Group Affiliation ...
date this form was received by the Medicaid Program, the listed date cannot be used. The effective date will be set at the 90day limit).- ***** SECTION B: I agree to participate in the Medicaid Program as a Member of the group listed above. I realize I am personally
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www.cms.govALCMP@adph.state.al.us Alaska Health Facilities Licensing & Certification 4501 Business Park Blvd, Building L, Suite 24 Anchorage, Alaska 99503 Email: dhcs.hflc@alaska.gov; Attention: CMP Reinvestment Program Arizona Arizona Dept. of Health Services 150 N. 18th Avenue, Suite 440 : Phoenix, AZ 85007 ; Email: LTC.licensing@azdhs.gov
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