BACKGROUND SCREENING Application for …
AHCA Form #3110-0019, January 2017 Page 2 of 6 Rule 59A-35.090, F.A.C. Form available at: http://ahca.myflorida.com/BackgroundScreening Where to send the application:
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LTC Plan Contact: Provider Networks
www.ahca.myflorida.comEmail: jagutierrez@aetna.com Molina Healthcare of Florida 5, 6, and 11 Lissette Martinez Phone: 1-888-562-5442, ext. 223515 Email: lissette.martinez@MolinaHealthcare.com
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