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Business Location » NY » Broome » Binghamton » Medicaid License » Medicaid Provider Enrollment Application (for Durable Medical Equipment) »

Medicaid License:

Medicaid Provider Enrollment Application (for Durable Medical Equipment)

The following special signature/seal are required: ( An original signature )

The cost of the form & instructions is $19.99

Submit Online ($49.99) Not available on this form The application needs an original signature.
	Online submission is fast & easy Upload any attachments Sign your forms online Click a button to submit

Print and Mail
	Print your forms Sign them Mail to provided authority

Used For:

TOTAL:

$19.99

How is this Calculated?

The pricing schedule is as follows:
Form and instructions	$19.99
Associated documents, such as schedules, ordinances, statutes, etc	$19.99
Electroning Filing	$49.99

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