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Subscribers Statement of Claim Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 959272540. This form is to be used only when the provider of service does not submit your
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box 272540 in Chico, CA is a designated address for filing certain types of tax forms or documents.
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Fill out the required information on the designated tax form or document and send it to the address indicated on box 272540 in Chico, CA.
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