Fillable Form B 1 of 2 Nursing Home Technology Pilot Grant Program August ... - careproviders

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See Next Page for Instructions Form B 1 of 2 MINNESOTA DEPARTMENT OF HEALTH GRANT APPLICATION FACE SHEET NURSING HOME TECHNOLOGY PILOT GRANT PROGRAM 1. Applicant or Organization (with which grant contract is to be executed) Legal Name Address Phone Federal Tax ID Number State Tax ID Number...
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