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The ACT ProgramPATIENT ENROLLMENT FORM PO Box 18979 Louisville, KY 402610979Please use this form to request reimbursement support and/or to have the patient referred to the patient assistance program.
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How to fill out po box 18979
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What is po box 18979?
PO Box 18979 is a specific post office box address.
Who is required to file po box 18979?
Individuals or businesses who have been assigned PO Box 18979 are required to file.
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To fill out PO Box 18979, simply write the necessary information on the envelope or form.
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The purpose of PO Box 18979 is to provide a secure mailing address for individuals or businesses.
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The information required on PO Box 18979 may vary, but typically includes the recipient's name and address.
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