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Va form 5655Va Form 5655Page 1va form 5655Page 2va form 5655Page 3va form 5655Page 4va form 5655va form 5655 PDF VA Form VA5655. Search VA Forms. Financial Status Report (Fillable) File Type: PDF

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What is va form va-5655?

VA Form VA-5655 is the Health Care Provider Enrollment Application for VA Community Care.

Who is required to file va form va-5655?

Health care providers who wish to participate in VA Community Care programs are required to file VA Form VA-5655.

How to fill out va form va-5655?

VA Form VA-5655 can be filled out online on the VA website or by contacting the VA Community Care Network.

What is the purpose of va form va-5655?

The purpose of VA Form VA-5655 is to enroll health care providers in the VA Community Care network to provide care to eligible veterans.

What information must be reported on va form va-5655?

VA Form VA-5655 requires information such as provider contact information, licensing information, services offered, and other provider details.

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