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Shasta County Health & Human Services Agency Attn: Managed Care & Compliance HD410MC P.O. Box 496005 Redding, CA 960496005SHASTA COUNTY HEALTH AND HUMAN SERVICES AGENCY2640 Bresler Way Redding, CA

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How to fill out change of provider request

01

Obtain the change of provider request form from your current provider.

02

Fill out the form with your personal information, account details, and reason for changing providers.

03

Submit the completed form to your current provider either in person, via mail, or through their online portal.

04

Wait for confirmation from your current provider that they have received your request and will begin processing it.

05

Once approved, you will receive notification from your new provider that the transfer process is complete.

Who needs change of provider request?

01

Individuals who wish to switch to a new service provider for various reasons such as better pricing, improved services, or dissatisfaction with current provider.

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What is change of provider request?

A change of provider request is a formal request to switch to a different service provider or vendor.

Who is required to file change of provider request?

Any individual or organization looking to change their service provider must file a change of provider request.

How to fill out change of provider request?

To fill out a change of provider request, one must provide details about the current provider, the new provider, and reasons for the switch.

What is the purpose of change of provider request?

The purpose of a change of provider request is to officially notify the current provider of the decision to switch to a new provider.

What information must be reported on change of provider request?

The change of provider request must include details such as current provider information, new provider information, reason for switch, and effective date of change.

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