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Massachusetts Cannabis Control Commission Marijuana Microbusiness General Information: License Number:MB281675Original Issued Date: 09/16/2020 Issued Date:08/12/2021Expiration Date:09/16/2022ABOUT
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The HCA Cert Form is a document required for certain health care providers to certify eligibility for health care assistance programs.
Health care providers who participate in health care assistance programs must file the HCA Cert Form.
To fill out the HCA Cert Form, complete all sections with accurate information, provide supporting documentation, and ensure all signatures are obtained.
The purpose of the HCA Cert Form is to document and certify eligibility for health care assistance programs.
The HCA Cert Form requires reporting of the provider's information, patient details, service types, and eligibility criteria.
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