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DEPARTMENT OF HUMAN SERVICES SENIOR & DISABLED SERVICES DIVISION 500 Summer Street NE Salem, Oregon 973101015 Phone: (503) 9455811AUTHORIZED BY: SDSD Administrator/Deputy/ Assistant AdministratorINFORMATION
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APD-IM-20-019 is a transmittal cover form used for submitting certain documents related to Medicaid services and programs.
Providers, agencies, and organizations eligible to receive Medicaid reimbursement are required to file the APD-IM-20-019 transmittal cover.
To fill out the APD-IM-20-019 transmittal cover, enter the relevant organization details, document type, submission date, and any required signatures in the designated fields.
The purpose of the APD-IM-20-019 transmittal cover is to provide a clear and organized means of submitting necessary documents for Medicaid programs to ensure they are processed efficiently.
The information that must be reported includes the submitting organization’s name, contact information, document titles, and purpose of submission.
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