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Get Va Eft For For Oklahoma Form

*A VOIDED CHECK OR A BANK LETTER VERIFYING THE ACCOUNT AND ROUTING NUMBERS IS REQUIRED.* Financial Institution Name: Financial Institution Routing Number: Type of Account at Financial Institution: Provider s Account Number with Financial Institution: Account Number Linkage to Provider Identifier: Provider Tax Identification Number (TIN) or National Provider Identifier (NPI) You must contact your financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data.

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