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Get Professional Provider Application - #B-3308 - Wellmark Blue Cross ...

Ion if you are interested in contracting with any Wellmark network for the first time. In it s sole discretion, Wellmark reserves the right not to process or accept a provider s application. Please check the appropriate box below. I am completing this application because: c I want to submit claims and not contract with Wellmark. Complete Sections A and D. c I am adding an emergency room location. Complete Sections A, B and D. c I am adding a new practice location for a Wellmark provider n.

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