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Contractual Validation Form - Atlanta HMO/QPOS Two-Nine Eligible Lives This form must accompany all new case submissions. All information must be submitted 30 days prior to the effective date to ensure ID cards are received prior to effective date. Aetna U.S. Healthcare - Small Business Center 841 Prudential Drive 6th Floor West F602 Jacksonville FL 32207 Phone 800 223-2125 Fax 800 814-5677 New Business Case Information Case Name Proposed Effecti.

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