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/NF-B) Quality Assurance Fee FREE TEXT (FY) Payment Invoice for FREE TEXT (Month, Day, Year) to FREE TEXT (Month, Day, Year) Department of Health Care Services Accounting Section/Cashiers Unit, Mail Stop 1101 1501 Capitol Avenue, Suite 71.2048 P.O. Box 997415 Sacramento, CA 95899-7415 Office of Statewide Health Planning and Development Number: FREE TEXT (Facility Name) FREE TEXT (Facility Address) FREE TEXT (Facility City, State, Zip Code) Due Date: FREE TEXT (Date).

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