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Get Typeable Map Of South Carolina Form

Attachment s Check appropriate box Medicaid Remittance Advice required Explanation of Benefits EOMB from Insurance Company if applicable Refund check Make all checks payable to South Carolina Department of Health and Human Services Mail to SC Department of Health and Human Services Cash Receipts Post Office Box 8355 Columbia SC 29202-8355 DHHS Form 205 01/08 Refund SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES ESRD ENROLLMENT FOR MEDICAI.

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