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Get CMS-339 2006

and Human Services will render the amount claimed in the cost report unallowable. A. Provider Organization and Operation NOTE: Section A to be completed by all providers. 1. The provider has: a. Changed ownership. If "yes", submit name and address of new owner, date of change, copy of sales agreement, or any similar agreement affecting change of ownership. b. Terminated participation. If "yes", list date of termination, and reason (Voluntary/Involuntary). 2. The provider, members of the bo.

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