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Get CMS-588 2010

SSION Reason for Submission: Check here if EFT payment is being made to the Home Office of Chain New EFT Authorization Revision to Current Authorization (Attach letter Authorizing EFT payment to Chain Home Office) (e.g. account or bank changes) Since your last EFT authorization agreement submission, have you had a: Change of Ownership, and/or Change of Practice Location? If you checked either a change of ownership or change of practice location above, you must submit a change of information .

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