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Get Meridian Form 30 2013-2023

Set up with central pay. The central pay PSAO is eligible to receive EFT. If you are an affiliate of a PSAO utilizing central pay and would like to change your payment to EFT, you will need to contact your PSAO directly. PART I: REASON FOR SUBMISSION New EFT Authorization Cancel EFT Revision to Existing Enrollment (e.g. account or bank changes) Enroll in Electronic Remittance Advice (ERA) to Receive 835 Transmissions PART II: PHARMACY/ORGANIZATION INFORMATION Tax ID: Chain C.

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