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Get TX Form 8603 2016-2024

On Review (PE/UR) Mailing Address: P.O. Box 149030, Mail Code W-551 Austin, TX 78714-9030 Fax: 512-438-4249 Physical Address: 701 West 51st Street, Mail Code W-551 Austin, TX 78751-4015 (Do not fax more than 25 pages without prior approval.) Date Submitted Program Type: (check one) Intermediate Care Facilities/Intellectual Disability (ICF/ID) Home and Community-based Services (HCS) From: Provider Name Component Code Contract No. Provider Contact Information LIDDA: Provider Contact Ar.

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