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Treatment Provider Application Fees. DHCS assesses fees to all licensed and/or certified residential and certified outpatient SUD recovery and treatment facilities, regardless of the form of organization orownership. Please see the Department's website for the current fee structure.
14 wrz 2023 · Forms: DHCS 6000. DHCS 6002 (06/16) - Initial Treatment Provider Application. DHCS 6011-1112 Direct Provider Narcotic Treatment Program - Alcohol and Drug (Excel) Alt: Instructions. DHCS 6012-1112 Direct Provider Narcotic Treatment Program - Perinatal (Excel) Alt: Instructions. DHCS 6204 (01/13) - Medi-Cal Provider Application.
Fill out and download the Form DHCS6002 Initial Treatment Provider Application in California online. Get the blank document in PDF and Word formats for free.
1 maj 2021 · Fill Out The Medi-cal Provider Application - California Online And Print It Out For Free. Form Dhcs6204 Is Often Used In California Department Of Health Care Services, California Legal Forms, Legal And United States Legal Forms.
California Participating Practitioner Application. This form should be typed. If more space is needed than provided on original, attach additional sheets and reference the question being answered. Please refer to cover page for a list of the required documents to be submitted with this application. II.
3 wrz 2024 · The following are applications for individuals and providers to participate in DHCS programs: Medi-Cal Provider Enrollment Application Packages Alphabetical by Provider Type
Any alteration or modification by the applicant or Provider of this Medi-Cal Provider Agreement (DHCS Form 9098) or to any of the terms in its exhibits or attachments, shall automatically and immediately void this agreement upon submission of the signed agreement to the State, unless such agreement is also signed by the State.
