Free Utah Department Of Health Forms

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Medicaid (4)

4 Forms found in Utah — Department Of Health — Statewide — Page 1 of 1

Title	Last Updated
Utah Medicaid Electronic Funds Transfer (EFT) Enrollment And Authorization Agreement	July 22, 2015
Medicaid Provider Application	June 9, 2011
Disclosure Of Ownership And Control Interest Statement	June 9, 2011
Direct Deposit Authorization Form For Electronic Funds Transfers (EFT) For Medicaid Providers	June 9, 2011

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