dma-5055-ia Third Party Resource Transmittal
| Form Number | dma-5055-ia |
| Medicaid Form Number | dma-5055-ia |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Form Effective Date | 2011-01-04T16:05:00-04:00 |
| Form File | dma-5055-ia.pdf |
| Form Number | dma-5055-ia |
| Medicaid Form Number | dma-5055-ia |
| Agency/Division | Health Benefits/NC Medicaid (DHB) |
| Form Effective Date | 2011-01-04T16:05:00-04:00 |
| Form File | dma-5055-ia.pdf |