DMA-5157 SP Notice of Total Countable Resources; Right to Rebute Value

Form Numberdma-5157sp
Medicaid Form Numberdma-5157sp
Agency/DivisionHealth Benefits/NC Medicaid (DHB)
Form Effective Date 2020-08-20T00:05:00-04:00
Form File DMA-5157 SP 8-19-2020.pdf