Form 1342, Antiviral Agents for Hepatitis C Virus Initial Request – Standard PA Addendum (Medicaid)

Texas Health and Human Services

This government document is issued by Texas Health and Human Services for use in Texas

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File Details: PDF (127 KB)
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Source
https://www.hhs.texas.gov/regulations/forms/1000-1999/form-1342-antiviral-agents-hepatitis-c-virus-initial-request-standard-pa-addendum-medicaid

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