PRA Disclosure Statement

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Identifying Medicaid Payment for Physician Administered Drugs (CMS-10215)

PRA Disclosure Statement

OMB: 0938-1026

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1026 can be found here:

2024-04-12 - Extension without change of a currently approved collection

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