CMS-10636 Facility HSD Table
Triennial Network Adequacy Review for Medicare Advantage Organizations and 1876 Cost Plans (CMS-10636)
MA_Facility_Table_Template_(2022 version 2)
Three-Year Network Adequacy Review for Medicare Advantage Organizations
OMB: 0938-1346
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1346 can be found here:
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