Model No.: | 50135R |
Alternate Model Numbers: | TOP50135RV 50135R |
UPC: | 025932513503 |
Ship Weight (lbs): | 2.660 |
Care Warehouse SKU: | 2111363 (71) |
Manufacturer: |
TOPS BUSINESS FORMS Please click on the manufacturer's name or logo to preview all products |
Retail: $24.96
Your Price
$23.32
Save: $1.64 that is over 7% off
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Expedite Medicare, Medicaid or private insurance benefits. NUCC, CMS and AMA approved format. (02/12) version. Printed front and back in red OCR ink for scanning. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. Form Size: 11 x 8 1/2; Forms Per Page: 1; Form Quantity: 250; Principal Heading(s): 1500 Health Insurance Claim Form.
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