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Parallon credentialing

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Submit a non-refundable renewal application fee of 225 c. Submit an annual credentialing fee of 225 d. Th Credit Card Payment Authorization Name as it appears on Card Date // Print Name of Representative/DHP if not the same as card holder Name of Company/Vendor Management Solutions to charge a non-refundable processing fee of 225 Initial Credentialing Processing Fee 225 Annual Credentialing Fee Visa MasterCard AMEX Discover Credit Card Number Expiration Date // Billing Address on Credit Card Ac ...

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