Home / Nurse's Station and Office Supplies / Forms / Healthcare Form / Healthcare Form Claim Form790-0116QR
Picture of Healthcare Form Claim Form790-0116QR

Healthcare Form Claim Form790-0116QR

Healthcare-Form-Claim-Form790-0116QR

SKU #

#876547

MPN #

790-0116QR

Brand

Phoenix Printing

Stock

In Stock

Quantity

100

Features

FORM, HCFA 1 PT CONT REVISION DATE 02/12 (2500/CT)
Billing Form
Claim Form
Medical Claim 2 Part

$130.54 USD

Product Specifications Product Usage Additional Information
Print
Attribute Name Attribute Value
McKesson # 876547
Manufacturer # 790-0116QR
Manufacturer Phoenix Printing
Application Healthcare Form
Color White / Red
Material Paper
Type Claim Form
UNSPSC Code 42142304
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  • Continuous revision date 02/12