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TOPS®: CMS 1500 Health Insurance Claim, Lttr, 2-Part, 100 Continuos Form Sets/Pack
	Quantity in Basket: None Code: TOP-50129R Price: $21.32
	Quantity:
TOPS® Centers for Medicare and Medicaid Services (CMS) Forms with Sensor Bar Centers for Medicare and Medicaid Services (CMS) claim form with sensor bar. CMS-1500 claim forms (formerly known as HCFA-1500 claim forms) expedite Medicare, Medicaid or private insurance benefits. Top sensor bar for microfiche duplication, as required in some states. OCR red ink for scanning. • UPC = 025932501296 • Weight = 2.06 lbs/PK • Mfgr Code: 50129R • Mfgr Name: TOPS BUSINESS FORMS • PRICED PER PK If your SHIP TO address is in California, you will receive a second invoice showing the California SALES TAX that you paid for this item