3-Appendix AA FFS CoverSheet.pdf
PDF 28 KB Posted
- Solicitation number
- US.194189
- Issued by
- Delaware County, Pennsylvania
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Other files
| File | Type | Posted |
|---|---|---|
| 8-RFP Cost Report.xlsx | XLSX spreadsheet | |
| 11-Long Term Structured Residence.pdf | ||
| 5-Appendix DD.pdf | ||
| 4-Appendix CC.pdf | ||
| 6-Appendix EE.pdf | ||
| 7-Appendix FF.pdf | ||
| 10-Appendix U.docx | DOCX document | |
| 2-Appendix AA.pdf | ||
| 1-Appendix F.pdf | ||
| 9-Appendix II.pdf |
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Text version
FEE FOR SERVICE INVOICE COVER SHEET
Service / Level of Care Total Units Rate Total Service / Program Expenses
Total Invoice -$
Authorized Signature Date
Provider Name / Location
Delaware County DHS Program Office
Unique Invoice Reference #
Service Month
Program Name
Standard_Appendices(AppendixAA_FFSCoverSheet)
7/19 APPENDIX AA
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