Medi-Cal Rx Electronic Funds Transfer (EFT) Authorization Agreement Form
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https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/Medi-Cal_Rx_Electronic_Funds_Transfer_Form.pdfUnless the owner has removed it from the web, you can access the full document via its original URL:
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