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Medi-Cal Rx Electronic Funds Transfer (EFT) Authorization Agreement FormNovember 30th, 2021
Instructions: Carefully read and complete the EFT authorization form. By submitting this form, the provider is authorizing Medi-Cal Rx to electronically post or cancel posting of payments into their designated bank account. This authorization remains in effect until Medi-Cal Rx receives written notification from the provider of its termination, or until Medi-Cal Rx or appointing authority deems it necessary to terminate the agreement.
