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Newborn Certification Alabama Medicaid Agency Attn: Certification Support 501 Dexter Avenue P.O. Box 5624 Montgomery, AL 36103-5624 Name and Address of Mother Agency/Hospital: Contact Person: Contact.

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Keywords relevant to Form 284 Fillable

  • enroll
  • medicaid
  • Postage
  • Revised
  • provider
  • receives
  • responses
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