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O. Box 91030 Baton Rouge Louisiana 70821-9030 for approval to enroll in the Medicaid Program as a nonemergency medical transportation provider in the parish es of. Please contact Molina Medicaid Solutions Provider Relations 225 924-5040 or the Transportation Program 225 342-9404 if you have any questions. STATE OF LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS NON-EMERGENCY MEDICAL TRANSPORTATION LICENSE APPLICATION FORM check if any change has occ.

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