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Get Wi Dhs F-10181 2010-2024

E this form or you can complete an online form at ACCESS.wi.gov. If you have questions about completing this form, please call 1-866-710-2026. Thank you for your cooperation. Return the completed form to: Department of Health Services, EVHI Unit, PO Box 6530, Suite 100, Madison, WI 53716 or by fax to (608) 222-4523. SECTION 1 – BASIC INFORMATION Please provide the basic information about your company. Your Federal Employer Identification Number (FEIN) is a required field to match information w.

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