3C Patch Reimbursement Support

Provider Registration Form

Provider Enrollment – ReApplix
Practice Address
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Additional Location Address (1)
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Facility Address
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Facility Address (2)
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PROGRAM SUPPORT:

MONDAY–FRIDAY 8:30AM–5:00PM EST
PHONE: 1-866-3CP-3025 FAX: (860) 516-1546
EMAIL: 3CPATCH@PRIAHEALTHCARE.COM