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Florida - Roster Billing Information

First Coast Service Options, Inc.

Immunization Roster Billing:

Forms:

Sample CMS Form with Pneumococcal Vaccine Fields Noted:

Pneumococcal Vaccine Roster Form:

Sample CMS Form with Influenza Vaccine Fields Noted:

Influenza Vaccine Roster Form:

Medicare Enrollment Information:

Electronic Data Interchange (EDI) Information: