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HIV Case Management Forms

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  • HIV Case Management - Basic Training Request Form (DMA-3159)

HIV Recertification Application Packet

  • HIV Case Management - Provider Recertification Application (NC Medicaid 3158) 
  • HIV Case Management - Provider Recertification Application Instructions(NC Medicaid 3158 I) 

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Contact Information

NC Medicaid, Division of Health Benefits
2501 Mail Service Center
Raleigh, NC 27699-2501

NC Medicaid Contact Center
Phone: 888-245-0179
Monday-Friday 8 a.m. to 5 p.m.
Closed on State holidays.
 
Visit RelayNC for information about TTY services.
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