![113927471-with-payment-to-mhpa-1150-18th-street-nw-suite-1010-washington-dc-20036-or-fax-to-202-8575731-mhpa](https://cdn.cocodoc.com/cocodoc-form/png/113927471--with-payment-to-MHPA-1150-18th-Street-NW-Suite-1010-Washington-DC-20036-or-fax-to-202-8575731-mhpa--x-01.png)
with payment to MHPA, 1150 18th Street, NW, Suite 1010, Washington, DC 20036 or fax to (202) 8575731 - mhpa
Partner/supporting member application to become a medicaid health plan of america partner or supporting member, complete this form and return with payment to: mhpa, 1150 18th street, nw, suite 1010, washington, dc 20036; or fax to (202) 8575731...
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