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Page 105 of hcfa cms 1500 health insurance business forms

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Thermaltake View 270 Plus TG ARGB ATX Mid-Tower Computer Case, Hydrangea Blue (CA-1Y7-00MFWN-01)Thermaltake View 270 Plus TG ARGB ATX Mid-Tower Computer Case, Hydrangea Blue (CA-1Y7-00MFWN-01)
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Thermaltake View 270 Plus TG ARGB ATX Mid-Tower Computer Case, Hydrangea Blue (CA-1Y7-00MFWN-01)
Item #: 901-24603042
Item #: 901-24603042
Mid Tower Chassis
Color Hydrangea Blue, Material Tempered Glass, SPCC
Form Factor Mid-tower
$93.99
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Out of stock
Arf Pets Freestanding 360° Foldable Dog Gate, 4-Panel Extension, 80W x 31.5H, Rich Espresso (APDGWD4P)Arf Pets Freestanding 360° Foldable Dog Gate, 4-Panel Extension, 80W x 31.5H, Rich Espresso (APDGWD4P)
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Arf Pets Freestanding 360° Foldable Dog Gate, 4-Panel Extension, 80"W x 31.5"H, Rich Espresso (APDGWD4P)
Item #: 901-APDGWD4P
Item #: 901-APDGWD4P
Have this easy-to-use tall dog gate up in seconds with step-by-step instructions
Interconnecting panels can form a foldable gate to block off select areas of your home
Sturdy, high-quality wooden construction is safe for pets and is durable for long use
$89.99
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Out of stock
OtterBox Defender Series Pro XT Clear MagSafe Case for iPhone 17 Pro, Shock Absorbing, Clear/Black (77-98518)OtterBox Defender Series Pro XT Clear MagSafe Case for iPhone 17 Pro, Shock Absorbing, Clear/Black (77-98518)
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OtterBox Defender Series Pro XT Clear MagSafe Case for iPhone 17 Pro, Shock Absorbing, Clear/Black (77-98518)
Item #: 901-IM1XS9745
Item #: 901-IM1XS9745
Designed as a rugged basic case for iPhone 17 Pro with dual-layer protection.
Formed from polycarbonate and silicone in a clear/black finish.
Drop-tested 7x beyond military standard for extreme impact resistance.
$87.99
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Out of stock
Plantronics HL10 Handset Lifter, Black (86H62AA)
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Plantronics HL10 Handset Lifter, Black (86H62AA)
Item #: 901-IM1HH0610
Item #: 901-IM1HH0610
Handset lifter
Power source: AC adapter
Form factor: desktop
$84.09
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Out of stock
Dell External Slim 8X DVD-ROM USB Computer Disc Drive, Black (429-AAOX)
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Dell External Slim 8X DVD-ROM USB Computer Disc Drive, Black (429-AAOX)
Item #: 901-IM13DW796
Item #: 901-IM13DW796
Slim external form factor with USB interface; DVD-ROM type drive designed for portability and plug-and-play use.
Supports DVD-ROM discs for reading optical media, software, and multimedia content.
Provides up to 8x maximum DVD read speed; optimized buffer management ensures smooth playback and data access.
$60.99
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Activa Products Art Plaster 5 Lb. Can [Pack Of 2] (2PK-225)
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Activa Products Art Plaster 5 Lb. Can [Pack Of 2] (2PK-225)
Item #: 901-2169402ASN
Item #: 901-2169402ASN
Create free-form sculpture
Make original molds
size: 5 lb. can
$40.99
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Out of stock
JAM PAPER 8.5 x 11 Matte Paper, 28lb, Burgundy, 100 Sheets/Pack (36395839G)
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JAM PAPER 8.5" x 11" Matte Paper, 28lb, Burgundy, 100 Sheets/Pack (36395839G)
Item #: 901-24565097
(1)
Item #: 901-24565097
Color: Burgundy Red | Make your work stand out with premium colored paper.
Size: Standard Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 per pack | Plenty of paper for a big project, or to last a long time.
$39.99
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Out of stock
SaharaCase Tri-Fold Folio Case for Samsung Galaxy Tab A7 Lite, Blue (TB00124)SaharaCase Tri-Fold Folio Case for Samsung Galaxy Tab A7 Lite, Blue (TB00124)
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SaharaCase Tri-Fold Folio Case for Samsung Galaxy Tab A7 Lite, Blue (TB00124)
Item #: 901-24551411
Item #: 901-24551411
Designed for Samsung Galaxy Tab A7 Lite - Complement your Samsung device with this lightweight, form-fitting case featuring an open-button design.
Foldable kickstand - Its strong magnetic connection creates a stable viewing stand with two angles for your tablet.
Ergonomic open-button design - Provides quick and simple access to ports and buttons.
$36.99
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Out of stock
Philips Hue 60W Equivalent A19 LED Smart Bulb, Soft Warm White, 2/Pk (476951)Philips Hue 60W Equivalent A19 LED Smart Bulb, Soft Warm White, 2/Pk (476951)
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Philips Hue 60W Equivalent A19 LED Smart Bulb, Soft Warm White, 2/Pk (476951)
Item #: 901-IM16PK205
Item #: 901-IM16PK205
Light your home your way with this smart bulb, offering instant, out-of-the-box dimming and a high quality of light
A19 form factor bulb with E26 (medium) base emits soft warm white color
Connects via Bluetooth or Hue Bridge
This product is not eligible for earning points.
$34.69
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JAM PAPER 8.5 x 11 Vellum Bristol Cardstock, 67lb, Cherry, 100/pack (169823G)
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JAM PAPER 8.5" x 11" Vellum Bristol Cardstock, 67lb, Cherry, 100/pack (169823G)
Item #: 901-24565093
Item #: 901-24565093
Color: Cherry Pink | Our premium solid core cardstock shows no white when folding, tearing, or cutting; its colorful all the way through!
Size: Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 Sheets | Plenty of paper for a big project, or to last a long time.
$27.99
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Out of stock
JAM PAPER 8.5 x 11 Vellum Bristol Cardstock, 67lb, Pink, 100/pack (169831G)
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JAM PAPER 8.5" x 11" Vellum Bristol Cardstock, 67lb, Pink, 100/pack (169831G)
Item #: 901-24565122
(1)
Item #: 901-24565122
Color: Light Pink | Our premium solid core cardstock shows no white when folding, tearing, or cutting; its colorful all the way through!
Size: Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 Sheets | Plenty of paper for a big project, or to last a long time.
$27.99
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Out of stock
JAM PAPER 8.5 x 11 Vellum Bristol Cardstock, 67lb, Green, 100/pack (169826G)
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JAM PAPER 8.5" x 11" Vellum Bristol Cardstock, 67lb, Green, 100/pack (169826G)
Item #: 901-24565135
(4)
Item #: 901-24565135
Color: Green | Our premium solid core cardstock shows no white when folding, tearing, or cutting; its colorful all the way through!
Size: Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 sheets | Plenty of paper for a big project, or to last a long time.
$27.99
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Out of stock
JAM PAPER 8.5 x 11 Vellum Bristol Cardstock, 67lb, Goldenrod, 100/pack (169825G)
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JAM PAPER 8.5" x 11" Vellum Bristol Cardstock, 67lb, Goldenrod, 100/pack (169825G)
Item #: 901-24565128
Item #: 901-24565128
Color: Goldenrod Orange | Our premium solid core cardstock shows no white when folding, tearing, or cutting; its colorful all the way through!
Size: Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 Sheets | Plenty of paper for a big project, or to last a long time.
$27.99
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Out of stock
SaharaCase Raider Series Heavy Duty Case Compatible with Magsafe for Airpods Pro 3, Secure Lock, White Stone (HP00218)SaharaCase Raider Series Heavy Duty Case Compatible with Magsafe for Airpods Pro 3, Secure Lock, White Stone (HP00218)
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SaharaCase Raider Series Heavy Duty Case Compatible with Magsafe for Airpods Pro 3, Secure Lock, White Stone (HP00218)
Item #: 901-24670228
Item #: 901-24670228
Heavy-Duty Protection - Durable TPU construction with shock-absorbing corners defends against drops, scratches, and dirt.
MagSafe Compatible - Built-in magnets allow seamless MagSafe wireless charging without removing the case.
Heavy-Duty & Portable Design - Form-fitting build enhances portability while keeping installation quick and simple.
$26.99
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Out of stock
SaharaCase Venture Series MagSafe Compatible Phone Case for iPhone Air, Shock Absorbing, Scorpion Black (CP00950)SaharaCase Venture Series MagSafe Compatible Phone Case for iPhone Air, Shock Absorbing, Scorpion Black (CP00950)
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SaharaCase Venture Series MagSafe Compatible Phone Case for iPhone Air, Shock Absorbing, Scorpion Black (CP00950)
Item #: 901-24659664
Item #: 901-24659664
Form-Fitting Design - Exclusively tailored for the Apple iPhone Air, offering a sleek and lightweight protection solution.
Desert-Inspired Design - The rich, Smooth finish reflect the beauty and resilience of the Sahara Desert.
Raised Edge Protection - Reinforced edges around the camera and screen provide extra protection against drops and impacts, like the desert shields its treasures.
$22.99
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Out of stock
Bower Flexible Large Bendi Pods
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Bower Flexible Large Bendi Pods
Item #: 901-271111BWC
Item #: 901-271111BWC
Dimensions: 13" x 2.2" x 5.6"
For use with hold all manual and digital SLR cameras and camcorders
Flexible joints bend and rotate 360 degree to form every possible shape
$22.99
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Out of stock
Cyber Acoustics ACM-500 Stereo Headphone
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Cyber Acoustics ACM-500 Stereo Headphone
Item #: 901-IM1289557IN
(1)
Item #: 901-IM1289557IN
Rotary volume control, stereo/mono switch
Earpiece type: Binaural
Form factor: Circumaural
$23.09
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Out of stock
JAM Paper 30% Recycled Parchment Colored Paper, 24 lb., 8.5 x 11, Salmon Pink, 100 Sheets/Pack (17137622)JAM Paper 30% Recycled Parchment Colored Paper, 24 lb., 8.5 x 11, Salmon Pink, 100 Sheets/Pack (17137622)
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JAM Paper 30% Recycled Parchment Colored Paper, 24 lb., 8.5" x 11", Salmon Pink, 100 Sheets/Pack (17137622)
Item #: 901-24508553
(1)
Item #: 901-24508553
Color: Parchment Salmon | Make your work stand out with premium colored paper.
Size: Standard Letter (8.5 x 11 inches) | Ideal for newsletters, brochures, invitations, announcements, flyers, forms, and more.
Quantity: 100 per pack | Plenty of paper for a big project, or to last a long time.
$21.39
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Roylco Inc. Rangoli Mega Stencils, 4/Pack (R5621)
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Roylco Inc. Rangoli Mega Stencils, 4/Pack (R5621)
Item #: 901-24012011
Item #: 901-24012011
Rangoli is a traditional and beautiful art form from India
Use the 11" x 11" stencils with large butcher paper or place pattern directly onto outdoor pavement and design with with sidewalk chalk
Includes 4 stencils and idea guide
$20.59
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Out of stock
Vangoddy 13 Laptop Sleeve, Black/Blue (NBKLEA652)Vangoddy 13 Laptop Sleeve, Black/Blue (NBKLEA652)
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Vangoddy 13" Laptop Sleeve, Black/Blue (NBKLEA652)
Item #: 901-2435038
Item #: 901-2435038
Form fitting sleeve with quick top loading access
Slim design allows you to carry the case by itself or in a bag
Water resistant neoprene material offers lightweight design and superior protection
$14.49
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Out of stock
Hamilton Buhl SchoolMate Deluxe Headphones, Gray (SC-7V)Hamilton Buhl SchoolMate Deluxe Headphones, Gray (SC-7V)
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Hamilton Buhl SchoolMate Deluxe Headphones, Gray (SC-7V)
Item #: 901-JV38412
(7)
Item #: 901-JV38412
Gray over-ear headphones for rich sound reproduction
Wired over-ear form factor offers high-fidelity sound
Standard 3.5mm earphone plug works with almost every 3.5mm audio jack device
$10.69
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Vangoddy Leather Tablet Sleeve for iPad Samsung Galaxy Kindle Fire, Black (PT_RDYLEA591_HP)Vangoddy Leather Tablet Sleeve for iPad Samsung Galaxy Kindle Fire, Black (PT_RDYLEA591_HP)
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Vangoddy Leather Tablet Sleeve for iPad Samsung Galaxy Kindle Fire, Black (PT_RDYLEA591_HP)
Item #: 901-24292440
Item #: 901-24292440
Fits up to 10.5 Inch tablet, including iPad Pro, Asus, Samsung Galaxy Tab, Lenovo, Kindle Fire and other 10 Inch tablet.
Form-fitting ensures a precise fit for your tablet up to 10.5 Inch.
Back zippered compartment is great for holding accessories
$8.79
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Snow Joe Frostys Nightmare Ice Melt Crystals, 40 lb. Bag, 63 Bags/Pallet (FN40)Snow Joe Frostys Nightmare Ice Melt Crystals, 40 lb. Bag, 63 Bags/Pallet (FN40)
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Snow Joe Frosty's Nightmare Ice Melt Crystals, 40 lb. Bag, 63 Bags/Pallet (FN40)
Item #: 901-24649631
Item #: 901-24649631
CAN BE USED AS A PREVENTATIVE: Frequent use throughout snowfall periods prevents ice from forming on ground surfaces
ULTRA CONVENIENT: Can be dispensed directly out of the bag or into a handheld or wheeled salt spreader
Preventative Power: Use it throughout snowfall periods to prevent ice formation on surfaces, saving you time and minimizing the risk of accidents by keeping areas clear and manageable
$7.99
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School Days, Daily Record Book, 96 pages
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School Days, Daily Record Book, 96 pages
Item #: 901-JV42822
Item #: 901-JV42822
Age group and grade: Grades kindergarten - 6th
Includes attendance records, assignments and tests, record of standards assessed, communication log, roster, grade finder, calendar and more
Book is jam packed with valuable forms and resources to help you stay organized
$6.09
Per each
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