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Complete the Provider Demographic Form.
Complete the Provider Demographic Termination Form.
Complete the Non Covered Service Fee Form.
Complete the Provider Termination Form.
Either print the form and fax it to MARCH at (877) 627-2488 or save it as a PDF file and email it to
Retrieve User ID: Step 1 of 3
Fields marked with asterisk (*) are required
Tax ID Number
Office Phone Number
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