Form DHCS6172SP is a California Department of Health Care Services form also known as the "Solicitud Para El Programa De Pago De Primas De Seguro De Salud (health Insurance Premium Payment, Hipp)". The latest edition of the form was released in September 1, 2015 and is available for digital filing.
Download a PDF version of the Form DHCS6172SP down below or find it on California Department of Health Care Services Forms website.
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