product-thumb
product-thumb

Tops Ub-04 Forms, 1 Part, White, 8 1/2" X 11", Box Of 2,500

$262.89

Used by hospitals and institutions to file a medical claim with a patient's insurance company Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink. | Tops Ub-04...

Used by hospitals and institutions to file a medical claim with a patient's insurance company Meets the requirements of the Centers for Medicare and Medicaid Services (CMS). Printed on carbonless, 20-lb bond, 1-ply paper with red ink. | Tops Ub-04...

Out of stock
  • RevType
  • 2
  • Manufacturer
  • TOPS
  • Sku
  • 526935
  • Identity
  • 37411545476

Customers Also Searched

New
thumbnail

Freestanding Toilet Paper Holder with Storage

$73.99
New
thumbnail

Black Toilet Paper Holder Stand - 6"L x 6"W x 17.00"H

$32.99
New
thumbnail

Vintage Freestanding Toilet Paper Holder - Oil Rubbed bronze

$92.48
New
thumbnail

Alessi "Birillo" Toilet Paper Roll Holder - White

$145.00
New
thumbnail

Home Basics Stainless Steel Paper Towel Holder with Integrated Wrap Dispenser - Silver

$18.99
New
thumbnail

28" Tall - Chrome White Stainless Steel Toilet Paper Holder and Reserve - Chrome and White

$57.99
New
thumbnail

Two Post Wall Mount Toilet Paper Holder

$25.49
New
thumbnail

Two Post Wall Mount Toilet Paper Holder

$26.49
New
thumbnail

Toilet Paper Holder with Storage

$34.99
New
thumbnail

Bright Creations 2 Pack White EVA Foam Roll, 3mm High Density Sheets for Crafts, Cosplay, 14x39"

$28.49