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CoverKids Provider Disclosure Forms

The Provider Disclosure form from this site should be completed and returned to:

BlueCross BlueShield of Tennessee (BCBST)
One Cameron Hill Circle, Suite 0007
Chattanooga, TN 37402
Fax: (423) 535-3066
Fax: (423) 535-5808

• Disclosure Form for a Provider Person
• Disclosure Form for Provider Entities
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