Form MC-3020 is an important document for businesses and individuals doing business in Missouri. This form is used to report certain types of sales and purchases to the Department of Revenue. Understanding when and how to use this form can help you avoid penalties and fines. This article will provide a brief overview of what the Form MC-3020 is, when it should be used, and how to complete it properly.
| Question | Answer |
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| Form Name | Form Mc 3020 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | medi, TARs, california, TRANSMITTAL |
STATE OF |
DEPARTMENT OF HEALTH CARE SERVICES |
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TRANSMITTAL FORM
TAR
APPEAL
INSTRUCTIONS:
Each group of TARs presented via Mail, Fax or Onsite to the Field Office, Pharmacy Section or Appeals (TAR Administrative Remedy Section) may include this form. Providers who would like to receive a copy of the Transmittal Form as an acknowledgement of receipt of TARs must send 2 copies of the Transmittal Form and a self addressed stamped envelope.
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FAX |
ONSITE |
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FACILITY INFORMATION: |
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Name |
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National Provider |
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Identifier (NPI) |
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Address |
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City and ZIP |
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Fax ( |
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Date Sent |
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Date Stamp
Initials
STATE USE ONLY
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Discharge |
Sent for |
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Patient’s Name |
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TAR Sequence Number Admit Date |
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Review |
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Received by |
Received by |
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Field Office |
Facility |
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For STATE use only:PAGE ______ OF ______ (including this form)
Date Returned to Facility: _________________ Returned By: _______________________________
This information is for the sole use of the intended recipient and may contain confidential and privileged information. Any unauthorized review or use including disclosure is prohibited.
If you are not the intended recipient of this information, please contact the sender and destroy all copies of the documentation.
MC 3020 (rev. 06/09)