CMS-116 (CLIA Application for Certification):
Complete the CMS-116 Application for Certification, in its entirety, for any of the following:· Initial Laboratory Certification· Change in Certification Type· Change in Provider Name· Change in Address, Telephone Number, etc.· Change in Laboratory DirectorFor laboratories located in the State of Wyoming, mail the completed and signed CMS-116 Application for Certification to the address listed below.
Mailing address (Wyoming Laboratories only): CLIA Certification Healthcare Licensing and Surveys 6101 Yellowstone Rd. Ste. 186C Cheyenne WY 82002
Not a Wyoming laboratory? Refer to the Federal CLIA home page for contact information in your home state.
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