Providers

< Back to Providers Home

Apply to our Provider Network

Step 1 of 4:

Enter contact information

Are you a consultant applying on behalf of this entity?

Yes

No

Are you already contracted with Dean Health Plan, Prevea360 Health Plan, Medica formerly known as WellFirst Health?

Yes

No

Administrative Contact Information

This is the person who provides necessary documentation for contracting and accurate demographic system setup.

First name

Last name

Phone number

Email address

Confirm email address

Contracting Contact Information

This is the contract negotiator.

Same contact as Administrative Contact

First name

Last name

Phone number

Email address

Confirm email address