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Join the ArchCare Provider Commmunity

Participation Request Form

Please complete the Provider Participation Request Form below. Once your request has been reviewed, you will be notified by an ArchCare Provider Relations Representative. If accepted, you will be required to complete a Credentialing Application, or apply through CAQH on the following website: http://caqh.org/credapp. You are required to submit a current copy of your W-9 with this form.

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