State Health Benefit Plan - Provider Orientation
REQUEST FOR SCHEDULING AN ORIENTATION
We ask that you fax this request form to us to schedule a orientation for your office/facility.  Please indicate which members in your organization plan to attend.  Please fax this form to the Joint Venture office at (877) 376-9260.
(Please Print)
Name  Organization    Title  Phone #  Fax #
For more information call the Provider Relations Department at (800) 675-6492.