Roster Submission

Please choose one of the options below to access the Sample Provider Roster as applicable to your practice.

Note: An incomplete roster and/or missing supporting documentation may result in the resubmission of the provider’s application and/or delay in provider’s effective date for participation.

Contact Information*
First Name Last Name Phone
Email*
Roster Upload
Please upload your completed roster here.
Drop files here or

Max. file size: 50 MB.
Contract Upload
If you have recently received a contract for participation with Center Care and need to submit along with your roster, please upload the contract here.
Drop files here or

Max. file size: 50 MB.
Please indicate that you have reviewed the Center Care supporting documentation requirements as applicable to your provider type.*
- Yes, I have reviewed the Center Care supporting documentation requirements and will upload the necessary documentation to this submission or to the provider's CAQH application.
Supporting Documentation Upload
Please upload all necessary supporting documentation here.
Drop files here or

Max. file size: 50 MB.

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