ARE YOU A CERTIFIED BEP / MINORITY OWNED BUSINESS?

If you are a certified BEP Minority Owned Business interested in collaborating with Medicaid health plan,

please let IAMHP know and they will send that information on to the Medicaid health plans.

Complete the Submission Form and IAMHP will send at least a weekly report to the plans with your information.

Company Information

Company Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Company Website *

Contact Person

First Name *

Last Name *

Phone Number *

Email Address *

Head of Company

First Name *

Last Name *

Phone Number *

Email Address *

Company Information

Tax ID #, if applicable

Confirm BEP Certified *

Category of Service *

IT

Operational support: legal, finance, staffing agencies, healthcare consulting

Communication: marketing, community outreach, printing, marketing materials, event support

Healthcare provider

Care coordination services

Other

Please supply a 250-500 word description of your company which will be sent to members of IAMHP. * 🛈

0/500 characters

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