Contracting in Washington

Please download and fill out the following forms:

• Interest form
• W9
• Roster

 

Are you a behavioral health provider or facility? If so, please download and fill out the appropriate form:

• Professional form
• Facilities form

 

Once your interest packet has been received, we'll start reviewing your request to become a participating provider. You'll be assigned a representative who will give you some next steps in the contracting process, like reviewing your current credentialing status.

You can return all forms to: wacontracting@pacificsource.com