Sign Up to Join the TriWest Healthcare Alliance Network

Complete and submit the form below to start the process of joining TriWest’s network of health care professionals who care for military families and Veterans. More details on TriWest's areas of responsibility are on the Join the TriWest Healthcare Alliance Network page. Our provider contracting team looks forward to working with you.

Want to learn more about TriWest and its role in delivering access to care for the U.S. Department of Defense and the U.S. Department of Veterans Affairs? Go to the network overview page.

Provider Contract Request

Fields with an asterisk ( * ) are required.

Date of Submission: 4/27/2024

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Provider Point of Contact

Primary Practice Address


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