Welcome

Join Our Network

The community care programs through the Department of Veterans Affairs (VA) allow providers in the community to treat Veterans when VA is unable to do so. If you’d like to care for Veterans in your community and request a contract for all lines of TriWest business now and in the future, please complete the registration form below. Thank you for considering joining the TriWest provider network!

Please take a moment to review a sample provider contract, as well as the terms and conditions of the program which are outlined in the Provider Handbook.

If you are a facility/group with 25+ providers please use the Provider Roster List and email your list to TriWest at providerservices@triwest.com.

Provider Contract Request

* = Required
Date Entered:
5/26/2020 7:29:49 PM
Name (must fill in the Provider's First and Last Name OR the Facility/Group Name. That is, enter the W-9 legal name.)
OR
hold the 'CTRL' key down to select multiple items
Provider Point of Contact
Optional
 
Primary Practice Address
Optional