Colorado RAC Stakeholder Contact List Request Form
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*Required
You have the option to provide your orginizational title.
If you are a provider you have the option to provide your provider location Medicaid ID.
If you are a provider you have the option to provide the name of your location, facility office.
If your facility or office is part of a larger hospital system you have the option to provide the name of your hospital system.
If you are a representative of a provider association you have the option to provide the name of your association.
If you are an attorney or representative you have the option to provide the name of your firm.
If you work for a Government Agency you have the option to provide the name of your agency.
If you work for the Department you have an option to provide the name of your office.
You can choose multiple preferences, if needed.
Please give us feedback if there are other options of communication you prefer.