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This Box for PHC Use Only Contract Initials: IN #: Provider Information FormPartnership Health plan of California (PHC) reserves the right to determine network participation. Purpose for this request:Legal

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What is this box for phc?

This box is for reporting information related to the Public Health Credit.

Who is required to file this box for phc?

Entities that are eligible for the Public Health Credit are required to file this box for phc.

How to fill out this box for phc?

The box for phc should be filled out with accurate information regarding the public health expenditures made by the entity.

What is the purpose of this box for phc?

The purpose of this box is to track and report public health expenditures in order to claim the Public Health Credit.

What information must be reported on this box for phc?

Information regarding public health expenditures made by the entity must be reported on this box for phc.

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