Family PACT


Provider Enrollment

Solo providers, group providers or primary care clinics who currently have a National Provider Identifier (NPI), are enrolled, and in good standing with Medi-Cal, are eligible to apply for enrollment into the Family Planning, Access, Care, and Treatment (Family PACT) program. Providers that are interested in enrolling into the Family PACT program must apply for enrollment by completing and submitting the DHCS 4468 application packet.

  1. Confirm you are eligible to enroll into the Family PACT Program. Licensed medical personnel with family planning skills, competency and knowledge, who will provide the full range of services covered in the program, as long as these services are within the provider’s scope of licensure and practice, are eligible to enroll into the Family PACT program.
  2. Apply to become a Family PACT Provider. You must complete and submit a Family PACT provider application,     DHCS 4468 in order to become a Family PACT provider. To enroll as a Family PACT provider, you can complete the attached provider enrollment application packet and return it by email to:
     
    *Please ensure you are using a secure browser/email when submitting confidential information!
    Mail: Department of Health Care Services
    Office of Family Planning
    P.O. Box 997413 MS 8400 
    Sacramento, California, 95899-7413

  3. Complete the Provider Orientation. The medical director, physician, nurse practitioner, or certified nurse   midwife responsible for overseeing the family planning services is eligible to certify the site. Family PACT providers will be certified on a provisional basis for enrollment into the Family PACT program until an eligible representative completes the legislatively mandated, two-part, provider orientation. A provider must complete both parts of the orientation within six (6) months of the date of initial Family PACT enrollment for the provisional certification to be lifted. If a provider does not complete both parts of the orientation within six (6) months of the date of initial Family PACT enrollment, that provider and/or provider location will be disenrolled from the Family PACT program. For more information on the two-part provider orientation, please click here.                        

Please contact the Office of Family Planning by phone (916) 650-0414 or email us at ProviderServices@dhcs.ca.gov if you have any questions regarding the Provider Enrollment process. 

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