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Changes in MediCal Provider Records

Has your agency had a change of address? Be sure to report such changes in a timely fashion to DHCS.  Any changes in provider information must be reported to DHCS within 35 days of the change.  Deactivation of the provider billing number will occur if DHCS is unable to contact a provider at the last known pay-to, business or mailing address.

• Billing Address Change (fillable form 1MB)
• Mailing Address Change (fillable form 1MB)
• Service Address Change

This document was updated last at Monday, August 31, 2009

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