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You are about to exit this enrollment. Click CANCEL to continue the application process. Click OK to exit the application. All entered data will be lost.

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 Required fields are marked with an asterisk (*).
Please choose the option that best describes your intent: *


Are you a Pharmacy Provider? *

Pharmacy providers are not eligible to add a location. Please use "Exit Enrollment" to return to the provider enrollment screen




The Medicaid Service Area determination is In-State.
The Medicaid Service Area determination is Out-of-State, outside the MSA.
Select the city of the Primary Practice Location. When city is not found, select City Not Found.


Select the city of the Primary Practice Location. When city is not found, select City Not Found.


The Medicaid Service Area determination is Out-of-State, within the MSA.
The Medicaid Service Area determination is Out-of-State, outside the MSA.

 

 

 

SC Health & Human Services • P.O. Box 8809 • Columbia, SC 29202-8809 • Phone: (888) 289-0709