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Contact Us - Health Division

Please provide all appropriate information. This data is used to allow access to our secure B2B site with access to the CORE ERA and EFT Enrollment forms.

Fields marked with * are required.

Provider Information

(Includes individual medical provider, facility, clinic, etc.)

(Multiple TINs or NPIs require multiple Contact Us forms to enable multiple enrollment access.)

(Entity Type Code 1 : Individual, 2 : Organization)

Provider Address
Provider Contact Information :

(Provide direct phone number for use during B2B registration.)

Additional Information Required
Are you acting on behalf of provider *

Only complete this section, if you will be completing the ERA EFT Enrollment forms on behalf of the provider

ERA or ERA/EFT Enrollment, provide the Method of Retrieval

By choosing to send a message to State Farm, you acknowledge that all information contained in your message, including questions, comments, suggestions, etc., shall not be deemed confidential, and State Farm shall have no obligation of any kind whatsoever with respect to such information, and shall be free to use, reproduce, disclose, and distribute the information to others without limitation.

We value your privacy. We may collect personal information from you for business, marketing, and commercial purposes. Read more

Do Not Sell or Share My Personal Information (CA residents only)
WA My Health Notice (consumer/customer)
WA My Health Notice (B2B/Agent/job applicant)