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Provider Contact Change Form - Hawaii Department of Health 2026
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- Click ‘Get Form’ to open the Provider Contact Change Form in our platform.
- Begin by entering your Agency Name and the Date at the top of the form. This information is essential for identifying your submission.
- Specify the Type of Service(s) provided by your agency, ensuring clarity on what services are affected by this change.
- Fill in the Contact Name & Telephone Number for direct communication regarding this change.
- Indicate the Action to be taken (Add, Change, or Close) and provide the Effective Date of Action.
- Complete the Old Location Address and New Location Address fields, including the 4-digit zip code extension for accuracy.
- Answer whether the New Location Address is your Agency’s Primary Business Location and provide details if it is not.
- If applicable, indicate if this is a Mailing Address Change and attach any necessary documentation as specified.
- Provide both Old and New Telephone/Facsimile Numbers to ensure updated contact information.
- Sign and date the form at the bottom before mailing it to the specified address for processing.
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| 2013 | 4.9 Satisfied (537 Votes) |
How does Hawaii healthcare work?
In June 2021, over 200 stakeholders, advocates, and visionaries gathered to launch the Healthy Hawaii Strategic Plan 2030 (HHSP), a 10-year strategic plan for improving the health of Hawaii residents by preventing and reducing chronic disease and advancing health equity.
How do I contact the Hawaii Department of Health?
Questions? Please call SHPDA at (808) 587-0788 or email SHPDA at SHPDA@doh.hawaii.gov.
What is the fastest way to get a birth certificate in Hawaii?
Employers must provide health care coverage to employees who work at least twenty (20) hours per week and earn 86.67 times the current Hawaii minimum wage a month (see the Maximum Weekly Wage Base and Maximum Weekly Benefit Amount).
What is the biggest health problem in Hawaii?
In 2021, the leading causes of death among non-Hispanic Native Hawaiians/Pacific Islanders were COVID-19, heart disease, cancer, unintentional injuries, and diabetes.
What does the Hawaii Department of Health do?
Health department employees work tirelessly to promote healthy lifestyles and workplaces, prevent disease and injury, encourage the strength and integrity of families and communities, assure basic physical and mental health care, and prevent pollution to preserve a clean, healthy and natural environment.
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Related links
, Consumer Update Form (PDF). , Provider Contact Change Form (PDF). , Provider Claim Payment Inquiry Form (PDF). , Provider Quarterly Self Report (PDF).Read more
**Call your **health care providers office. Contact your health care providers office to ask for help with the appeals process. Someone in his or her office
Dec 6, 2022 Counties of Hawaii and Kauai employees may continue to use the EUTF Address Change form, which can be accessed at more