Report an Error in Provider Directory

Report an Error in Provider Directory

Use this form to report an error in the provider directory to the Contra Costa Health Plan. Please provide your name, e-mail address, and phone number along with any issues you found with the directory.

	First name:		Last name:

	E-mail:		Phone (include extension if needed):

YesNo

ProviderFacilityPharmacy

	Name of Provider, Facility or Pharmacy:

	Select which area:

	What needs to be corrected?