Follow the steps to successfully complete your Medco 13 application.

1. Begin by locating the Medco 13 form. To obtain the form, use the ‘Get Form’ button to initiate the download.
2. Once you have accessed the form, carefully review the instructions at the beginning. Ensure you understand that you need to submit one application per federal tax identification number and indicate all practice locations.
3. In Section 1, select your provider type from the provided list. Complete the corresponding sections as instructed.
4. Proceed to Section 2 and fill out the general information section. This includes your current BWC provider number, business and tax identification numbers, and your practice location address.
5. Complete Section 3 with your individual provider information, including board specialties and education history, if applicable.
6. Respond to the questions in Section 4. If you answer 'yes' to any questions, provide a detailed explanation on a separate sheet as instructed.
7. Finally, review Section 5, the provider application/agreement. Sign and date the application, certifying that all information is true and accurate.
8. Once you have filled out the form completely, save your changes. You can then download, print, or share the completed Medco 13 form as required.

Take the next step in your provider enrollment by completing the Medco 13 online today.