Fill out the form below to receive a Contract and Enrollment Application Packet.  Please fill this out on behalf of the Practice rather than the individual provider, unless it is for a solo practice.

    Joining the Passport Advantage network is only available to providers in the following counties: Grayson, Breckinridge, Hardin, Meade, Larue, Marion, Washington, Nelson, Bullitt, Spencer, Jefferson, Shelby, Oldham, Henry, Trimble and Carroll.