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St Raphael Health Plan - Action Item Location Information
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1. Parish/School/Entity NAME
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2. Parish/School/Entity LEGAL NAME (as noted on your Articles of Incorporation)
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3. Parish/School/Entity CODE (e.g., A01; if you do not know your parish/school code, contact Kim Kasten at kastenk@archmil.org)
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4. Parish/School/Entity TAX ID NUMBER
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5. Parish/School/Entity ADDRESS (include City, State, and Zip Code)
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6. Parish/School/Entity PHONE and FAX
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7. Location
Billing
Contact NAME (only one person may be designated)
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8. Location
Billing
Contact PHONE
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9. Location
Billing
Contact EMAIL
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10. Location
Admin
Contact NAME (this is the person who will manage the MyEnroll360 benefits platform; multiple persons may have access
)
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11. Location
Admin
Contact PHONE
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12. Location
Admin
Contact EMAIL
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Your name
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Your title
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Your email
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