Provider Enrollment Process 

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Early detection and treatment are our best bets for helping Arkansas women fight breast and cervical cancer.  We need more providers to accomplish this goal.  During fiscal year 2011, BreastCare was able to provide mammograms and pap smears to 10,000 women out of a possible 48,000 women that are eligible for services.

It is easy to enroll. Just go to and complete your application, it should require only 15 minutes to complete a basic application. Click here, for detailed information on the process.

In order to enroll as a BreastCare provider you will need to complete: Provider Basic Identification, Provider Demography, Provider Banking Information, W-9 Form, Provider Specialty Form, and Questionnaire.  Have all documents for the application ready and the process will move faster.

After you submit your application online, BreastCare will review it and email the Public Health Service Agreement back to you for your signature. After we receive your signed application with attachments and copy of licenses and DEA’s (when applicable), it will be processed and approved.

You are now a BreastCare provider. Welcome to a network of providers who help the eligible women in your community receive free breast and cervical screenings.