Personal Protective Equipment Survey

Please fill out the information below regarding charges to MVP Health Care Members for PPE. Be sure to submit your completed survey no later than September 18, 2020.

1. Please complete all fields below:

Provider/Practice Name

Provider TIN

Contact Name

Contact Phone Number

How many non-Medicare MVP Members did you charge?

How much did you charge each non-Medicare MVP Member for PPE?

You must provide a refund to Members. Describe your process for how you will refund MVP Members.