Joining the Network areaThank you for your interest in participating in Adirondacks ACO. Complete the form below and our Network Operations team will evaluate your request and reach out to you to discuss next steps.1. Primary Contact Information:First Name *Last Name *Job Title *Organization *Street Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodePhone *Email Address *2. Care Section:What care do you provide:HospitalPrimary CareBehavioral HealthHome HealthSpecialist3. Reason on wanting to JoinTell us why you are interested in joining Adirondacks ACO? *4. Location Population ServedTell us which counties in New York you primarily serve? *Clinton CountyEssex CountyFranklin CountyHamilton CountyNorthern Saratoga CountiesWarren CountyWashington CountyNumber of Organization’s Sites? *5. Payer Program Interest:Please provide the number of New York residents you service by each payer *Medicaid *Medicare *Commercial *6. TimingWhen would you hope to join the Adirondacks ACO Network?202220232024Not SureSend Message
