Financial Assistance Application - Alaska

Download and Mail

Please download the paper form and mail it, and the required documents, to:

PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395

If you have any questions, please call us at:

  • Providence Alaska Medical Center
    Kodiak Island Medical Center
    855-229-6466
    Monday-Friday, 8 a.m.-5:30 p.m. (PT)
  • Providence Anchorage Physician Billing
    855-229-6466
    Monday-Friday, 8 a.m.-5:30 p.m. (PT)
  • Providence Seward Medical & Care Center
    907-224-2837
    Monday-Friday: 8 a.m.-5 p.m.
  • Providence Valdez Medical Center
    907-835-2249
    Monday-Friday: 8 a.m.-4:30 p.m.

We will respond to your request via mail within 14 business days of receiving it along with all required documents.