CFY - WISEWOMAN - Health Care Facility Program Enrollment

CFY- WISEWOMAN Program - Facility and Healthcare Provider Application

Thank you for your interest to enroll as a Corporation/Lead Facility for theCare for Yourself - WISEWOMAN Program. Please review the Healthcare Facility and Healthcare Provider Guide prior to completing the documents below. Approval to enroll in the WISEWOMAN Program is limited and pre-authorization to enroll as a Corporation/Lead Facility is required.

The WISEWOMAN Cooperative Agreement is not effective until the document has been fully executed with signatures of both parties and received by the Corporation/Lead Facility. The fully executed agreement will be scanned and electronically sent back to the applicant.

To request a Cooperative Agreement and/or a facility enrollment application, please submit your request in an email to The subject line should state “WW Enrollment” and the Corporation/Lead Facility name. The Corporation/Lead Facility Cooperative Agreement needs to be renewed every six years. For further questions and to see if your application is up to date, please contact Sonya Loynachan at: or 515-371-3387.