Name of Organization * Street Address * City, State * Zipcode * Primary Contact * Title * Phone Number * Email Address * Type of Organization * Business/Purchaser Health Coalition Employer Other type of purchasing or advocacy organization Is it specified in your bylaws that the majority of your members much be purchasers? * Number of hospitals in your market * 1-10 hospitals 11-25 hospitals 26-50 hospitals 51-75 hospitals Over 76 hospitals Health plan activity in your market * Aetna Anthem BlueCrossBlueShield Cigna UnitedHealthcare Other Why are you interested in becoming a Leapfrog Regional Leader? * Submit
