Email rcvd from: EriHernandez@wellmed.net  Subject: Valley Med Urgent Care PLLC - TIN 81-5123542  Good Afternoon,     Thank you for your continued participation with Wellmed Medical Management, Inc. Your facility is due for re-credentialing in the near future. Please complete the attached WellMed re-appointment application. Page 1 is required for each address. Return all required documentation for each facility listed below and listed on page 3 of the attached application as soon as possible.  Please attach copies of following documents:  Ø  State license if applicable         Ø  Documentation (such as a letter) of participation in the Medicare program  Ø  Accreditation approval letter and/or certificate with expiration date. If NOT accredited by any of the named accreditation organizations, please submit a CMS or state report that a site survey has been performed for your facility.  (A site visit on behalf of CMS suffices as documentation of participation in the Medicare program as well)  Ø  CLIA certificate, as applicable  Ø  Bureau of Radiation Control certificate(s), as applicable  Ø  Liability face sheet  Ø  W-9  Ø  Additional Locations – All addresses require an application.  Please submit application and all supporting documentation for each address to erhernandez@wellmed.net  Your timely response is greatly appreciated! Let me know if you have any questions.  J