Registration Forms

Registration forms for the Arkansas Healthcare Transparency Initiative ("Initiative") are below. Please note that two forms are available, one for issuers and one for pharmacy benefits managers (PBMs) and third party administrators (TPAs).

Instructions on how to complete the registration process are linked below. Please contact us at or 501-526-2244 with any questions, issues or concerns regarding the registration process.
*Please note that the NAIC Group Code requested on page 1 (box 1) and the NAIC Company Code requested on page 3-forward (box 2) should be different numbers.