Provider Relief Credit

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As a response to the COVID-19 pandemic, all licensed dentists in Michigan, Ohio and Indiana who are currently practicing, and have an active license and Type 1 NPI number, are eligible to receive a $1,000 grant from Delta Dental of of Michigan, Ohio, and Indiana. To ensure that the grants are used towards valid practice expenses, the grants will be provided in the form of a credit on account with Henry Schein. The grant is to the recipient and can be used toward existing account balances or toward any future purchase of dental products and/or services from Henry Schein.

HOW TO REDEEM CREDIT:
 

All outstanding applications for a Henry Schein credit provided by Delta Dental of Michigan, Ohio, and Indiana must be submitted by December 31, 2020

If you have an active account and have not received your credit, you must fill out the form below by December 31, 2020, to apply for this credit. 
If you filled out the form previously and did not receive your credit, the form may have been rejected due to missing or invalid information. We must receive your application with accurate data by December 31, 2020, or your credit will not be issued.
The program ends December 31, 2020, and forms will not be accepted in 2021.

 

If you are part of a group practice, you have two options:

  1. Request that your credit go to your group practice’s current account by filling out the form and including your practice’s Henry Schein account number. You must check the box at the bottom of the form to designate that your credit go to your group practice account.
  2. Open your own/new Henry Schein account where the credit can be applied. Call 844-269-4204 or set up your account on the Henry Schein website. Then, include your new account number in the form and fill out the top portion "Dentist Section" only.

Provider Relief Credit FAQs

View FAQs


HENRY SCHEIN ACCOUNT NUMBER:


NOTE: The “SHIP TO/LOCATION” account that is funded must be in Michigan, Ohio or Indiana. You must input your local Henry Schein “SHIP TO/LOCATION” account number. Forms with a “billing/corporate number” will result in an incomplete submission and credit will not be applied.


PERSONAL OR GROUP ACCOUNT:

* Assign to Personal Account or Group Practice:

You must select an option below. Failure to do so will result in an incomplete submission and credit will not be applied.



DENTIST SECTION:

 

 

 

 


Submitting a Type 2 NPI will be considered an incomplete submission and credit will not be issued.
 

 

 

 

 


DESIGNATED OFFICE SECTION (in lieu of personal acceptance of grant): 

Only complete this section if you are assigning your credit to a group/practice Henry Schein account.


 

 

 

 

 

 

 

 

 

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Required Acknowledgement:

You must select an option below. Failure to do so will result in an incomplete submission and credit will not be applied.