Request a Provider Directory, Pharmacy Directory, Formulary (List of Covered Drugs), or Evidence of Coverage (including the Dental Addendum and List of Covered Hearing Aids)


To get a Provider Directory, a Pharmacy Directory, a Formulary (List of Covered Drugs), or an Evidence of Coverage (including the Dental Addendum and List of Covered Hearing Aids) mailed to you, please complete the form below. You can submit the form multiple times to request more than one document.

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Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., seven days a week

H9001_200086_C | The information on this page was last updated on 10/1/2019.