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