Please complete the form below to request a directory.
Note: Medical Assistance and Medicare Advantage Provider and Pharmacy Directories include primary care, specialty care, urgent care, hospital, nursing home, mental health, chemical dependency, substance use disorder, pharmacy, and dental providers.
For printed directories, please enter your name and mailing address. For electronic directories, enter your email address.
This form will be sent securely to Member Services at firstname.lastname@example.org when you click "Submit." If you need help or have questions, call Member Services at 1-866-567-7242 (TTY 1-800-627-3529).