Request a formulary
Please complete the form below to have a paper formulary mailed to you.
Consider the following when making the formulary selection:
- Providence Medicare Advantage Plans:
Formulary for all Choice + RX, Compass + RX, Enrich + RX, Extra + RX, Harbor + RX, Latitude + RX, Prime + RX, and Summit + RX plan members
- Providence Medicare Advantage Plans Dual Plus:
Formulary for members of our Dual Plus (HMO SNP) plan
The formulary may change at any time. You will receive notice when necessary.