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.

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Please choose which formulary version you would like sent to you:

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