Request a formulary

Please complete the form below to have a PHIP Providence Medicare Advantage Plan formulary mailed to you.

The formulary may change at any time. You will receive notice when necessary.

Fill out my online form.

This information is not a complete description of benefits. Call 1-800-603-2340 TTY: 711 for more information.

Providence Medicare Advantage Plans is an HMO, HMO‐POS and HMO SNP with Medicare and Oregon Health Plan contracts. Enrollment in Providence Medicare Advantage Plans depends on contract renewal.

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Website is current as of 9/12/2018