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To contact us, simply fill out the form below and click Send Message.

Are you a member? If so, we can handle your message much more efficiently if you give us your subscriber ID number. This is the nine digit #, plus two additional digits that appear on the face of your member card.

Please remember anonymous complaints are difficult to investigate. If you prefer to remain anonymous, please be aware that our ability to investigate your concern and take any appropriate action may be limited.

Subject:
Your Subscriber ID:
Patient Name:
Address:
City:
State:
Zip:
Daytime Phone Number:
Fax Number:
E-mail Address:
How do you prefer to receive information? Please note: Due to confidentiality, some questions may not be addressable via e-mail.
	E-mail (please provide e-mail address above)
	Mail (please provide address above)
	Phone call (please provide phone number above)
	Fax (please provide fax number above)

Your Message: Please provide as much detail as possible, including dates, names, medication(s), and/or location to fully describe your issue or comment.