Pharmacy Prior Authorization Forms
The file(s) below are in PDF format (
).
Pharmacy Prior Authorization Contact Information
Passport Health Plan by Molina Healthcare
Phone: (800) 578-0775
Fax: (844) 802-1406
The file(s) below are in PDF format ().
Passport Health Plan by Molina Healthcare
Phone: (800) 578-0775
Fax: (844) 802-1406