PSHP PSHP Printed Materials Request Form

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Printed Materials Request Form

First Name		Directions Please enter your information so we can send the materials to you.
Last Name
Address
Address Line Two
City
State
Zip Code
Phone Number 000-000-0000
Email Address
Choose item(s) to be sent:
Directory of Network Primary Care Providers and Hospitals Directory of Network Pharmacies Comprehensive Formulary Decision Maker Guide

Please allow 1 week for the materials to arrive before requesting materials again. If you do not receive your materials in 2 weeks, please contact Member Services at 1-866-789-PSHP (7747), 8 a.m. – 8 p.m.,7 days a week. TTY/TDD for the hearing-impaired, call 1-866-264-4141.

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