Form can be faxed to: (406) 513-1928 (Local) or 1 (800) 294-1350 (Toll-Free)
Form can be mailed to: Drug Prior Authorization Unit, Mountain-Pacific Quality Health, 3404 Cooney Drive, Helena, MT 59602
Updated November 13, 2024
Form can be faxed to: (406) 513-1928 (Local) or 1 (800) 294-1350 (Toll-Free)
Form can be mailed to: Drug Prior Authorization Unit, Mountain-Pacific Quality Health, 3404 Cooney Drive, Helena, MT 59602