Home > Blog > For Members > PCP Change Request Form

PCP Change Request Form

  • Phone Numbers

    (866) 912-6285
    TDD/TTY: (877) 725-7753
    Fax: (866) 480-3227
    8 a.m. – 5 p.m. (CST)

    Mississippi Relay Services: 711

    Division of Medicaid Bureau of Mental Health
    (800) 421-2408

    NurseWise®
    (866) 912-6285

    Transportation - LogistiCare Solutions, LLC
    (866) 331-6004

  • Resources

    Member Handbooks
    Forms
    Newsletters

    You will need Adobe Reader to open PDFs on this site.
    Download the free version of Reader

You can change your Primary Care Physician (PCP) at any time. 

Directions for changing PCP.

  • Please print the form below and fax form with a copy of your ID card, if available, to Magnolia Member Services Department at (877)-779-5219 or mail the form to Magnolia Member Services, 111 E Capitol Street, Suite 500, Jackson, MS  39201.

PCP Change Request Form (PDF)

If you have questions about how to complete this form, please call the Magnolia Member Services Department, Monday through Friday, 8 a.m. – 5 p.m., at (866)-912-6285 (TDD/TTY (877)- 725-7753 or Mississippi Relay Service at 711).