PCP Change Request Form

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).