Appeals and Grievances

• Medicare Prescription Drug Determination Request Form (for members)
• Medicare Part D Coverage Determination Request Form (for providers)
• Appointment of Representation Form
  

Member Services: (800) 209-3945 TTY users: (800) 662-1220
Hours: Monday-Friday 7:00 a.m. - 8:00 p.m.(ET)
MVP Health Plan, Inc., 625 State Street, Schenectady, NY 12305

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