Forms
Counties Served:
California: Fresno, Los Angeles, Madera, Orange, Riverside, San Bernardino, and San Diego (New for 2025: Kern & Imperial)
Nevada: Churchill, Clark, Carson City, and Washoe
Select your state:
California
Nevada
California
Enrollment Form
MedImpact Direct Mail Order Prescription Drug Forms
Nevada
Enrollment Form
MedImpact Direct Mail Order Prescription Drug Forms
Covered Medication List (Formulary)
This page was last updated on 1/29/2025. Pending CMS approval.