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STANDARDIZED×ONE×PAGE×PHARMACYPRIOR×AUTHORIZATION×FORM Mississippi×Division×of Medicaid, ×Pharmacy×Prior×Authorization×Unit,550×High×St., ×Suite×1000, Jackson, ×MS39201Medicaid×Fee×for×Service/Change×Healthcare×to: 18775370720Ph: 18775370722×Magnolia×Health/Involve×Pharmacy×Solutions×to: 18663990928Ph: 18004608988https://www.magnoliahealthplan.com/providers/pharmacy.html×UnitedHealthcare/OptumRxhttps://medicaid

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