Provider Directory Request Form

Provider Directory Request

Use this form to have a printed copy sent to you at no cost.
Who are you?*

Member or Authorized RepresentativeCounty Staff or Care CoordinatorHealthcare ProviderOther (please describe)
Which directory do you want sent to you?*

Medical Assistance Directory for Families and Children, MinnesotaCare, Minnesota Senior Care Plus, SharedCare and SingleCareMedicare Advantage Provider and Pharmacy Directory for AbilityCare and SeniorCare Complete
To receive a free printed directory by mail, you must enter your name and mailing address.

To receive an electronic directory by email, enter your email address only.

Please note that you can download directories directly from the website by clicking on a link above.

Because these directories are large electronic files, many email accounts will refuse them. In that case, we will send you a link to download them.
Name*

First NameLast Name
Mailing Address where directory is to be sent

Street Address

Street Address Line 2

CityState

Zip Code
Phone number (optional)
We will not use this number for any other purpose except to contact you if we have trouble sending you a directory.
Email
If our directory file is too large to be accepted by your email, we will send you a link to download it. You can download the directory at any time by using the links on the page above. We may contact you if we have trouble sending a printed directory to your address.
This form will be sent securely to Member Services at members@mnscha.org when you click "Submit." If you need help or have questions, call Member Services at 1-866-567-7242 (TTY users call 1-800-627-3529). The call is free.
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