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Molina Healthcare Service Request Form

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

The following information applies to Los Angeles County only.

Molina Healthcare requires that its directly contracting primary care physicians (PCPs), staff model physicians and directly contracting medical groups adhere to the requirements in the Molina Healthcare operations manual.

Last Updated: 12/04/2024