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Get Molina Redetermination Online Form

The right to ask us for a redetermination (appeal) of our decision. You have 60 days from the date of our Notice of Denial of Medicare Prescription Drug Coverage to ask us for a redetermination. This form may be sent to us by mail or fax: Address: 7050 S Union Park Center Drive Suite 200 Midvale, Utah 84047 Fax Number: (866) 290-1309 You may also ask us for an appeal through our website at www.molinamedicare.com. Expedited appeal requests can be made by phone at (888) 665-1328. Who May Make a.

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