Alabama Department of Public Health – Wellness Program (PEEHIP Wellness) fax number

Fax destination details

Department

ADPH Wellness Program

Purpose

Submission of healthcare provider screening data for the Public Education Employees’ Health Insurance Program (PEEHIP) Wellness program (via the Healthcare Provider Screening Form) to the Alabama Department of Public Health Wellness Program.

Form

Healthcare Provider Screening Form (PEEHIP HPSF) — PEEHIP Healthcare Provider Screening Form

Address

ADPH Wellness Program, 201 Monroe Street, Suite 986, Montgomery, AL 36104

Voice phone

1-800-252-1818

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Fill Section 1 (patient information) and Section 2 (provider measurements) and fax to the ADPH Wellness Program to record a PEEHIP wellness screening.

Official form instructions are published as a downloadable file on the organization's website.