Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Elderly Pharmaceutical Insurance Coverage (EPIC) Program, New York State Department of Health before sending sensitive documents. FaxFlow is not affiliated with this organization.
Elderly Pharmaceutical Insurance Coverage (EPIC) Program, New York State Department of Health fax number
(518) 452-3576
EPIC Program – New York State Department of Health
Used for: Submitting EPIC enrollment applications and related documents; forms and communications can be faxed to the EPIC program.
Fax destination details
- Department
- EPIC Program – New York State Department of Health
- Purpose
- Submitting EPIC enrollment applications and related documents; forms and communications can be faxed to the EPIC program.
- Form
- DOH-5080 — EPIC Enrollment Application / Benefits Checkup (DOH-5080)
- Address
- EPIC, P.O. Box 15018, Albany, NY 12212-5018
- Voice phone
- 1-800-332-3742
- 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 out DOH-5080 with required information (age, income, residency, Medicare status, Part D enrollment). Attach required documentation; sign; mail to EPIC or fax to the EPIC fax number 518-452-3576.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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