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Elderly Pharmaceutical Insurance Coverage (EPIC) Program, New York State Department of Health fax number
(518) 452-3576
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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.
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