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Primary Care Clinic Change Request

The following errors occurred:

You may change your primary care clinic by notifying Medica using the form below. Changes become effective the first day of the month. If you submit your change by the 20th of the month, it will become effective on the first day of the next month. If you submit your change later than the 20th of the month, it will become effective the month after next. Please refer to your coverage document on mymedica.com for more information on primary care clinic changes.

Complete the form and select Submit to return the form electronically to Medica.

Required Fields

Member Information

Group number help Five or six digits
Member/subscriber help Nine digits

Clinic Information

Find a clinic’s PCC ID in your provider search tool.

Current Clinic

PCC help 11 digits

New Clinic

PCC help 11 digits


Dependent Information

Enter any clinic changes for dependents below. If you enter a dependent’s name, all fields are required for that dependent.

  Current clinic New clinic
Dependent name Name PCC ID Name PCC ID