This form is no longer in use for Mountain Health Co-Op, please submit your request through one of the contacts below:
Mail - 2100 Covington Centre, Suite B, Covington, LA 70433
Fax – 958-898-1505
Phone – 800-643-4416
Email - Mountainhealthcoop@healthcomp.com
Retail Pharmacy Fax – (Pending)
Retail Pharmacy Phone – (Pending)