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The provider must retain copies of all documentation for five years. Mail or Fax Information to: Magellan Medicaid Administration, Inc. Prior Authorization P. O. Box 7082 Tallahassee, FL 32314-7082 Phone: 877-553-7481 Fax: 877-614-1078.
Sunshine State Health Plan, Florida. (Do Not Use This Form for Biopharmaceutical Products*) FAX this completed form to 866-399-0929. OR Mail requests to: US Script PA Dept / 2425 West Shaw Avenue / Fresno, CA 93711. Call 800-460-8988 to request a 72-hour supply of medication. I. Provider Information II.