PHC California

Rachel Sakai
AHF Provider

Publications and Forms

If you need a publication or form that is not available here, please contact Provider Relations.

• Comprehensive Formulary (effective March 2018)
• Prescription Drug Authorization Request
• Direct Referral Authorization Form
• Authorization Request Form
• Claim Dispute Submission Form
• Provider Grievance Form
• Injectable Drugs Requiring Pre-Service Approval (last updated May 1, 2013)
• California Pre-Service Injectable Drug Authorization Request
• 2014 Cultural & Linguistics Program
• PHC California Provider Manual
• Quick Reference Guide

• To find a network provider, search online using our Network Provider/Facility/Pharmacy Search application.
• Provider and Pharmacy Directory (effective December 1, 2018)

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.

DHCS 030716 PHC Form 1.0