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REQUEST CHANGE ADDRESS INFORMATION

If you have changed your contact information, please call the Department of Children and Families (DCF). Only they can update your Medicaid file. Their local toll free office number is 1-866-762-2237 or you can make changes online at www.myflorida.com/accessflorida. 

First Coast Advantage cannot change your contact information with DCF, but if you would like to tell FCA of your change, send your new contact information  by filling out the information below.

* = Required Information

*Medicaid ID# (on card):

*Members First Name:

*Members Last Name:

*Date of Birth:

*Address:

*City:

*State: *Zip Code:  *Phone Number:

*Email Address:

*New Address Information:

Date of Change:

*New Address:

*City:  

*State:  *Zip Code:  *Phone:

*Comments:

 

*Person Sending E-Mail:

*First Name: *Last Name:

*Relationship:

*How can we contact you?: