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Enroll By Fax Or Mail
  Fax   Enroll by Fax
Click the button to the right to download Inter Valley Health Plan's Enrollment Form, complete the enrollment form, sign and date it, then fax it to Inter Valley Health Plan at:
(909) 397-0139

Click here for instructions on completing the enrollment form

  Download Enrollment Form


  Mail   Enroll by Mail
Click the button to the right to download Inter Valley Health Plan's Enrollment Form, complete the enrollment form, sign and date it, then return it to Inter Valley Health Plan at:
Sales Department
Inter Valley Health Plan
PO Box 6002
Pomona, CA 91769-6002

Please be sure to date the enrollment form

Click here for instructions on completing the enrollment form
 

 Download Enrollment Form


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