andy:
WITH cteContractFipsMatches (contract_h_name, plan_name, segment, fipsRowToMatch) AS (
 SELECT
  t1.contract_h_name
  ,t1.plan_name
  ,t1.segment
  ,MIN(f1.rownum) AS fipsRowToMatch
 FROM
  mds_schema.mds_wc_tmp_moc_plan_county t1
  INNER JOIN
  mds_schema.mds_vFips_wc f1 ON t1.fips = f1.fips
 GROUP BY contract_h_name, plan_name, segment
)

SELECT DISTINCT
 z.[zip code],f1.fips, c1.county_name -- , cte1.contract_h_name, cte1.plan_name, cte1.segment, t1.planDetailsUrl
FROM
 cteContractFipsMatches cte1
INNER JOIN
 mds_schema.mds_vFips_wc f1 ON cte1.fipsRowToMatch = f1.rownum
INNER JOIN
 mds_schema.mds_county c1 ON f1.fips = c1.fips
INNER JOIN
 mds_schema.mds_wc_tmp_moc_plan_county t1 ON cte1.contract_h_name = t1.contract_h_name
 AND
 cte1.plan_name = t1.plan_name
 AND
 cte1.segment = t1.segment
 AND
 f1.fips = t1.fips
LEFT JOIN
 --mds_schema.mds_zip_preferred z on (z.fips=f1.fips)
(
    SELECT p.*
    FROM
    mds_schema.mds_zip_preferred p
    INNER JOIN
    (
        SELECT
            CASE
                WHEN len(fips)=4 THEN '0'+fips
                ELSE fips
            END AS FIPS
        FROM
            dbo.alex_fips
    ) a ON a.fips=p.fips
) z ON (z.fips=f1.fips)