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Continued Health Care Benefit Program Claim Forms

TRICARE DoD/CHAMPUS Claim Form-Patient's Request for Medical Payment (DD Form 2642)

Claims for care received under the Continued Health Care Benefit Program are filed on the same form as all other TRICARE medical claims. Submit your completed form and supporting documentation to:

CHCBP Claims
PGBA
P.O. Box 7031
Camden, SC 29020

Last Updated 9/3/2013