Official websites use .mil
A .mil website belongs to an official U.S.
Department of Defense organization.
Secure .mil websites use HTTPS
A
lock (
) or https:// means you’ve safely connected to
the .mil website. Share sensitive information only on official,
secure websites.
The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.
Patient Resources
Resources for patients.TRICARE DoD/CHAMPUS Claim Form-Patient’s Request for Medical Payment (DD Form 2642)
If you’re enrolled in the Continued Health Care Benefit Program, send your completed claim form and supporting documents to:
CHCBP Claims
P.O. Box 202146
Florence, SC 29502-2146
Fax: 877-489-0007
Last Updated 6/30/2025
