Get DD 2642 2007
Date of each service; 3. Place of each service; 4. Description of each surgical or medical service or supply furnished; 5. Charge for each service; 6. The diagnosis should be included on the bill. If not, make sure that you've completed block 8a on the form. DRUGS: Prescription claims require the name of the patient; the name, strength, date filled, days supply, quantity dispensed, and price of each drug; NDC for each drug if available; the prescription number of each drug; the name and address.
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How to fill out and sign dd 2642 form for tricare online?
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