Non-network providers should use this form to update specialty information in the TRICARE West Region non-network provider file.
Note: If your specialty is mental health, you must complete the appropriate mental health application.
Return completed form to:
TRICARE West Provider Data Management
PO Box 202106
Florence, SC 29502-2106
- Created: Jun 13, 2018
- Modified: Jun 12, 2018
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