TRICARE Prime Enrollment, Disenrollment, and PCM Change Form
https://www.tricare-west.com/content/hnfs/home/tw/bene/res/bene_forms/enrollment/application_pcm_change.html
webDec 20, 2010 · TRICARE Prime Enrollment, Disenrollment, and Primary Care Manager (PCM) Change Form. Beneficiaries can enroll in or disenroll from TRICARE Prime, or to change your primary care manager online through Beneficiary Web Enrollment (BWE) or you can print, complete and mail this form to Health Net Federal Services, LLC for …
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