For reimbursement, complete items
1-9 of the claim form, attach receipt(s) and submit to:
Tri-County Schools Insurance Group
c/o Delta Health Systems
P. O. Box 80
Stockton, CA 95201-3080
If you need Delta Health Systems to reimburse the provider, then also sign item 10 and following the same procedures listed above.
One claim form per patient.
Complete the claim form and submit it to:
1230 US HWY 11
Gouverneur, NY 13642
Attn: DMR Dept.
Costco Mail Order Pharmacy
215 Deininger Circle
Corona, CA 92880-9911
Property Casualty Forms
Our Mission is to pool risk and purchasing power of public entities to provide quality programs to our participants in an effective manner while emphasizing customer satisfaction, stability, financial solvency and cost.
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