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Breast Pump Supply Request Form

Tricare Breastpumps - A Tricare Family

TRICARE Breast Pump Policy

  • 90 Milk Storage Bags per month
 
  • 12 Valves per year

  • 1 set of bottles/flanges/tubing per birth


Additional supplies or milk storage bags will be covered with a new prescription. 

 

Questions about Breast Resupply Requests?

Congratulations on your growing family!

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  • Included Supplies
    • (2) A4281 Tubing for Breast Pump
    • (2) A4282 Adapter for Breast Pump
    • (2) A4283 Cap for Breast Pump Bottle
    • (2) A4284 Breast Shield for Breast Pump
    • (2) A4285 Bottle for use with Breast Pump
    • (2) A9999 Valve for Breast Pump
    • (90) A9900 Breast Milk Storage Bags
  • This field is for validation purposes and should be left unchanged.