Approved supplier manual payment reconciliation form (PB242)

Use this form if you are an approved supplier manually claiming or reconciling a payment for suppling PBS items or highly specialised drugs, or both.

If you close your claim electronically, you do not need to use this form.

We require you to keep a copy of the completed form that is submitted to the department for your records.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 18 January 2019