CMS-R-262 Section B-5-Partial Hospitalization-Base 1

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

Appendix C - PBP_2008_screenshots_sec_b5

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)

OMB: 0938-0763

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0763 can be found here:

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PBP 2008 Data Entry System Screens

Section B – 5 – Partial Hospitalization – Base 1 Screen

Section B – 5 – Partial Hospitalization – Base 2 Screen

Page 2

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File Modified	2006-12-20
File Created	2006-12-20

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