CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

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

Appendix C - PBP_2010_screenshots_sec_a_2008_12_12

CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

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⚠️ Notice: This form may be outdated.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 2010 Mock-up Data Entry System Screens

SECTION A – A-1 SCREEN

CY 2010 PBP PRA Package – Section A

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PBP 2010 Mock-up Data Entry System Screens

SECTION A – A-2 SCREEN

CY 2010 PBP PRA Package – Section A

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PBP 2010 Mock-up Data Entry System Screens

SECTION A – A-3 SCREEN

CY 2010 PBP PRA Package – Section A

Page 3 of 4

PBP 2010 Mock-up Data Entry System Screens

SECTION A – A-4 SCREEN

CY 2010 PBP PRA Package – Section A

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File Modified	2008-12-18
File Created	2008-12-18