CMS-R-262 CY 2016 PBP Data Entry System Screens (section A)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_PBP_2016_ screenshots_section_a_2014_12_05

CY2016 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⚠️ Notice: This form may be outdated.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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Section A-1

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 1 of 7

Section A-2

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 2 of 7

Section A-3

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 3 of 7

Section A-4

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 4 of 7

Section A-5

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 5 of 7

Section A-6

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 6 of 7

Section A-7

Fu Associates, Ltd.

CY 2016 PBP Data Entry System Screens

CY2016 PBP – Section A
12/5/2014
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING

Page 7 of 7

File Type	application/pdf
File Title	CY 2016 PBP Data Entry System Screens
Author	Scott Meyer
File Modified	2014-12-05
File Created	2014-12-05