Document
Appendix C-3 (EHB Prescription Drug Template)
ICR 201505-0938-012 · OMB 0938-1174 · Object 55983001.
This document may belong to an older filing. More recent activity for OMB 0938-1174:
Document Viewer [pdf]
Status: No verified local artifact is currently available. The document remains flagged for repair and upstream re-check.
Queue: Repair is queued and waiting for the next worker pass. (priority 140 · next 2026-08-06 14:39:50)
Missing: pdf
No local or Spaces-backed artifact is available yet for this document.
Loading document viewer…
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | Appendix C-3 (EHB Prescription Drug Template) |
| Subject | EHB, Prescription drugs, NDC, Formulary, Drug, Template, EHB prescription drugs, Essential Health Benefit, Submission, EHB presc |
| Author | Centers for Medicare and Medicaid Services |
| File Modified | 2012-07-29 |
| File Created | 2012-07-27 |
| Conversion State | failed_conversion |