CMs-10725 Transparency Detailed Template

Pharmacy Benefit Manager Transparency (CMS-10725)

CMS-10725 - Appendix B PBM Transparency Detailed Template

OMB: 0938-1394

Document [pdf]
Download: pdf | pdf
Issuer HIOS Plan ID

11-digit NDC

Total Number of Prescriptions Dispensed

Total Number of Prescriptions Dispensed at Retail Pharmacies

Total Number of Prescriptions Dispensed at Mail Order Pharmacies

Total Rebate Dollars


File Typeapplication/pdf
File TitlePBM Transparency Collection Template
SubjectCMS; Centers for Medicare & Medicaid Services; Center for Consumer Information and Insurance Oversight; CCIIO
AuthorCMS
File Modified2020-08-25
File Created2020-08-06

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