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CMS-10141 3e - Exhibit D: Example of Section 3 (Amounts and Defini
Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)
Attachment 3e. CY 2022 EOB Exhibit D
Medicare Prescription Drug Benefit Program (Plans)
OMB: 0938-0964
OMB.report
HHS/CMS
OMB 0938-0964
ICR 202302-0938-009
IC 187164
CMS-10141 3e - Exhibit D: Example of Section 3 (Amounts and Defini
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