CMS-10141 3a - 2022 Model Part D Explanation of Benefits (All Sect

Medicare Prescription Drug Benefit Program - IRASA (CMS-10141)

Attachment 3a. CY 2022 EOB

Medicare Prescription Drug Benefit Program (Plans)

OMB: 0938-0964

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0964 can be found here:

2024-12-04 - Revision of a currently approved collection

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