{"short_name":"Pharmacy Benefit Manager Disclosure Form","name":"Pharmacy Benefit Manager Disclosure Form","icons":[{"src":"/Tenant/LogoImage?urlSlug=pharmacy-benefit-disclosure&width=512&height=512&type=image%2Fpng","type":"image/png","sizes":"512x512"},{"src":"/Tenant/LogoImage?urlSlug=pharmacy-benefit-disclosure&width=192&height=192&type=image%2Fpng","type":"image/png","sizes":"192x192"},{"src":"/Tenant/LogoImage?urlSlug=pharmacy-benefit-disclosure&width=144&height=144&type=image%2Fpng","type":"image/png","sizes":"144x144"},{"src":"/Tenant/LogoImage?urlSlug=pharmacy-benefit-disclosure&width=128&height=128&type=image%2Fpng","type":"image/png","sizes":"128x128"}],"start_url":"https://vt.accessgov.com/pharmacy-benefit-disclosure","background_color":"#ffffff","theme_color":"#033003","display":"standalone"}