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2025-126D
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2025-126D
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Last modified
9/18/2025 10:43:54 AM
Creation date
9/8/2025 1:42:16 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
06/03/2025
Control Number
2025-126D
Agenda Item Number
13.D.1.
Entity Name
Rightway Healthcare, Inc.
Subject
Pharmacy Benefit Management Services Agreement
Document Relationships
2025-126
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126A
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126B
(Cover Page)
Path:
\Official Documents\2020's\2025
2025-126C
(Cover Page)
Path:
\Official Documents\2020's\2025
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Docusign Envelope ID: 921F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />45550060000120 <br />Esbriet CAPS 267 MG <br />17.00% <br />74.00% <br />45550060000325 <br />Esbriet TABS 267 MG <br />17.00% <br />74.00% <br />45550060000333 <br />Pirfenidone TABS 534 MG <br />74.00% <br />51200060002030 <br />Sucraid SOLN 8500 UNIT/ML <br />14.25% <br />52100010000305 <br />Chenodal TABS 250 MG <br />10.00% <br />52350050102020 <br />Livmarli SOLN 9.5 MG/ML <br />10.00% <br />52350050102040 <br />Livmarli SOLN 19 MG/ML <br />13.00% <br />52350060000120 <br />Bylvay CAPS 400 MCG <br />13.00% <br />52350060000140 <br />Bylvay CAPS 1200 MCG <br />13.00% <br />52350060006830 <br />Bylvay (Pellets) CPSP 600 MCG <br />13.00% <br />52504050402030 <br />Omvoh SOLN 300 MG/15ML <br />20.00% <br />52504060702020 <br />Skyrizi SOLN 600 MG/ IOML <br />18.00% <br />52522010301820 <br />Rebyota SUSP 150 ML <br />13.00% <br />52533070006420 <br />Gattex KIT 5 MG <br />16.50% <br />52700025000120 <br />Cholbam CAPS 50 MG <br />2.00% <br />52700025000140 <br />Cholbam CAPS 250 MG <br />2.00% <br />52750060000320 <br />Ocaliva TABS 5 MG <br />17.50% <br />52780020000320 <br />Igirvo TABS 80 MG <br />13.00% <br />52780070500120 <br />Livdelzi CAPS 10 MG <br />13.00% <br />56400030103020 <br />Procysbi PACK 75 MG <br />13.00% <br />56400030103040 <br />Procysbi PACK 300 MG <br />13.00% <br />56400030106530 <br />Procysbi CPDR 75 MG <br />10.00% <br />56600050000620 <br />Thiola EC TBEC 100 MG <br />13.00% <br />13.00% <br />56626040202020 <br />Oxlumo SOLN 94.5 MG/0.5ML <br />14.04% <br />56626050602020 <br />Rivfloza SOLN 80 MG/0.5ML <br />13.00% <br />58060090000125 <br />Zurzuvae CAPS 25 MG <br />11.50% <br />58060090000130 <br />Zurzuvae CAPS 30 MG <br />13.00% <br />60250070000130 <br />Hetlioz CAPS 20 MG <br />15.50% <br />35.00% <br />60250070001820 <br />Hetlioz LQ SUSP 4 MG/ML <br />15.50% <br />62255010101820 <br />Lenmeldy SUSP <br />13.00% <br />62380030000330 <br />Austedo TABS 12 MG <br />19.00% <br />62380030007535 <br />Austedo XR TB24 30 MG <br />13.00% <br />62380030007540 <br />Austedo XR TB24 36 MG <br />13.00% <br />62380030007545 <br />Austedo XR TB24 42 MG <br />13.00% <br />62380030007550 <br />Austedo XR TB24 48 MG <br />13.00% <br />62380070000310 <br />Xenazine TABS 12.5 MG <br />17.50% <br />66.00% <br />62380070000320 <br />Xenazine TABS 25 MG <br />17.50% <br />66.00% <br />61 <br />This document is CONFIDENTIAL AND PROPRIETARY to RIGHTWAY Healthcare, Inc. and may not be reproduced, <br />transmitted, published, or disclosed to others without the prior written authorization of RIGHTWAY Healthcare, Inc. <br />
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