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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: 921 F7A24-D5CE-4BCC-9F3C-5E7844661266 <br />62405010002020 <br />Lemtrada SOLN 12 MG/1.2ML <br />15.75% <br />62405085052030 <br />Briumvi SOLN 150 MG/WL <br />13.00% <br />62407060000320 <br />Ponvory TABS 20 MG <br />16.00% <br />62407070200330 <br />Mayzent TABS I MG <br />14.00% <br />62407070200340 <br />Mayzent TABS 2 MG <br />14.00% <br />62450060202020 <br />Sodium Oxybate SOLN 500 MG/ML <br />10.57% <br />62450060203020 <br />Lumryz PACK 4.5 GM <br />15.00% <br />62450060203025 <br />Lumryz PACK 6 GM <br />15.00% <br />62450060203030 <br />Lumryz PACK 7.5 GM <br />15.00% <br />62450060203035 <br />Lumryz PACK 9 GM <br />15.00% <br />62459904202020 <br />Xywav SOLN 500 MG/ML <br />10.00% <br />62706060102020 <br />Onpattro SOLN 10 MG/5ML <br />14.04% <br />66450060002120 <br />Arcalyst SOLR 220 MG <br />16.50% <br />66460020002015 <br />Ilaris SOLN 150 MG/ML <br />16.50% <br />68000050002020 <br />Krystexxa SOLN 8 MG/ML <br />16.35% <br />72170085000320 <br />Sabril TABS 500 MG <br />17.50% <br />95.00% <br />72600033001820 <br />Ztalmy SUSP 50 MG/ML <br />13.00% <br />74135060000120 <br />Skyclarys CAPS 50 MG <br />13.00% <br />74504080002020 <br />Qalsody SOLN 100 MG/ 15ML <br />13.00% <br />74509030001820 <br />Radicava ORS Starter Kit SUSP 105 <br />MG/5ML <br />11.72% <br />74509902703020 <br />Relyvrio PACK 3-1 GM <br />13.00% <br />74600030406410 <br />Elevidys 10.0-10.4 kg KIT 10 x 10 ML <br />13.00% <br />74600030406411 <br />Elevidys 10.5-11.4 kg KIT 11 x 10 ML <br />13.00% <br />74600030406412 <br />Elevidys 11.5-12.4 kg KIT 12 x 10 ML <br />13.00% <br />74600030406413 <br />Elevidys 12.5-13.4 kg KIT 13 x 10 ML <br />13.00% <br />74600030406414 <br />Elevidys 13.5-14.4 kg KIT 14 x 10 ML <br />13.00% <br />74600030406415 <br />Elevidys 14.5-15.4 kg KIT 15 x 10 ML <br />13.00% <br />74600030406416 <br />Elevidys 15.5-16.4 kg KIT 16 x 10 ML <br />13.00% <br />74600030406417 <br />Elevidys 16.5-17.4 kg KIT 17 x 10 ML <br />13.00% <br />74600030406418 <br />Elevidys 17.5-18.4 kg KIT 18 x 10 ML <br />13.00% <br />74600030406419 <br />Elevidys 18.5-19.4 kg KIT 19 x 10 ML <br />13.00% <br />74600030406420 <br />Elevidys 19.5-20.4 kg KIT 20 x 10 ML <br />13.00% <br />74600030406421 <br />Elevidys 20.5-21.4 kg KIT 21 x I0 ML <br />13.00% <br />74600030406422 <br />Elevidys 21.5-22.4 kg KIT 22 x 10 ML <br />13.00% <br />74600030406423 <br />Elevidys 22.5-23.4 kg KIT 23 x 10 ML <br />13.00% <br />74600030406424 <br />Elevidys 23.5-24.4 kg KIT 24 x 10 ML <br />13.00% <br />74600030406425 <br />Elevidys 24.5-25.4 kg KIT 25 x 10 ML <br />13.00% <br />62 <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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