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2025-126D
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2025-126D
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Entry Properties
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 />74600030406463 <br />Elevidys 62.5-63.4 kg KIT 63 x 10 ML <br />13.00% <br />74600030406464 <br />Elevidys 63.5-64.4 kg KIT 64 x 10 ML <br />13.00% <br />74600030406465 <br />Elevidys 64.5-65.4 kg KIT 65 x 10 ML <br />13.00% <br />74600030406466 <br />Elevidys 65.5-66.4 kg KIT 66 x 10 ML <br />13.00% <br />74600030406467 <br />Elevidys 66.5-67.4 kg KIT 67 x 10 ML <br />13.00% <br />74600030406468 <br />Elevidys 67.5-68.4 kg KIT 68 x 10 ML <br />13.00% <br />74600030406469 <br />Elevidys 68.5-69.4 kg KIT 69 x 10 ML <br />13.00% <br />74600030406470 <br />Elevidys 69.5 kg plus KIT 70 x 10 ML <br />13.00% <br />74603025201820 <br />Duvyzat SUSP 8.86 MG/ML <br />14.00% <br />74653075002020 <br />Daybue SOLN 200 MG/ML <br />12.00% <br />74701050002020 <br />Spinmza SOLN 12 MG/5ML <br />13.00% <br />74704050106410 <br />Zolgensma 2.6-3.0 kg KIT 2x8.3 ML <br />13.00% <br />74704050106412 <br />Zolgensma 3.1-3.5 kg KIT 2x5.5ML & <br />1x8.3ML <br />13.00% <br />74704050106414 <br />Zolgensma 3.64.0 kg KIT Ix5.5ML & <br />2x8.3ML <br />13.00% <br />74704050106416 <br />Zolgensma 4.14.5 kg KIT 3x8.3 ML <br />13.00% <br />74704050106418 <br />Zolgensma 4.6-5.0 kg KIT 2x5.5ML & <br />2x8.3ML <br />13.00% <br />74704050106420 <br />Zolgensma 5.1-5.5 kg KIT 1x5.5ML & <br />3x8.3ML <br />13.00% <br />74704050106422 <br />Zolgensma 5.6-6.0 kg KIT 4x8.3 ML <br />13.00% <br />74704050106424 <br />Zolgensma 6.1-6.5 kg KIT 2x5.5ML & <br />3x8.3ML <br />13.00% <br />74704050106426 <br />Zolgensma 6.6-7.0 kg KIT 1x5.5ML & <br />4x8.3ML <br />13.00% <br />74704050106428 <br />Zolgensma 7.1-7.5 kg KIT 5x8.3 ML <br />13.00% <br />74704050106430 <br />Zolgensma 7.6-8.0 kg KIT 2x5.5ML & <br />4x8.3ML <br />13.00% <br />74704050106432 <br />Zolgensma 8.1-8.5 kg KIT 1x5.5ML & <br />5x8.3ML <br />13.00% <br />74704050106434 <br />Zolgensma 8.6-9.0 kg KIT 6x8.3 ML <br />13.00% <br />74704050106436 <br />Zolgensma 9.1-9.5 kg KIT 2x5.5ML & <br />5x8.3ML <br />13.00% <br />74704050106438 <br />Zolgensma 9.6-10.0 kg KIT Ix5.5ML & <br />6x8.3ML <br />13.00% <br />74704050106440 <br />Zolgensma 10.1-10.5 kg KIT 7x8.3 ML <br />13.00% <br />74704050106442 <br />Zolgensma 10.6-11.0 kg KIT 2x5.5ML & <br />6x8.3ML <br />13.00% <br />74704050106444 <br />Zolgensma l I.1-11.5 kg KIT Ix5.5ML & <br />7x8.3ML <br />13.00% <br />74704050106446 <br />Zolgensma 11.6-12.0 kg KIT 8x8.3 ML <br />13.00% <br />74704050106448 <br />Zolgensma 12.1-12.5 kg KIT 2x5.5ML & <br />7x8.3ML <br />13.00% <br />64 <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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