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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 />74704050106450 <br />Zolgensma 12.6-13.0 kg KIT 1x5.5ML & <br />8x8.3ML <br />13.00% <br />74704050106452 <br />Zolgensma 13.1-13.5 kg KIT 9x8.3 ML <br />13.00% <br />74704050106454 <br />Zolgensma 13.6-14.0 kg KIT 2x5.5ML & <br />8x8.3ML <br />13.00% <br />74704050106456 <br />Zolgensma 14.1-14.5 kg KIT 1x5.5ML & <br />9x8.3ML <br />13.00% <br />74704050106458 <br />Zolgensma 14.6-15.0 kg KIT 10x8.3 ML <br />13.00% <br />74704050106460 <br />Zolgensma 15.1-15.5 kg KIT 2x5.5ML & <br />9x8.3ML <br />13.00% <br />74704050106462 <br />Zolgensma 15.6-16.0 kg KIT 1x5.5ML & <br />10x8.3ML <br />13.00% <br />74704050106464 <br />Zolgensma 16.1-16.5 kg KIT 11x8.3 ML <br />13.00% <br />74704050106466 <br />Zolgensma 16.6-17.0 kg KIT 2x5.5ML & <br />lOx8.3ML <br />13.00% <br />74704050106468 <br />Zolgensma 17.1-17.5 kg KIT 1x5.5ML & <br />11x8.3ML <br />13.00% <br />74704050106470 <br />Zolgensma 17.6-18.0 kg KIT 12x8.3 ML <br />13.00% <br />74704050106472 <br />Zolgensma 18.1-18.5 kg KIT 2x5.5ML & <br />11x8.3ML <br />13.00% <br />74704050106474 <br />Zolgensma 18.6-19.0 kg KIT 1x5.5ML & <br />12x8.3ML <br />13.00% <br />74704050106476 <br />Zolgensma 19.1-19.5 kg KIT 13x8.3 ML <br />13.00% <br />74704050106482 <br />Zolgensma 20.6-21.0 kg KIT 14x8.3 ML <br />13.00% <br />74706560002120 <br />Evrysdi SOLR 0.75 MG/ML <br />10.00% <br />75886060000130 <br />Sohonos CAPS 2.5 MG <br />13.00% <br />75886060000135 <br />Sohonos CAPS 5 MG <br />13.00% <br />75886060000140 <br />Sohonos CAPS 10 MG <br />13.00% <br />76000012100320 <br />Firdapse TABS 10 MG <br />12.00% <br />80200080000920 <br />Dojolvi LIQD 100 % <br />15.09% <br />82400540102140 <br />Reblozyl SOLR 75 MG <br />14.25% <br />82405030050330 <br />Alvaiz TABS 36 MG <br />13.00% <br />82405030050340 <br />Alvaiz TABS 54 MG <br />13.00% <br />82405030100320 <br />Promacta TABS 25 MG <br />17.40% <br />82405030100330 <br />Promacta TABS 50 MG <br />17.40% <br />82405030100340 <br />Promacta TABS 75 MG <br />17.40% <br />82405045000320 <br />Mulpleta TABS 3 MG <br />17.50% <br />82405060002130 <br />Nplate SOLR 500 MCG <br />15.00% <br />82502046000120 <br />Xolremdi CAPS 100 MG <br />13.00% <br />82502060002020 <br />Mozobil SOLN 24 MG/1.2ML <br />15.00% <br />15.00% <br />82700040600120 <br />Cerdelga CAPS 84 MG <br />15.00% <br />82700070000120 <br />Zavesca CAPS 100 MG <br />16.00% <br />67.00% <br />65 <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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