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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 />82804020101820 <br />Casgevy SUSP <br />13.00% <br />82804050101820 <br />Lyfgenia SUSP <br />13.00% <br />82805080000310 <br />Oxbryta TABS 300 MG <br />15.25% <br />82805080007320 <br />Oxbryta TBSO 300 MG <br />15.25% <br />85080025202020 <br />Givlaari SOLN 189 MG/ML <br />14.00% <br />85100010226430 <br />Nuwiq KIT 500 UNIT <br />30.00% <br />85100010226440 <br />Nuwiq KIT 1000 UNIT <br />30.00% <br />85100010226460 <br />Nuwiq KIT 2000 UNIT <br />30.00% <br />85100010226465 <br />Nuwiq KIT 2500 UNIT <br />30.00% <br />85100010226470 <br />Nuwiq KIT 3000 UNIT <br />30.00% <br />85100010226480 <br />Nuwiq KIT 4000 UNIT <br />30.00% <br />85100010252120 <br />Kovaltry SOLR 250 UNIT <br />40.00% <br />85100010252130 <br />Kovaltry SOLR 500 UNIT <br />40.00% <br />85100010252140 <br />Kovaltry SOLR 1000 UNIT <br />40.00% <br />85100010252150 <br />Advate SOLR 1500 UNIT <br />42.00% <br />85100010252180 <br />Kovaltry SOLR 3000 UNIT <br />40.00% <br />85100010266430 <br />Xyntha KIT 500 UNIT <br />40.00% <br />85100010266440 <br />Xyntha KIT 1000 UNIT <br />40.00% <br />85100010266460 <br />Xyntha KIT 2000 UNIT <br />40.00% <br />85100010266470 <br />Xyntha Solofuse KIT 3000 UNIT <br />40.00% <br />85100010302130 <br />Eloctate SOLR 750 UNIT <br />28.60% <br />85100010302145 <br />Eloctate SOLR 1500 UNIT <br />28.60% <br />85100010302155 <br />Eloctate SOLR 2000 UNIT <br />28.60% <br />85100010302165 <br />Eloctate SOLR 3000 UNIT <br />28.60% <br />85100010302170 <br />Eloctate SOLR 4000 UNIT <br />28.60% <br />85100010402150 <br />Adynovate SOLR 2000 UNIT <br />36.50% <br />85100010402160 <br />Adynovate SOLR 3000 UNIT <br />36.50% <br />85100026202117 <br />NovoSeven RT SOLR I MG <br />32.00% <br />85100026202145 <br />NovoSeven RT SOLR 5 MG <br />32.00% <br />85100028352120 <br />Idelvion SOLR 500 UNIT <br />13.00% <br />85100028352130 <br />Idelvion SOLR 1000 UNIT <br />13.00% <br />85100028352140 <br />Idelvion SOLR 2000 UNIT <br />13.00% <br />85100028352150 <br />Idelvion SOLR 3500 UNIT <br />13.00% <br />85102585601820 <br />Roctavian SUSP 20000000000000 <br />VG/ML <br />13.00% <br />85105030202010 <br />Hemlibra SOLN 30 MG/ML <br />26.00% <br />85105030202020 <br />Hemlibra SOLN 60 MG/0.4ML <br />26.00% <br />85105030202030 I <br />Hemlibra SOLN 105 MG/0.7ML 126,00% <br />•e <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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