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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 />85105030202040 <br />Hemlibra SOLN 150 MG/M[L <br />26.00% <br />85105030202060 <br />Hemlibra SOLN 300 MG/2ML <br />38.00% <br />85151020806420 <br />Cablivi KIT 11 MG <br />16.00% <br />85804065002020 <br />Empaveli SOLN 1080 MG/20ML <br />17.50% <br />85805030302030 <br />Piasky SOLN 340 MG/2ML <br />13.00% <br />85805050002020 <br />Soliris SOLN 300 MG/30ML <br />16.35% <br />85805070152020 <br />Veopoz SOLN 400 MG/2ML <br />13.00% <br />85805080202060 <br />Ultomiris SOLN 1100 MG/11 ML <br />15.00% <br />85805510000120 <br />Tavneos CAPS 10 MG <br />14.00% <br />85807535200130 <br />Fabhalta CAPS 200 MG <br />15.50% <br />85840010200120 <br />Orladeyo CAPS 110 MG <br />12.50% <br />85840010200130 <br />Orladeyo CAPS 150 MG <br />12.50% <br />85840030002020 <br />Kalbitor SOLN 10 MG/ML <br />15.50% <br />85842040202020 <br />Takhzyro SOLN 300 MG/2ML <br />13.00% <br />85870050700310 <br />Pyrukynd TABS 5 MG <br />13.00% <br />85870050700325 <br />Pyrukynd TABS 20 MG <br />13.00% <br />85870050700340 <br />Pytvkynd TABS 50 MG <br />13.00% <br />86300017102304 <br />Yutiq IMPL 0.18 MG <br />13.00% <br />86300017102305 <br />Iluvien IMPL 0.19 MG <br />16.50% <br />86300017102320 <br />Retisert IMPL 0.59 MG <br />13.00% <br />86330070002320 <br />Mose TR IMPL 75 MCG <br />13.00% <br />86370070601810 <br />Luxturna SUSP 5000000000000 VG/ML <br />14.50% <br />86770020202020 <br />Oxervate SOLN 0.002 % <br />10.00% <br />90922010102320 <br />Scenesse IMPL 16 MG <br />13.00% <br />90944520204020 <br />Vyjuvek GEL 5000000000 PFU/2.5ML <br />13.00% <br />93000084203040 <br />Vistogard PACK 10 GM <br />13.00% <br />93100028000345 <br />Ferriprox Twice -A -Day TABS 1000 MG <br />10.00% <br />93100028002020 <br />Fen-iprox SOLN 100 MG/ML <br />2.00% <br />94200070202020 <br />Cytalux SOLN 3.2 MG/1.6ML <br />13.00% <br />99350035002120 <br />Xiaflex SOLR 0.9 MG <br />13.00% <br />99391540600320 <br />Joenja TABS 70 MG <br />13.00% <br />99392070000135 <br />Thalomid CAPS 150 MG <br />13.00% <br />99392070000140 <br />Thalomid CAPS 200 MG <br />16.00% <br />99394050000110 <br />Revlimid CAPS 2.5 MG <br />18.50% <br />30.00% <br />99394050000120 <br />Revlimid CAPS 5 MG <br />18.50% <br />30.00% <br />99394050000130 <br />Revlimid CAPS 10 MG <br />18.50% <br />30.00% <br />99394050000140 <br />Revlimid CAPS 15 MG <br />18.50% <br />30.00% <br />67 <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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