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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 />99394050000145 <br />Revlimid CAPS 20 MG <br />18.50% <br />30.00% <br />99398270552030 <br />Rystiggo SOLN 420 MG/3ML <br />13.00% <br />99398270552040 <br />Rystiggo SOLN 560 MG/4ML <br />13.00% <br />99398270552060 <br />Rystiggo SOLN 840 MG/6ML <br />13.00% <br />99398510500320 <br />Rezurock TABS 200 MG <br />13.00% <br />99399902152020 <br />Vyvgart Hytrulo SOLN 180-2000 MG- <br />UNIT/ML <br />13.00% <br />99402080000120 <br />Lupkynis CAPS 7.9 MG <br />16.00% <br />99405035402040 <br />Gamifant SOLN 50 MG/10ML <br />15.50% <br />99405035402060 <br />Gamifant SOLN 100 MG/20ML <br />15.50% <br />99405040202020 <br />Uplizna SOLN 100 MG/IOML <br />13.00% <br />99463045000120 <br />Zokinvy CAPS 50 MG <br />13.00% <br />99463045000130 <br />Zokinvy CAPS 75 MG <br />13.00% <br />99486010003020 <br />Vijoice PACK 50 MG <br />13.00% <br />3004405510E 110 <br />Natpara CART 25 MCG <br />15.50% <br />3004405510EI20 <br />Natpara CART 50 MCG <br />15.50% <br />3010002000EI20 <br />Humatrope CART 6 MG <br />19.00% <br />3004405510EI30 <br />Natpara CART 75 MCG <br />15.50% <br />3010002000F130 <br />Humatrope CART 12 MG <br />19.00% <br />3004405510EI40 <br />Natpara CART 100 MCG <br />15.50% <br />1235990460B720 <br />Viekira Pak TBPK 12.5-75-50 &250 MG <br />19.00% <br />2133505420B210 <br />Lenvima (4 MG Daily Dose) CPPK 4 MG <br />16.50% <br />2133505420B215 <br />Lenvima (8 MG Daily Dose) CPPK 2 x 4 <br />MG <br />16.50% <br />2133505420B220 <br />Lenvima (10 MG Daily Dose) CPPK 10 <br />MG <br />16.50% <br />2133505420B223 <br />Lenvima (12 MG Daily Dose) CPPK 3 x <br />4 MG <br />16.50% <br />2133505420B230 <br />Lenvima (20 MG Daily Dose) CPPK 2 x <br />10 MG <br />16.50% <br />2133505420B240 <br />Lenvima (14 MG Daily Dose) CPPK 10 <br />&4MG <br />16.50% <br />2133505420B244 <br />Lenvima (18 MG Daily Dose) CPPK 10 <br />MG&2x4MG <br />16.50% <br />2133505420B250 <br />Lenvima (24 MG Daily Dose) CPPK 2 x <br />IOMG&4MG <br />16.50% <br />2153051000B720 <br />Alunbrig TBPK 90 & 180 MG <br />15.50% <br />215310705OB740 <br />Kisqali (400 MG Dose) TBPK 200 MG <br />19.50% <br />2153107050B760 <br />Kisqali (600 MG Dose) TBPK 200 MG <br />19.50% <br />2153223540B220 <br />Truseltiq (50MG Daily Dose) CPPK 25 <br />MG <br />13.00% <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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