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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 />215322354OB225 <br />Truseltiq (75MG Daily Dose) CPPK 25 <br />MG <br />13.00% <br />215322354OB230 <br />Truseltiq (100MG Daily Dose) CPPK 100 <br />MG <br />13.00% <br />215322354OB235 <br />Truseltiq (125MG Daily Dose) CPPK 100 <br />& 25 MG <br />13.00% <br />2153801000B720 <br />Piqray (200 MG Daily Dose) TBPK 200 <br />MG <br />17.00% <br />2153801000B725 <br />Piqray (250 MG Daily Dose) TBPK 200 <br />&50 MG <br />17.00% <br />2153801000B730 <br />Piqray (300 MG Daily Dose) TBPK 2 x <br />150 MG <br />17.00% <br />21560060008720 <br />Xpovio (80 MG Twice Weekly) TBPK 20 <br />MG <br />13.00% <br />2156006000B755 <br />Xpovio (60 MG Twice Weekly) TBPK 20 <br />MG <br />13.00% <br />2156006000B760 <br />Xpovio (40 MG Once Weekly) TBPK 40 <br />MG <br />13.00% <br />21560060008765 <br />Xpovio (40 MG Twice Weekly) TBPK 40 <br />MG <br />13.00% <br />2156006000B770 <br />Xpovio (80 MG Once Weekly) TBPK 40 <br />MG <br />13.00% <br />2156006000B775 <br />Xpovio (100 MG Once Weekly) TBPK <br />50 MG <br />13.00% <br />2156006000B780 <br />Xpovio (60 MG Once Weekly) TBPK 60 <br />MG <br />13.00% <br />217000775OE520 <br />Besremi SOSY 500 MCG/MI. <br />16.00% <br />21990002608740 <br />Kisqali Femara (400 MG Dose) TBPK <br />200 & 2.5 MG <br />16.50% <br />219900026OB760 <br />Kisqali Femara (600 MG Dose) TBPK <br />200 & 2.5 MG <br />16.50% <br />221000501 OG230 <br />Zilretta SRER 32 MG <br />13.00% <br />301700754OG210 <br />Signifor LAR SRER 10 MG <br />13.00% <br />301700754OG220 <br />Signifor LAR SRER 20 MG <br />13.00% <br />301700754OG225 <br />Signifor LAR SRER 30 MG <br />13.00% <br />301700754OG230 <br />Signifor LAR SRER 40 MG <br />13.00% <br />30I700754OG240 <br />Signifor LAR SRER 60 MG <br />13.00% <br />303000100OD420 <br />Acthar Gel AUIJ 40 UNIT/0.5ML <br />13.00% <br />303000100OD430 <br />Acthar Gel AUIJ 80 UNIT/ML <br />13.00% <br />3045406000B710 <br />Jynarque TBPK 15 MG <br />17.50% <br />3045406000B720 <br />Jynarque TBPK 30 & 15 MG <br />17.50% <br />30454060008725 <br />Jynarque TBPK 45 & 15 MG <br />17.50% <br />30454060008735 <br />Jynarque TBPK 60 & 30 MG <br />17.50% <br />3045406000B745 <br />Jynarque TBPK 90 & 30 MG <br />17.50% <br />30908060008120 <br />Olpruva (2 GM Dose) T-IPK 2 GM <br />12.00% <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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