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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 />3090806000B 130 <br />Olpruva (3 GM Dose) THPK 3 GM <br />13.00% <br />3090806000B 140 <br />Olpruva (4 GM Dose) THPK 2 & 2 GM <br />12.00% <br />3090806000B 150 <br />Olpruva (5 GM Dose) THPK 2 & 3 GM <br />12.00% <br />3090806000B 160 <br />Olpruva (6 GM Dose) THPK 3 & 3 GM <br />12.00% <br />3090806000B 170 <br />Olpruva (6.67 GM Dose) THPK 3 & 3.67 <br />GM <br />12.00% <br />309085504OE530 <br />Palynziq SOSY 20 MG/ML <br />16.25% <br />4012007000B720 <br />Uptravi Titration TBPK 200 & 800 MCG <br />13.00% <br />453099028OB710 <br />Symdeko TBPK 50-75 & 75 MG <br />17.00% <br />453099028OB720 <br />Symdeko TBPK 100-150 & 150 MG <br />17.00% <br />453099034OB 120 <br />Trikafta THPK 8040-60 & 59.5 MG <br />17.50% <br />453099034OB140 <br />Trikafta THPK 100-50-75 & 75 MG <br />13.00% <br />453099034OB720 <br />Trikafta TBPK 50-25-37.5 & 75 MG <br />17.50% <br />453099034OB740 <br />Trikafta TBPK 100-50-75 & 150 MG <br />17.50% <br />525040504OD520 <br />Omvoh SOAJ 100 MG/ML <br />20.00% <br />525040504OE520 <br />Omvoh SOSY 100 MG/ML <br />20.00% <br />525050201 OF860 <br />Cimzia Starter Kit PSKT 6 X 200 <br />MG/ML <br />20.50% <br />566260506OE520 <br />Rivfloza SOSY 128 MG/0.8ML <br />13.00% <br />566260506OE530 <br />Rivfloza SOSY 160 MG/ML <br />13.00% <br />624010150OB718 <br />Mavenclad (4 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB722 <br />Mavenclad (5 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB726 <br />Mavenclad (6 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB732 <br />Mavenclad (7 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB736 <br />Mavenclad (8 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB740 <br />Mavenclad (9 Tabs) TBPK 10 MG <br />18.50% <br />624010150OB744 <br />Mavenclad (10 Tabs) TBPK 10 MG <br />18.50% <br />6240306045D520 <br />Rebif Rebidose SOM 22 MCG/0.5ML <br />19.40% <br />6240306045D540 <br />Rebif Rebidose SOM 44 MCG/0.5ML <br />19.40% <br />6240306045D560 <br />Rebif Rebidose Titration Pack SOM <br />6X8.8 & 6X22 MCG <br />19.40% <br />6240306045E520 <br />Rebif SOSY 22 MCG/0.5ML <br />19.40% <br />6240306045E560 <br />Rebif Titration Pack SOSY 6X8.8 & <br />6X22 MCG <br />19.40% <br />6240306045F830 <br />Avonex Prefilled PSKT 30 MCG/0.5ML <br />20.00% <br />624055250OB320 <br />Tecfidera CDPK 120 & 240 MG <br />19.00% <br />96.50% <br />624070502OB220 <br />Zeposia Starter Kit CPPK 0.23MG & <br />0.46MG & 0.92MG <br />16.50% <br />627010251OD520 <br />Wainua SOM 45 MG/0.8ML <br />13.00% <br />627010401OE520 <br />Tegsedi SOSY 284 MG/1.5ML <br />13.00% <br />70 <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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