24Q0113_Price-Cost Schedule.xlsx
XLSX spreadsheet 17 KB Posted
- Attached to
- Q517--VISN-10 First Fill Prescription Contract
- Solicitation number
- 36C25024Q0222
About this file
This document contains a price-cost schedule template and solicitation for a pharmacy first fill and urgent prescription services contract for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The template requires offerors to provide their discount percentages off AWP pricing for generic and brand name prescriptions, as well as dispensing and administrative fees. The solicitation is a request for quote set aside for Service-Disabled Veteran Owned Small Businesses, with responses due by February 8, 2024. The government intends to award an indefinite delivery indefinite quantity contract with a one year base period and four option years to provide pharmacy services for VISN10 medical centers and community-based outpatient clinics.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25024Q0222 0001.docx | DOCX document | |
| 36C25024Q0222.docx | DOCX document |
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Text version
Sheet1
Business Name: Example Enterprises Business POC: Important POC E-Mail:
SAM UEI: Date Submitted: 1/1/24 Phone: (123)-123-1234 x 1234
| Generic Prescriptions (Claims) | |||||||||||
| Ordering Period | Period of Performance | Estimated Average Cost Per Generic Claim without any discount or dispensing fee | Estimated Annual # of Generic Claims | ||||||||
| (all sites) | Estimated Total cost prior to discounts (Generic Claims) | Offeror's discount off AWP listing (Generic) | Estimated discounted total generic price without dispensing fee | Offeror's Dispensing fee per claim (Generic) | Estimated price with dispensing fee only added to AWP generic price | Total Estimated Generic price with discount and dispensing fees | |||||
| Base Year | 4/1/2024 - 3/31/2025 | $ 62.77 | 10446 | $ 655,695.42 | 0.00% | $ 655,695.42 | $ - 0 | $ - 0 | $ 655,695.42 | ||
| Option Year 1 | 4/1/2025 - 3/31/2026 | $ 62.77 | 10446 | $ 655,695.42 | 0.00% | $ 655,695.42 | $ - 0 | $ - 0 | $ 655,695.42 | ||
| Option Year 2 | 4/1/2026 - 3/31/2027 | $ 62.77 | 10446 | $ 655,695.42 | 0.00% | $ 655,695.42 | $ - 0 | $ - 0 | $ 655,695.42 | ||
| Option Year 3 | 4/1/2027 - 3/31/2028 | $ 62.77 | 10446 | $ 655,695.42 | 0.00% | $ 655,695.42 | $ - 0 | $ - 0 | $ 655,695.42 | ||
| Option Year 4 | 4/1/2028 - 3/31/2029 | $ 62.77 | 10446 | $ 655,695.42 | 0.00% | $ 655,695.42 | $ - 0 | $ - 0 | $ 655,695.42 | ||
| Total: | 52230 | Total: | $ 3,278,477.10 | $ - 0 | $ 3,278,477.10 |
| Brand Name Prescriptions (Claims) | |||||||||||
| Ordering Period | Period of Performance | Estimated Average Cost Per Brand Name without any discount or dispensing fee | Estimated Annual # of Brand Name | ||||||||
| (all sites) | Estimated Total cost prior to discounts (Brand Name Claims) | Offeror's discount off AWP listing (Brand Name) | Estimated discounted total Brand Name without dispensing fee | Offeror's Dispensing fee per claim (Brand Name) | Estimated price with dispensing fee only added to AWP Brand Name | Total Estimated Brand Name price with discount and dispensing fees | |||||
| Base Year | 4/1/2024 - 3/31/2025 | $ 130.57 | 1843 | $ 240,640.51 | 0.00% | $ 240,640.51 | $ - 0 | $ - 0 | $ 240,640.51 | ||
| Option Year 1 | 4/1/2025 - 3/31/2026 | $ 130.57 | 1843 | $ 240,640.51 | 0.00% | $ 240,640.51 | $ - 0 | $ - 0 | $ 240,640.51 | ||
| Option Year 2 | 4/1/2026 - 3/31/2027 | $ 130.57 | 1843 | $ 240,640.51 | 0.00% | $ 240,640.51 | $ - 0 | $ - 0 | $ 240,640.51 | ||
| Option Year 3 | 4/1/2027 - 3/31/2028 | $ 130.57 | 1843 | $ 240,640.51 | 0.00% | $ 240,640.51 | $ - 0 | $ - 0 | $ 240,640.51 | ||
| Option Year 4 | 4/1/2028 - 3/31/2029 | $ 130.57 | 1843 | $ 240,640.51 | 0.00% | $ 240,640.51 | $ - 0 | $ - 0 | $ 240,640.51 | ||
| Total: | 9215 | Total: | $ 1,203,202.55 | $ - 0 | $ 1,203,202.55 |
| No Cost Prescriptions (Administrative Fees) - These are NOT Common | ||||||||||
| Ordering Period | Period of Performance | Estimated Annual Generics | ||||||||
| (No Cost - all sites) | Estimated Annual Brand Name | |||||||||
| (No Cost - all sites) | Offeror's Admin. Fee per claim | |||||||||
| (No Cost - Generic) | Offeror's Admin. Fee per claim | |||||||||
| (No Cost - Brand Name) | Estimated Fees | |||||||||
| (No Cost - Generic) | Estimated Fees | |||||||||
| (No Cost Brand Name) | Total No Cost Administrative Fees | |||||||||
| Base Year | 4/1/2024 - 3/31/2025 | 250 | 250 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Option Year 1 | 4/1/2025 - 3/31/2026 | 250 | 250 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Option Year 2 | 4/1/2026 - 3/31/2027 | 250 | 250 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Option Year 3 | 4/1/2027 - 3/31/2028 | 250 | 250 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Option Year 4 | 4/1/2028 - 3/31/2029 | 250 | 250 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | ||
| Total: | 1250 | 1250 | Total: | $ - 0 |
| Totals | ||||||||||
| Ordering Period | Period of Performance | Claims With Discount | ||||||||
| (Generic) | Claims With Discount | |||||||||
| (Brand Name) | Dispensing Fees | |||||||||
| (Generic) | Dispensing Fees | |||||||||
| (Brand Name) | Administrative Fees | |||||||||
| (No Cost - Generic) | Administrative Fees | |||||||||
| (No Cost - Brand Name) | Total | |||||||||
| Base Year | 4/1/2024 - 3/31/2025 | $ 655,695.42 | $ 240,640.51 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 896,335.93 | ||
| Option Year 1 | 4/1/2025 - 3/31/2026 | $ 655,695.42 | $ 240,640.51 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 896,335.93 | ||
| Option Year 2 | 4/1/2026 - 3/31/2027 | $ 655,695.42 | $ 240,640.51 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 896,335.93 | ||
| Option Year 3 | 4/1/2027 - 3/31/2028 | $ 655,695.42 | $ 240,640.51 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 896,335.93 | ||
| Option Year 4 | 4/1/2028 - 3/31/2029 | $ 655,695.42 | $ 240,640.51 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 896,335.93 | ||
| Total | $ 3,278,477.10 | $ 1,203,202.55 | $ - 0 | $ - 0 | $ - 0 | $ - 0 | $ 4,481,679.65 |
INSTRUCTIONS: All items except the yellow highlighed areas are locked for editing.
All offerors are to provide their discount off AWP pricing in cells (F3:F7) and (F11:F15) as a positive percentage (%).
In addition all offerors are to include the fee per claim in cells (H3:H7) and (H11:H15) as a price ($0.00).
Enter any administrative fees for no cost prescriptions (Generic & Brand Name) in cells (E19:E23) and (F19:F23).
All items in Rows 27-32 are the calculated totals based upon the offeror's entries and cannot be edited.
If you have any questions or concerns with the formulas, or notice an error, please reach out to the contracting officer.
File details come from the government source that posted it. Updated .