24Q0448 - Price-Cost Schedule.xlsx
XLSX spreadsheet 55 KB Posted
- Solicitation number
- 36C25024Q0448
About this file
This document is a price/cost schedule spreadsheet related to a Request for Quote (RFQ) for Hazardous Compounding services for the VHA VISN10 Medical Centers and CBOCs. The spreadsheet contains detailed pricing information for over 200 pharmaceuticals, fees, and supplies associated with this requirement. The RFQ is a full and open competition for a 12-month base period contract with one option year. The government is requesting offers to be submitted by 1:30 PM EST on 4/5/2024. The pricing in the spreadsheet includes the estimated annual usage for each item and instructions for how to calculate the final pricing, which involves providing a discount or surcharge percentage to be applied to the AWP price. The spreadsheet also includes various special handling fees for services like STAT orders and intrathecal mixing. Offerors are instructed to fill out all required pricing information in the highlighted cells.
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| 36C25024Q0448.pdf | ||
| Guidance Documents for Outsourcing of Compounded Sterile Products.docx | DOCX document |
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INSTRUCTIONS
INSTRUCTIONS / ADDITIONAL INFORMATION:
ALL OFFERORS ARE TO FILL OUT EACH TAB, BASE YEAR and Option 1 below.
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F178, F179. F180, F181, F182, and G183)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY23 use / 7 locations that required HAZ Compounding / 12 months.
BASE Year
| Generic Name | Brand/Trade Name | VISN 10 CY 2023 Usage | Estimated Contingency | ||||||
| Usage / MO (1 site) | AWP BASE Price | ||||||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Base Year | 5/1/2024 - 4/30/2025 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | -99% | Total Price Medication (Less other) | $ 18,286.23 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 0.01 | $ 0.01 | Total Price Fees (Less Supplies) | $ 12.44 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 1 | $ 4,205.88 | $ 42.06 | $ 42.06 | Total Evaluated Price | |||
| (Less Supplies/other) | $ 18,298.67 | ||||||||
| Ado-trastuzumab emtansine 160mg | Kadcyla | 30 | 1 | $ 7,166.80 | $ 71.67 | $ 71.67 | |||
| Arsenic Trioxide 12mg | Trisenox | 522 | 7 | $ 645.03 | $ 6.45 | $ 45.15 | |||
| Atezoliumab 1200mg | Tecentriq | 976 | 12 | $ 12,385.63 | $ 123.86 | $ 1,486.28 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F178, F179. F180, F181, F182, and G183)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY23 use / 7 locations that required HAZ Compounding / 12 months.
| Azacitidine 100mg | Vidaza | 947 | 12 | $ 616.07 | $ 6.16 | $ 73.93 | |
| Bendamustine 100mg | Belrapzo | 0 | 1 | $ 3,112.20 | $ 31.12 | $ 31.12 | |
| Bendamustine 100mg | Bendeka | 509 | 7 | $ 2,961.14 | $ 29.61 | $ 207.28 | |
| Bevacizumab 100mg | Avastin | 1 | $ 953.94 | $ 9.54 | $ 9.54 | ||
| Bevacizumab 400mg | Avastin | 2051 | 25 | $ 3,815.75 | $ 38.16 | $ 953.94 | |
| Bevacizumab-awwb 100mg | Mvasi | 1 | $ 835.18 | $ 8.35 | $ 8.35 | ||
| Bevacizumab-awwb 400mg | Mvasi | 1 | $ 3,340.69 | $ 33.41 | $ 33.41 | ||
| Bevacizumab-bvzr 100mg | Zirabev | 1 | $ 734.24 | $ 7.34 | $ 7.34 | ||
| Bevacizumab-bvzr 400mg | Zirabev | 1296 | 16 | $ 2,936.96 | $ 29.37 | $ 469.91 | |
| Bleomycin 15 units | Blenoxane | 1 | $ 41.30 | $ 0.41 | $ 0.41 | ||
| Bleomycin 30 units | Blenoxane | 42 | 1 | $ 79.83 | $ 0.80 | $ 0.80 | |
| Blinatumomab 35mcg | Blincyto | 1 | $ 5,865.48 | $ 58.65 | $ 58.65 | ||
| Bortezomib 3.5mg | Velcade | 0 | 1 | $ 1,918.79 | $ 19.19 | $ 19.19 | |
| Bortezomib 3.5mg | 1242 | 15 | $ 359.10 | $ 3.59 | $ 53.87 | ||
| Brentuximab vedotin 50mg | Adcetris | 262 | 4 | $ 13,020.97 | $ 130.21 | $ 520.84 | |
| Cabazitaxel 60mg | Jevtana | 95 | 2 | $ 15,341.55 | $ 153.42 | $ 306.83 | |
| Carboplatin 150mg | Paraplatin | 1 | $ 27.41 | $ 0.27 | $ 0.27 | ||
| Carboplatin 50mg | Paraplatin | 1 | $ 8.28 | $ 0.08 | $ 0.08 | ||
| Carboplatin 600mg | Paraplatin | 1935 | 24 | $ 79.11 | $ 0.79 | $ 18.99 | |
| Carfilzomib 60mg | Kyprolis | 387 | 5 | $ 3,566.10 | $ 35.66 | $ 178.31 | |
| Ceftazidime 1g | Tazicef | 1 | $ 5.39 | $ 0.05 | $ 0.05 | ||
| Cetuximab 100mg | Erbitux | 752 | 9 | $ 916.13 | $ 9.16 | $ 82.45 | |
| Cisplatin 100mg | Platinol | 808 | 10 | $ 43.22 | $ 0.43 | $ 4.32 | |
| Cisplatin 50mg | Platinol | 1 | $ 22.45 | $ 0.22 | $ 0.22 | ||
| Cladribine 10mg | Leustatin | 24 | 1 | $ 418.95 | $ 4.19 | $ 4.19 | |
| Cyanocobalamin 1000mcg | 1 | $ 4.44 | $ 0.04 | $ 0.04 | |||
| Cyclophosphamide 1g | Cytoxan | 1 | $ 822.00 | $ 8.22 | $ 8.22 | ||
| Cyclophosphamide 2g | Cytoxan | 1 | $ 1,644.01 | $ 16.44 | $ 16.44 | ||
| Cyclophosphamide 500mg | Cytoxan | 1173 | 14 | $ 411.00 | $ 4.11 | $ 57.54 | |
| Cytarabine 100mg | ARA-C, Cytosar | 3334 | 40 | $ 7.59 | $ 0.08 | $ 3.04 | |
| Cytarabine 2g | ARA-C, Cytosar | 1 | $ 24.32 | $ 0.24 | $ 0.24 | ||
| Dacarbazine 200mg | DTIC | 219 | 3 | $ 19.64 | $ 0.20 | $ 0.59 | |
| Dactinomycin 0.5mg | Cosmegen | 1 | $ 1,675.80 | $ 16.76 | $ 16.76 | ||
| Daratumumab 400mg | Darzalex | 1163 | 14 | $ 3,203.16 | $ 32.03 | $ 448.44 | |
| Daratumumab100mg | Darzalex | 1 | $ 800.79 | $ 8.01 | $ 8.01 | ||
| Daunorubicin 20mg | Cerubidine | 1 | $ 160.57 | $ 1.61 | $ 1.61 | ||
| Decitabine 50mg | Dacogen | 483 | 6 | $ 1,946.12 | $ 19.46 | $ 116.77 | |
| Dexamethasone 10mg | 1 | $ 14.13 | $ 0.14 | $ 0.14 | |||
| Dexrazoxane 500mg | Zinecard, Totect | 1 | $ 548.83 | $ 5.49 | $ 5.49 | ||
| Dextrose 5% 1000ml | 1 | 1 | $ 4.42 | $ 0.04 | $ 0.04 | ||
| Dextrose 5% 100ml | 36 | 1 | $ 2.72 | $ 0.03 | $ 0.03 | ||
| Dextrose 5% 250ml | 296 | 4 | $ 4.73 | $ 0.05 | $ 0.19 | ||
| Dextrose 5% 500ml | 170 | 3 | $ 4.91 | $ 0.05 | $ 0.15 | ||
| Dextrose 5% 50ml | 8 | 1 | $ 2.72 | $ 0.03 | $ 0.03 | ||
| Diphenhydramine 50mg | Benadryl | 1 | $ 1.41 | $ 0.01 | $ 0.01 | ||
| Docetaxel 160mg | Taxotere | 542 | 7 | $ 2,913.90 | $ 29.14 | $ 203.97 | |
| Docetaxel 20mg | Taxotere | 1 | $ 82.30 | $ 0.82 | $ 0.82 | ||
| Docetaxel 80mg | Taxotere | 1 | $ 1,456.95 | $ 14.57 | $ 14.57 | ||
| Docetaxel 80mg | Taxotere | 1 | $ 81.99 | $ 0.82 | $ 0.82 | ||
| Doxorubicin 20mg | Adriamycin | 1 | $ 24.30 | $ 0.24 | $ 0.24 | ||
| Doxorubicin 50mg | Adriamycin | 762 | 10 | $ 29.40 | $ 0.29 | $ 2.94 | |
| Durvalumab 120mg | Imfinzi | 1 | $ 1,100.98 | $ 11.01 | $ 11.01 | ||
| Durvalumab 500mg | Imfinzi | 1958 | 24 | $ 4,587.41 | $ 45.87 | $ 1,100.98 | |
| Eculizumab 300mg | Soliris | 1 | $ 7,808.03 | $ 78.08 | $ 78.08 | ||
| Elotuzumab 300mg | Empliciti | 1 | $ 2,467.18 | $ 24.67 | $ 24.67 | ||
| Elotuzumab 400mg | Empliciti | 255 | 4 | $ 3,289.55 | $ 32.90 | $ 131.58 | |
| Epirubicin 50mg | Ellence | 1 | $ 55.89 | $ 0.56 | $ 0.56 | ||
| Eribulin mesylate 1mg | Halaven | 1 | $ 1,637.50 | $ 16.37 | $ 16.37 | ||
| Etoposide 100mg | Vepesid, VP-16, Toposar | 2679 | 32 | $ 11.34 | $ 0.11 | $ 3.63 | |
| Etoposide Phosphate 100mg | Etopophos | 1 | $ 203.91 | $ 2.04 | $ 2.04 | ||
| Famotidine 20mg | Famotidine | 1 | $ 1.06 | $ 0.01 | $ 0.01 | ||
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 88 | 2 | $ 3,170.72 | $ 31.71 | $ 63.41 | |
| Ferric carboxymaltose 750mg | Injectafer | 1 | $ 1,552.79 | $ 15.53 | $ 15.53 | ||
| Fludarabine 50mg | Fludara | 34 | 1 | $ 113.12 | $ 1.13 | $ 1.13 | |
| Fluorouracil 1g | Adrucil, 5-FU | 1 | $ 28.61 | $ 0.29 | $ 0.29 | ||
| Fluorouracil 500mg | Adrucil, 5-FU | 12888 | 154 | $ 15.90 | $ 0.16 | $ 24.49 | |
| Fluorouracil 5g | Adrucil, 5-FU | 1 | $ 68.58 | $ 0.69 | $ 0.69 | ||
| Fosaprepitant 150mg | Emend | 1 | $ 320.44 | $ 3.20 | $ 3.20 | ||
| Fulvestrant 250mg | Faslodex | 1 | $ 508.72 | $ 5.09 | $ 5.09 | ||
| Furosemide 20mg | Lasix | 1 | $ 5.01 | $ 0.05 | $ 0.05 | ||
| Ganciclovir 500mg | Cytovene | 1 | $ 81.87 | $ 0.82 | $ 0.82 | ||
| Gemcitabine 1g | Gemzar | 1 | $ 79.00 | $ 0.79 | $ 0.79 | ||
| Gemcitabine 200mg | Gemzar | 16553 | 198 | $ 52.67 | $ 0.53 | $ 104.28 | |
| Gentamicin Sulfate 80mg | Gentamicin | 1 | $ 1.68 | $ 0.02 | $ 0.02 | ||
| Idarubicin 10mg | Idamycin | 1 | $ 129.02 | $ 1.29 | $ 1.29 | ||
| Idarubicin 20mg | Idamycin | 12 | 1 | $ 247.72 | $ 2.48 | $ 2.48 | |
| Idarubicin 5mg | Idamycin | 1 | $ 64.51 | $ 0.65 | $ 0.65 | ||
| Ifosfamide 1g | Ifex | 1 | $ 43.98 | $ 0.44 | $ 0.44 | ||
| Ifosfamide 3g | Ifex | 11500 | 137 | $ 128.73 | $ 1.29 | $ 176.35 | |
| Infliximab 100mg | Remicade | 1 | $ 1,397.88 | $ 13.98 | $ 13.98 | ||
| Infliximab-abda 100mg | Renflexis | 1 | $ 901.81 | $ 9.02 | $ 9.02 | ||
| Infliximab-dyyb 100mg | Inflectra | 1 | $ 1,132.70 | $ 11.33 | $ 11.33 | ||
| Irinotecan 100mg | Camptosar | 2365 | 29 | $ 35.98 | $ 0.36 | $ 10.43 | |
| Irinotecan 40mg | Camptosar | 1 | $ 17.40 | $ 0.17 | $ 0.17 | ||
| Iron Sucrose 100mg | Venofer | 1 | $ 69.13 | $ 0.69 | $ 0.69 | ||
| Iron Sucrose 200mg | Venofer | 1 | $ 138.25 | $ 1.38 | $ 1.38 | ||
| LC Bead 100-300 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead 300-500 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead 70-150 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead LUMI 40-90 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| Leucovorin 100mg | 1 | $ 19.15 | $ 0.19 | $ 0.19 | |||
| Leucovorin 350mg | 1 | $ 83.79 | $ 0.84 | $ 0.84 | |||
| Liposomal Doxorubicin 20mg | Doxil | 1 | $ 793.61 | $ 7.94 | $ 7.94 | ||
| Liposomal Doxorubicin 50mg | Doxil | 1 | $ 2,015.75 | $ 20.16 | $ 20.16 | ||
| Liposomal Irinotecan 4.3mg | Onivyde | 1 | $ 3,310.90 | $ 33.11 | $ 33.11 | ||
| Lurbinectedin 4mg | Zepzelca | 271 | 4 | $ 9,372.51 | $ 93.73 | $ 374.90 | |
| Magnesium Sulfate 1g | 1 | $ 2.38 | $ 0.02 | $ 0.02 | |||
| Mepolizumab 100mg | Nucala | 1 | $ 3,905.46 | $ 39.05 | $ 39.05 | ||
| Mesna 1g | Mesnex | 1 | $ 23.94 | $ 0.24 | $ 0.24 | ||
| Methotrexate 1g | Rheumatrex, Trexall | 1 | $ 41.06 | $ 0.41 | $ 0.41 | ||
| Methotrexate 250mg | Rheumatrex, Trexall | 308 | 4 | $ 11.14 | $ 0.11 | $ 0.45 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 1 | $ 4.02 | $ 0.04 | $ 0.04 | ||
| Methylprednisolone 125mg | Solu-Medrol | 1 | $ 13.95 | $ 0.14 | $ 0.14 | ||
| Mitomycin 20mg | Mutamycin | 1 | $ 706.05 | $ 7.06 | $ 7.06 | ||
| Mitomycin 40mg | Mutamycin | 37 | 1 | $ 1,412.10 | $ 14.12 | $ 14.12 | |
| Mitomycin 5mg | Mutamycin | 1 | $ 271.78 | $ 2.72 | $ 2.72 | ||
| Mitoxantrone 25mg | Novantrone | 5 | 1 | $ 258.19 | $ 2.58 | $ 2.58 | |
| Mycophenolate mofetil 500mg | Cellcept | 1 | $ 129.25 | $ 1.29 | $ 1.29 | ||
| Nivolumab 100mg | Opdivo | 1 | $ 3,517.79 | $ 35.18 | $ 35.18 | ||
| Nivolumab 240mg | Opdivo | 1803 | 22 | $ 8,442.72 | $ 84.43 | $ 1,857.40 | |
| Nivolumab 40mg | Opdivo | 1 | $ 1,407.12 | $ 14.07 | $ 14.07 | ||
| Ocrelizumab 300mg | Ocrevus | 1 | $ 22,474.40 | $ 224.74 | $ 224.74 | ||
| Ondansetron 40mg | 1 | $ 5.98 | $ 0.06 | $ 0.06 | |||
| Ondansetron 4mg | 1 | $ 0.72 | $ 0.01 | $ 0.01 | |||
| Oxaliplatin 100mg | Eloxatin | 1952 | 24 | $ 423.32 | $ 4.23 | $ 101.60 | |
| Oxaliplatin 50mg | Eloxatin | 1 | $ 211.66 | $ 2.12 | $ 2.12 | ||
| Paclitaxel 300mg | Taxol | 1296 | 16 | $ 65.84 | $ 0.66 | $ 10.53 | |
| Paclitaxel 100mg | Taxol | 1 | $ 33.74 | $ 0.34 | $ 0.34 | ||
| Paclitaxel 30mg | Taxol | 1 | $ 11.97 | $ 0.12 | $ 0.12 | ||
| Paclitaxel Protein-Bound 100mg | Abraxane | 0 | 1 | $ 1,891.33 | $ 18.91 | $ 18.91 | |
| Paclitaxel Protein-Bound 100mg | 1087 | 13 | $ 1,796.76 | $ 17.97 | $ 233.58 | ||
| Palonosetron 0.25mg | 1 | $ 23.94 | $ 0.24 | $ 0.24 | |||
| Pamidronate 30mg | 1 | $ 32.32 | $ 0.32 | $ 0.32 | |||
| Pamidronate 90mg | 1 | $ 111.99 | $ 1.12 | $ 1.12 | |||
| Panitumumab 100mg | Vectibix | 1 | $ 1,878.64 | $ 18.79 | $ 18.79 | ||
| Panitumumab 400mg | Vectibix | 261 | 4 | $ 7,514.55 | $ 75.15 | $ 300.58 | |
| Pegasparagase 3,750 units | Oncaspar | 32 | 1 | $ 29,113.60 | $ 291.14 | $ 291.14 | |
| Pembrolizumab 100mg | Keytruda | 6261 | 75 | $ 6,268.74 | $ 62.69 | $ 4,701.55 | |
| Pemetrexed 100mg | Alimta | 1 | $ 967.90 | $ 9.68 | $ 9.68 | ||
| Pemetrexed 100mg | 1 | $ 179.55 | $ 1.80 | $ 1.80 | |||
| Pemetrexed 500mg | Alimta | 0 | 1 | $ 4,839.47 | $ 48.39 | $ 48.39 | |
| Pemetrexed 500mg | 1264 | 16 | $ 806.58 | $ 8.07 | $ 129.05 | ||
| Pentamidine Isethionate 300mg | Pentam | 1 | $ 180.05 | $ 1.80 | $ 1.80 | ||
| Pentostatin 10mg | Nipent | 1 | $ 2,919.56 | $ 29.20 | $ 29.20 | ||
| Pertuzumab 420mg | Perjeta | 27 | 1 | $ 7,585.01 | $ 75.85 | $ 75.85 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 80 | 1 | $ 4,245.09 | $ 42.45 | $ 42.45 | |
| Potassium Chloride 20meq | 1 | $ 2.40 | $ 0.02 | $ 0.02 | |||
| Pralatrexate 20mg | Folotyn | 1 | $ 8,124.66 | $ 81.25 | $ 81.25 | ||
| Pralatrexate 40mg | Folotyn | 26 | 1 | $ 16,249.32 | $ 162.49 | $ 162.49 | |
| Ramucirumab 100mg | Cyramza | 1 | $ 1,579.86 | $ 15.80 | $ 15.80 | ||
| Ramucirumab 500mg | Cyramza | 129 | 2 | $ 7,899.29 | $ 78.99 | $ 157.99 | |
| Risankizumab-rzaa 150mg | Skyrizi | 1 | $ 21,872.53 | $ 218.73 | $ 218.73 | ||
| Rituximab 100mg | Rituxan | 1 | $ 1,124.60 | $ 11.25 | $ 11.25 | ||
| Rituximab 500mg | Rituxan | 190 | 3 | $ 5,623.03 | $ 56.23 | $ 168.69 | |
| Rituximab-abbs 100mg | Truxima | 1 | $ 1,012.12 | $ 10.12 | $ 10.12 | ||
| Rituximab-abbs 500mg | Truxima | 1 | $ 5,060.62 | $ 50.61 | $ 50.61 | ||
| Rituximab-pvvr 100mg | Ruxience | 1 | $ 858.01 | $ 8.58 | $ 8.58 | ||
| Rituximab-pvvr 500mg | Ruxience | 1957 | 24 | $ 4,290.05 | $ 42.90 | $ 1,029.61 | |
| Romidepsin 10mg | Istodax | 2 | 1 | $ 3,828.79 | $ 38.29 | $ 38.29 | |
| Sodium Chloride 0.9% 1000ml | 82 | 1 | $ 5.90 | $ 0.06 | $ 0.06 | ||
| Sodium Chloride 0.9% 100ml | 515 | 7 | $ 3.01 | $ 0.03 | $ 0.21 | ||
| Sodium Chloride 0.9% 250ml | 607 | 8 | $ 2.87 | $ 0.03 | $ 0.23 | ||
| Sodium Chloride 0.9% 500ml | 217 | 3 | $ 5.04 | $ 0.05 | $ 0.15 | ||
| Sterile Water 1000ml | 1 | $ 4.16 | $ 0.04 | $ 0.04 | |||
| Sterile Water 250ml | 1 | $ 2.62 | $ 0.03 | $ 0.03 | |||
| Sterile Water 500ml | 1 | $ 3.61 | $ 0.04 | $ 0.04 | |||
| Temsirolimus 25mg | Torisel | 1 | $ 1,906.18 | $ 19.06 | $ 19.06 | ||
| Topotecan 4mg | Hycamptin | 134 | 2 | $ 164.21 | $ 1.64 | $ 3.28 | |
| Trastuzumab 150mg | Herceptin | 1 | $ 1,865.43 | $ 18.65 | $ 18.65 | ||
| Trastuzumab-qyyp 420mg | Trazimera | 1 | $ 4,059.13 | $ 40.59 | $ 40.59 | ||
| Vancomycin 1g | Vancomycin | 1 | $ 6.01 | $ 0.06 | $ 0.06 | ||
| Vedolizumab 300mg | Entyvio | 1 | $ 9,786.69 | $ 97.87 | $ 97.87 | ||
| Vinblastine 10mg | Velban | 62 | 1 | $ 56.45 | $ 0.56 | $ 0.56 | |
| Vincristine 1mg | Oncovin | 1 | $ 19.32 | $ 0.19 | $ 0.19 | ||
| Vincristine 2mg | Oncovin | 298 | 4 | $ 16.74 | $ 0.17 | $ 0.67 | |
| Vinorelbine 50mg | Navelbine | 37 | 1 | $ 107.73 | $ 1.08 | $ 1.08 | |
| Zoledronic Acid 4mg | 1 | $ 836.19 | $ 8.36 | $ 8.36 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | 418 | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | VISN 10 CY 2023 Usage | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | 8755 | 1234 | $ 0.01 | $ 12.34 | |||
| Chemoembolic Mixing | 0 | 2 | $ 0.01 | $ 0.02 | |||
| Exact Volume Requirement | 0 | 2 | $ 0.01 | $ 0.02 | |||
| Intrathecal Mixing | 7 | 2 | $ 0.01 | $ 0.02 | |||
| STAT Order | 0 | 4 | $ 0.01 | $ 0.04 | |||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | 99% |
Option 1
| Generic Name | Brand/Trade Name | VISN 10 CY 2023 Usage | Estimated Contingency | ||||||
| Usage / MO (1 site) | AWP BASE Price | ||||||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Option Year 1 | 5/1/2025 - 4/30/2026 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | -99% | Total Price Medication (Less other) | $ 18,286.23 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 0.01 | $ 0.01 | Total Price Fees (Less Supplies) | $ 12.44 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 1 | $ 4,205.88 | $ 42.06 | $ 42.06 | Total Evaluated Price | |||
| (Less Supplies/other) | $ 18,298.67 | ||||||||
| Ado-trastuzumab emtansine 160mg | Kadcyla | 30 | 1 | $ 7,166.80 | $ 71.67 | $ 71.67 | |||
| Arsenic Trioxide 12mg | Trisenox | 522 | 7 | $ 645.03 | $ 6.45 | $ 45.15 | |||
| Atezoliumab 1200mg | Tecentriq | 976 | 12 | $ 12,385.63 | $ 123.86 | $ 1,486.28 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F178, F179. F180, F181, F182, and G183)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY23 use / 7 locations that required HAZ Compounding / 12 months.
| Azacitidine 100mg | Vidaza | 947 | 12 | $ 616.07 | $ 6.16 | $ 73.93 | |
| Bendamustine 100mg | Belrapzo | 0 | 1 | $ 3,112.20 | $ 31.12 | $ 31.12 | |
| Bendamustine 100mg | Bendeka | 509 | 7 | $ 2,961.14 | $ 29.61 | $ 207.28 | |
| Bevacizumab 100mg | Avastin | 1 | $ 953.94 | $ 9.54 | $ 9.54 | ||
| Bevacizumab 400mg | Avastin | 2051 | 25 | $ 3,815.75 | $ 38.16 | $ 953.94 | |
| Bevacizumab-awwb 100mg | Mvasi | 1 | $ 835.18 | $ 8.35 | $ 8.35 | ||
| Bevacizumab-awwb 400mg | Mvasi | 1 | $ 3,340.69 | $ 33.41 | $ 33.41 | ||
| Bevacizumab-bvzr 100mg | Zirabev | 1 | $ 734.24 | $ 7.34 | $ 7.34 | ||
| Bevacizumab-bvzr 400mg | Zirabev | 1296 | 16 | $ 2,936.96 | $ 29.37 | $ 469.91 | |
| Bleomycin 15 units | Blenoxane | 1 | $ 41.30 | $ 0.41 | $ 0.41 | ||
| Bleomycin 30 units | Blenoxane | 42 | 1 | $ 79.83 | $ 0.80 | $ 0.80 | |
| Blinatumomab 35mcg | Blincyto | 1 | $ 5,865.48 | $ 58.65 | $ 58.65 | ||
| Bortezomib 3.5mg | Velcade | 0 | 1 | $ 1,918.79 | $ 19.19 | $ 19.19 | |
| Bortezomib 3.5mg | 1242 | 15 | $ 359.10 | $ 3.59 | $ 53.87 | ||
| Brentuximab vedotin 50mg | Adcetris | 262 | 4 | $ 13,020.97 | $ 130.21 | $ 520.84 | |
| Cabazitaxel 60mg | Jevtana | 95 | 2 | $ 15,341.55 | $ 153.42 | $ 306.83 | |
| Carboplatin 150mg | Paraplatin | 1 | $ 27.41 | $ 0.27 | $ 0.27 | ||
| Carboplatin 50mg | Paraplatin | 1 | $ 8.28 | $ 0.08 | $ 0.08 | ||
| Carboplatin 600mg | Paraplatin | 1935 | 24 | $ 79.11 | $ 0.79 | $ 18.99 | |
| Carfilzomib 60mg | Kyprolis | 387 | 5 | $ 3,566.10 | $ 35.66 | $ 178.31 | |
| Ceftazidime 1g | Tazicef | 1 | $ 5.39 | $ 0.05 | $ 0.05 | ||
| Cetuximab 100mg | Erbitux | 752 | 9 | $ 916.13 | $ 9.16 | $ 82.45 | |
| Cisplatin 100mg | Platinol | 808 | 10 | $ 43.22 | $ 0.43 | $ 4.32 | |
| Cisplatin 50mg | Platinol | 1 | $ 22.45 | $ 0.22 | $ 0.22 | ||
| Cladribine 10mg | Leustatin | 24 | 1 | $ 418.95 | $ 4.19 | $ 4.19 | |
| Cyanocobalamin 1000mcg | 1 | $ 4.44 | $ 0.04 | $ 0.04 | |||
| Cyclophosphamide 1g | Cytoxan | 1 | $ 822.00 | $ 8.22 | $ 8.22 | ||
| Cyclophosphamide 2g | Cytoxan | 1 | $ 1,644.01 | $ 16.44 | $ 16.44 | ||
| Cyclophosphamide 500mg | Cytoxan | 1173 | 14 | $ 411.00 | $ 4.11 | $ 57.54 | |
| Cytarabine 100mg | ARA-C, Cytosar | 3334 | 40 | $ 7.59 | $ 0.08 | $ 3.04 | |
| Cytarabine 2g | ARA-C, Cytosar | 1 | $ 24.32 | $ 0.24 | $ 0.24 | ||
| Dacarbazine 200mg | DTIC | 219 | 3 | $ 19.64 | $ 0.20 | $ 0.59 | |
| Dactinomycin 0.5mg | Cosmegen | 1 | $ 1,675.80 | $ 16.76 | $ 16.76 | ||
| Daratumumab 400mg | Darzalex | 1163 | 14 | $ 3,203.16 | $ 32.03 | $ 448.44 | |
| Daratumumab100mg | Darzalex | 1 | $ 800.79 | $ 8.01 | $ 8.01 | ||
| Daunorubicin 20mg | Cerubidine | 1 | $ 160.57 | $ 1.61 | $ 1.61 | ||
| Decitabine 50mg | Dacogen | 483 | 6 | $ 1,946.12 | $ 19.46 | $ 116.77 | |
| Dexamethasone 10mg | 1 | $ 14.13 | $ 0.14 | $ 0.14 | |||
| Dexrazoxane 500mg | Zinecard, Totect | 1 | $ 548.83 | $ 5.49 | $ 5.49 | ||
| Dextrose 5% 1000ml | 1 | 1 | $ 4.42 | $ 0.04 | $ 0.04 | ||
| Dextrose 5% 100ml | 36 | 1 | $ 2.72 | $ 0.03 | $ 0.03 | ||
| Dextrose 5% 250ml | 296 | 4 | $ 4.73 | $ 0.05 | $ 0.19 | ||
| Dextrose 5% 500ml | 170 | 3 | $ 4.91 | $ 0.05 | $ 0.15 | ||
| Dextrose 5% 50ml | 8 | 1 | $ 2.72 | $ 0.03 | $ 0.03 | ||
| Diphenhydramine 50mg | Benadryl | 1 | $ 1.41 | $ 0.01 | $ 0.01 | ||
| Docetaxel 160mg | Taxotere | 542 | 7 | $ 2,913.90 | $ 29.14 | $ 203.97 | |
| Docetaxel 20mg | Taxotere | 1 | $ 82.30 | $ 0.82 | $ 0.82 | ||
| Docetaxel 80mg | Taxotere | 1 | $ 1,456.95 | $ 14.57 | $ 14.57 | ||
| Docetaxel 80mg | Taxotere | 1 | $ 81.99 | $ 0.82 | $ 0.82 | ||
| Doxorubicin 20mg | Adriamycin | 1 | $ 24.30 | $ 0.24 | $ 0.24 | ||
| Doxorubicin 50mg | Adriamycin | 762 | 10 | $ 29.40 | $ 0.29 | $ 2.94 | |
| Durvalumab 120mg | Imfinzi | 1 | $ 1,100.98 | $ 11.01 | $ 11.01 | ||
| Durvalumab 500mg | Imfinzi | 1958 | 24 | $ 4,587.41 | $ 45.87 | $ 1,100.98 | |
| Eculizumab 300mg | Soliris | 1 | $ 7,808.03 | $ 78.08 | $ 78.08 | ||
| Elotuzumab 300mg | Empliciti | 1 | $ 2,467.18 | $ 24.67 | $ 24.67 | ||
| Elotuzumab 400mg | Empliciti | 255 | 4 | $ 3,289.55 | $ 32.90 | $ 131.58 | |
| Epirubicin 50mg | Ellence | 1 | $ 55.89 | $ 0.56 | $ 0.56 | ||
| Eribulin mesylate 1mg | Halaven | 1 | $ 1,637.50 | $ 16.37 | $ 16.37 | ||
| Etoposide 100mg | Vepesid, VP-16, Toposar | 2679 | 32 | $ 11.34 | $ 0.11 | $ 3.63 | |
| Etoposide Phosphate 100mg | Etopophos | 1 | $ 203.91 | $ 2.04 | $ 2.04 | ||
| Famotidine 20mg | Famotidine | 1 | $ 1.06 | $ 0.01 | $ 0.01 | ||
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 88 | 2 | $ 3,170.72 | $ 31.71 | $ 63.41 | |
| Ferric carboxymaltose 750mg | Injectafer | 1 | $ 1,552.79 | $ 15.53 | $ 15.53 | ||
| Fludarabine 50mg | Fludara | 34 | 1 | $ 113.12 | $ 1.13 | $ 1.13 | |
| Fluorouracil 1g | Adrucil, 5-FU | 1 | $ 28.61 | $ 0.29 | $ 0.29 | ||
| Fluorouracil 500mg | Adrucil, 5-FU | 12888 | 154 | $ 15.90 | $ 0.16 | $ 24.49 | |
| Fluorouracil 5g | Adrucil, 5-FU | 1 | $ 68.58 | $ 0.69 | $ 0.69 | ||
| Fosaprepitant 150mg | Emend | 1 | $ 320.44 | $ 3.20 | $ 3.20 | ||
| Fulvestrant 250mg | Faslodex | 1 | $ 508.72 | $ 5.09 | $ 5.09 | ||
| Furosemide 20mg | Lasix | 1 | $ 5.01 | $ 0.05 | $ 0.05 | ||
| Ganciclovir 500mg | Cytovene | 1 | $ 81.87 | $ 0.82 | $ 0.82 | ||
| Gemcitabine 1g | Gemzar | 1 | $ 79.00 | $ 0.79 | $ 0.79 | ||
| Gemcitabine 200mg | Gemzar | 16553 | 198 | $ 52.67 | $ 0.53 | $ 104.28 | |
| Gentamicin Sulfate 80mg | Gentamicin | 1 | $ 1.68 | $ 0.02 | $ 0.02 | ||
| Idarubicin 10mg | Idamycin | 1 | $ 129.02 | $ 1.29 | $ 1.29 | ||
| Idarubicin 20mg | Idamycin | 12 | 1 | $ 247.72 | $ 2.48 | $ 2.48 | |
| Idarubicin 5mg | Idamycin | 1 | $ 64.51 | $ 0.65 | $ 0.65 | ||
| Ifosfamide 1g | Ifex | 1 | $ 43.98 | $ 0.44 | $ 0.44 | ||
| Ifosfamide 3g | Ifex | 11500 | 137 | $ 128.73 | $ 1.29 | $ 176.35 | |
| Infliximab 100mg | Remicade | 1 | $ 1,397.88 | $ 13.98 | $ 13.98 | ||
| Infliximab-abda 100mg | Renflexis | 1 | $ 901.81 | $ 9.02 | $ 9.02 | ||
| Infliximab-dyyb 100mg | Inflectra | 1 | $ 1,132.70 | $ 11.33 | $ 11.33 | ||
| Irinotecan 100mg | Camptosar | 2365 | 29 | $ 35.98 | $ 0.36 | $ 10.43 | |
| Irinotecan 40mg | Camptosar | 1 | $ 17.40 | $ 0.17 | $ 0.17 | ||
| Iron Sucrose 100mg | Venofer | 1 | $ 69.13 | $ 0.69 | $ 0.69 | ||
| Iron Sucrose 200mg | Venofer | 1 | $ 138.25 | $ 1.38 | $ 1.38 | ||
| LC Bead 100-300 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead 300-500 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead 70-150 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| LC Bead LUMI 40-90 | 1 | $ 1,806.72 | $ 18.07 | $ 18.07 | |||
| Leucovorin 100mg | 1 | $ 19.15 | $ 0.19 | $ 0.19 | |||
| Leucovorin 350mg | 1 | $ 83.79 | $ 0.84 | $ 0.84 | |||
| Liposomal Doxorubicin 20mg | Doxil | 1 | $ 793.61 | $ 7.94 | $ 7.94 | ||
| Liposomal Doxorubicin 50mg | Doxil | 1 | $ 2,015.75 | $ 20.16 | $ 20.16 | ||
| Liposomal Irinotecan 4.3mg | Onivyde | 1 | $ 3,310.90 | $ 33.11 | $ 33.11 | ||
| Lurbinectedin 4mg | Zepzelca | 271 | 4 | $ 9,372.51 | $ 93.73 | $ 374.90 | |
| Magnesium Sulfate 1g | 1 | $ 2.38 | $ 0.02 | $ 0.02 | |||
| Mepolizumab 100mg | Nucala | 1 | $ 3,905.46 | $ 39.05 | $ 39.05 | ||
| Mesna 1g | Mesnex | 1 | $ 23.94 | $ 0.24 | $ 0.24 | ||
| Methotrexate 1g | Rheumatrex, Trexall | 1 | $ 41.06 | $ 0.41 | $ 0.41 | ||
| Methotrexate 250mg | Rheumatrex, Trexall | 308 | 4 | $ 11.14 | $ 0.11 | $ 0.45 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 1 | $ 4.02 | $ 0.04 | $ 0.04 | ||
| Methylprednisolone 125mg | Solu-Medrol | 1 | $ 13.95 | $ 0.14 | $ 0.14 | ||
| Mitomycin 20mg | Mutamycin | 1 | $ 706.05 | $ 7.06 | $ 7.06 | ||
| Mitomycin 40mg | Mutamycin | 37 | 1 | $ 1,412.10 | $ 14.12 | $ 14.12 | |
| Mitomycin 5mg | Mutamycin | 1 | $ 271.78 | $ 2.72 | $ 2.72 | ||
| Mitoxantrone 25mg | Novantrone | 5 | 1 | $ 258.19 | $ 2.58 | $ 2.58 | |
| Mycophenolate mofetil 500mg | Cellcept | 1 | $ 129.25 | $ 1.29 | $ 1.29 | ||
| Nivolumab 100mg | Opdivo | 1 | $ 3,517.79 | $ 35.18 | $ 35.18 | ||
| Nivolumab 240mg | Opdivo | 1803 | 22 | $ 8,442.72 | $ 84.43 | $ 1,857.40 | |
| Nivolumab 40mg | Opdivo | 1 | $ 1,407.12 | $ 14.07 | $ 14.07 | ||
| Ocrelizumab 300mg | Ocrevus | 1 | $ 22,474.40 | $ 224.74 | $ 224.74 | ||
| Ondansetron 40mg | 1 | $ 5.98 | $ 0.06 | $ 0.06 | |||
| Ondansetron 4mg | 1 | $ 0.72 | $ 0.01 | $ 0.01 | |||
| Oxaliplatin 100mg | Eloxatin | 1952 | 24 | $ 423.32 | $ 4.23 | $ 101.60 | |
| Oxaliplatin 50mg | Eloxatin | 1 | $ 211.66 | $ 2.12 | $ 2.12 | ||
| Paclitaxel 300mg | Taxol | 1296 | 16 | $ 65.84 | $ 0.66 | $ 10.53 | |
| Paclitaxel 100mg | Taxol | 1 | $ 33.74 | $ 0.34 | $ 0.34 | ||
| Paclitaxel 30mg | Taxol | 1 | $ 11.97 | $ 0.12 | $ 0.12 | ||
| Paclitaxel Protein-Bound 100mg | Abraxane | 0 | 1 | $ 1,891.33 | $ 18.91 | $ 18.91 | |
| Paclitaxel Protein-Bound 100mg | 1087 | 13 | $ 1,796.76 | $ 17.97 | $ 233.58 | ||
| Palonosetron 0.25mg | 1 | $ 23.94 | $ 0.24 | $ 0.24 | |||
| Pamidronate 30mg | 1 | $ 32.32 | $ 0.32 | $ 0.32 | |||
| Pamidronate 90mg | 1 | $ 111.99 | $ 1.12 | $ 1.12 | |||
| Panitumumab 100mg | Vectibix | 1 | $ 1,878.64 | $ 18.79 | $ 18.79 | ||
| Panitumumab 400mg | Vectibix | 261 | 4 | $ 7,514.55 | $ 75.15 | $ 300.58 | |
| Pegasparagase 3,750 units | Oncaspar | 32 | 1 | $ 29,113.60 | $ 291.14 | $ 291.14 | |
| Pembrolizumab 100mg | Keytruda | 6261 | 75 | $ 6,268.74 | $ 62.69 | $ 4,701.55 | |
| Pemetrexed 100mg | Alimta | 1 | $ 967.90 | $ 9.68 | $ 9.68 | ||
| Pemetrexed 100mg | 1 | $ 179.55 | $ 1.80 | $ 1.80 | |||
| Pemetrexed 500mg | Alimta | 0 | 1 | $ 4,839.47 | $ 48.39 | $ 48.39 | |
| Pemetrexed 500mg | 1264 | 16 | $ 806.58 | $ 8.07 | $ 129.05 | ||
| Pentamidine Isethionate 300mg | Pentam | 1 | $ 180.05 | $ 1.80 | $ 1.80 | ||
| Pentostatin 10mg | Nipent | 1 | $ 2,919.56 | $ 29.20 | $ 29.20 | ||
| Pertuzumab 420mg | Perjeta | 27 | 1 | $ 7,585.01 | $ 75.85 | $ 75.85 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 80 | 1 | $ 4,245.09 | $ 42.45 | $ 42.45 | |
| Potassium Chloride 20meq | 1 | $ 2.40 | $ 0.02 | $ 0.02 | |||
| Pralatrexate 20mg | Folotyn | 1 | $ 8,124.66 | $ 81.25 | $ 81.25 | ||
| Pralatrexate 40mg | Folotyn | 26 | 1 | $ 16,249.32 | $ 162.49 | $ 162.49 | |
| Ramucirumab 100mg | Cyramza | 1 | $ 1,579.86 | $ 15.80 | $ 15.80 | ||
| Ramucirumab 500mg | Cyramza | 129 | 2 | $ 7,899.29 | $ 78.99 | $ 157.99 | |
| Risankizumab-rzaa 150mg | Skyrizi | 1 | $ 21,872.53 | $ 218.73 | $ 218.73 | ||
| Rituximab 100mg | Rituxan | 1 | $ 1,124.60 | $ 11.25 | $ 11.25 | ||
| Rituximab 500mg | Rituxan | 190 | 3 | $ 5,623.03 | $ 56.23 | $ 168.69 | |
| Rituximab-abbs 100mg | Truxima | 1 | $ 1,012.12 | $ 10.12 | $ 10.12 | ||
| Rituximab-abbs 500mg | Truxima | 1 | $ 5,060.62 | $ 50.61 | $ 50.61 | ||
| Rituximab-pvvr 100mg | Ruxience | 1 | $ 858.01 | $ 8.58 | $ 8.58 | ||
| Rituximab-pvvr 500mg | Ruxience | 1957 | 24 | $ 4,290.05 | $ 42.90 | $ 1,029.61 | |
| Romidepsin 10mg | Istodax | 2 | 1 | $ 3,828.79 | $ 38.29 | $ 38.29 | |
| Sodium Chloride 0.9% 1000ml | 82 | 1 | $ 5.90 | $ 0.06 | $ 0.06 | ||
| Sodium Chloride 0.9% 100ml | 515 | 7 | $ 3.01 | $ 0.03 | $ 0.21 | ||
| Sodium Chloride 0.9% 250ml | 607 | 8 | $ 2.87 | $ 0.03 | $ 0.23 | ||
| Sodium Chloride 0.9% 500ml | 217 | 3 | $ 5.04 | $ 0.05 | $ 0.15 | ||
| Sterile Water 1000ml | 1 | $ 4.16 | $ 0.04 | $ 0.04 | |||
| Sterile Water 250ml | 1 | $ 2.62 | $ 0.03 | $ 0.03 | |||
| Sterile Water 500ml | 1 | $ 3.61 | $ 0.04 | $ 0.04 | |||
| Temsirolimus 25mg | Torisel | 1 | $ 1,906.18 | $ 19.06 | $ 19.06 | ||
| Topotecan 4mg | Hycamptin | 134 | 2 | $ 164.21 | $ 1.64 | $ 3.28 | |
| Trastuzumab 150mg | Herceptin | 1 | $ 1,865.43 | $ 18.65 | $ 18.65 | ||
| Trastuzumab-qyyp 420mg | Trazimera | 1 | $ 4,059.13 | $ 40.59 | $ 40.59 | ||
| Vancomycin 1g | Vancomycin | 1 | $ 6.01 | $ 0.06 | $ 0.06 | ||
| Vedolizumab 300mg | Entyvio | 1 | $ 9,786.69 | $ 97.87 | $ 97.87 | ||
| Vinblastine 10mg | Velban | 62 | 1 | $ 56.45 | $ 0.56 | $ 0.56 | |
| Vincristine 1mg | Oncovin | 1 | $ 19.32 | $ 0.19 | $ 0.19 | ||
| Vincristine 2mg | Oncovin | 298 | 4 | $ 16.74 | $ 0.17 | $ 0.67 | |
| Vinorelbine 50mg | Navelbine | 37 | 1 | $ 107.73 | $ 1.08 | $ 1.08 | |
| Zoledronic Acid 4mg | 1 | $ 836.19 | $ 8.36 | $ 8.36 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | 418 | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | VISN 10 CY 2023 Usage | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | 8755 | 1234 | $ 0.01 | $ 12.34 | |||
| Chemoembolic Mixing | 0 | 2 | $ 0.01 | $ 0.02 | |||
| Exact Volume Requirement | 0 | 2 | $ 0.01 | $ 0.02 | |||
| Intrathecal Mixing | 7 | 2 | $ 0.01 | $ 0.02 | |||
| STAT Order | 0 | 4 | $ 0.01 | $ 0.04 | |||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | 99% |
Total Sheet
| Base Period | Option Year 1 | Total | ||
| Total Price Medication (Less other) | $ 18,286.23 | $ 18,286.23 | $ 36,572.45 | |
| Total Price Fees (Less Supplies) | $ 12.44 | $ 12.44 | $ 24.88 | |
| Total | $ 18,298.67 | $ 18,298.67 | $ 36,597.33 |
File details come from the government source that posted it. Updated .