3 - Attach 1 - Sample Infant Formula Rebate Invoice 092017~2.pdf

26 KB Posted

Attached to
T1057 - WIC Infant Formula Rebate:DOH
Solicitation number
18DPP00157
Issued by
New Jersey

About this file

Written by GovTribe AI ·

This document is a series of three monthly Infant Formula Rebate Invoices issued by the State of New Jersey Department of Health. The invoices detail the infant formula rebate amounts and participation for the state's WIC (Women, Infants, and Children) program. The invoices cover the months of November 2016, December 2016, and January 2017, and include data on the number of cans redeemed, the number of participating infants, and the total rebate amounts for various Enfamil infant formula products.

The related state and local contract opportunity is for the T1057 - WIC Infant Formula Rebate program, which covers the state of New Jersey and specifically the jurisdiction of Mercer County. The contract is for the provision of infant formula rebates to the state's WIC program. Key details include the rebate amounts per can for different formula products, the total number of cans redeemed and rebate amounts paid out over the three-month period, and the average number of participating infants per month.

View the file

Other files

File Type Posted
6 - T1057 Offer and Acceptance Page 092017.pdf PDF
1 - T1057 WIC Rebate RFP 092017.pdf PDF
8 - T1057 Vendor Checklist w source 092017.pdf PDF
4 - Attach 4_Sample Checks 110317~2.pdf PDF
5 - Attach 3_WIC Services Policy and Procedure Manual 092017~2.pdf PDF
5 - Attach 5_ Updated WIC Nutritionals 110317a.pdf PDF
2 - T1057 Revised Price Sheet 110317.xlsx XLSX spreadsheet
0 - T1057 BA_1 QA 110317.pdf PDF
6 - Attach 6_ Infant Participation by Product 110317.xlsx XLSX spreadsheet
7 - T1057 Vendor Bidder Data Sheet 092017~1.docx DOCX document
1 - T1057 REVISED WIC Rebate RFP 110317.pdf PDF
3 - T0725 Updated Attach 1 - 110317.pdf PDF
4 - Attach 2_State WIC Retailer List 092017~2.pdf PDF
2 - T1057 Price Schedule_Infant Formula Rebate Tab Sheet 092017~1.xlsx XLSX spreadsheet
Show all 14

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 12/07/2016

INVOICE # 201611 RUN TIME: 1:00:44FORMULA REBATES

CHECKS CASHED IN NOVEMBER 2016 PAGE: 1

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Prosobee 13 oz Concentrate Rebate amount per can 4.0345

ISSUE MONTH NOVEMBER 1,249 99 54 5,039.0905 23

30-DAY MONTH OCTOBER 1,027 80 48 4,143.4315 21____________________ _____________ _____________ ____________ _________________ T O T A L 2,276 179 102 9,182.5220

Enfamil Prosobee 12.9 oz Powder Rebate amount per can 15.8490

ISSUE MONTH NOVEMBER 8,028 2,037 1,225 127,235.7720 7

30-DAY MONTH OCTOBER 5,852 1,467 988 92,748.3480 6

CLOSEOUT MONTH SEPTEMBER 470 121 97 7,449.0300 5____________________ _____________ _____________ ____________ _________________ T O T A L 14,350 3,625 2,310 227,433.1500

Enfamil Prosobee 32 oz Ready to Use Rebate amount per can 3.6000

ISSUE MONTH NOVEMBER 12 1 1 43.2000 12____________________ _____________ _____________ ____________ _________________ T O T A L 12 1 1 43.2000

Enfamil Infant 13 oz Concentrate Rebate amount per can 4.1012

ISSUE MONTH NOVEMBER 7,783 607 338 31,919.6396 23

30-DAY MONTH OCTOBER 5,482 427 252 22,482.7784 22

CLOSEOUT MONTH SEPTEMBER 112 8 5 459.3344 22____________________ _____________ _____________ ____________ _________________ T O T A L 13,377 1,042 595 54,861.7524

Enfamil Infant 12.5 oz Powder Rebate amount per can 14.4742

DECEMBER 9 2 1 130.2678 9

ISSUE MONTH NOVEMBER 76,456 19,202 11,148 1,106,639.4352 7

30-DAY MONTH OCTOBER 47,981 12,064 7,462 694,486.5902 6

CLOSEOUT MONTH SEPTEMBER 1,818 457 321 26,314.0956 6____________________ _____________ _____________ ____________ _________________ T O T A L 126,264 31,725 18,932 1,827,570.3888

Enfamil Infant 32 oz Ready to Use Rebate amount per can 3.5550

ISSUE MONTH NOVEMBER 482 43 27 1,713.5100 18

30-DAY MONTH OCTOBER 363 31 23 1,290.4650 16____________________ _____________ _____________ ____________ _________________ T O T A L 845 74 50 3,003.9750

Attachment #1 - Sample Infant Formula Rebate Invoice

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 12/07/2016

CHECKS CASHED IN NOVEMBER 2016 PAGE: 2

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Gentlease 12.4 oz Powder Rebate amount per can 15.0008

ISSUE MONTH NOVEMBER 29,117 7,156 4,063 436,778.2936 7

30-DAY MONTH OCTOBER 17,665 4,339 2,645 264,989.1320 7

CLOSEOUT MONTH SEPTEMBER 575 146 96 8,625.4600 6____________________ _____________ _____________ ____________ _________________ T O T A L 47,357 11,641 6,804 710,392.8856

Enfamil Gentlease 32-oz Ready-to-Use Rebate amount per can 3.4050

ISSUE MONTH NOVEMBER 850 82 52 2,894.2500 16

30-DAY MONTH OCTOBER 535 49 36 1,821.6750 15____________________ _____________ _____________ ____________ _________________ T O T A L 1,385 131 88 4,715.9250

8oz (6 packs) Prosobee Ready to Use Rebate amount per can 6.7330

ISSUE MONTH NOVEMBER 33 5 3 222.1890 11

30-DAY MONTH OCTOBER 18 3 2 121.1940 9____________________ _____________ _____________ ____________ _________________ T O T A L 51 8 5 343.3830

8oz (6 packs) Enfamil AR Ready to Use Rebate amount per can 6.7330

ISSUE MONTH NOVEMBER 8 3 2 53.8640 4

30-DAY MONTH OCTOBER 8 4 2 53.8640 4____________________ _____________ _____________ ____________ _________________ T O T A L 16 7 4 107.7280

Enfamil AR 12.9 oz Powder Rebate amount per can 15.3455

ISSUE MONTH NOVEMBER 1,806 454 268 27,713.9730 7

30-DAY MONTH OCTOBER 1,237 300 190 18,982.3835 7

CLOSEOUT MONTH SEPTEMBER 35 8 6 537.0925 6____________________ _____________ _____________ ____________ _________________ T O T A L 3,078 762 464 47,233.4490

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 12/07/2016

CHECKS CASHED IN NOVEMBER 2016 PAGE: 3

STATE TOTALS

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________

OTHER MONTH DECEMBER 9 2 1 130.2678 9____________________ _____________ _____________ ____________ _________________

T O T A L OTHER MONTHS 9 2 1 130.2678

ISSUE MONTH NOVEMBER 125,824 29,689 17,181 1,740,253.2169 7

30-DAY MONTH OCTOBER 80,168 18,764 11,648 1,101,119.8616 7

CLOSEOUT MONTH SEPTEMBER 3,010 740 525 43,385.0125 6____________________ _____________ _____________ ____________ _________________

T O T A L EXCLUDING OTHER MONTHS 209,002 49,193 29,354 2,884,758.0910

T O T A L INCLUDING OTHER MONTHS 209,011 49,195 29,355 2,884,888.3588

*** END OF LISTING ***

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 1/05/2017

INVOICE # 201612 RUN TIME: 0:59:48FORMULA REBATES

CHECKS CASHED IN DECEMBER 2016 PAGE: 1

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Prosobee 13 oz Concentrate Rebate amount per can 4.0345

ISSUE MONTH DECEMBER 1,374 110 58 5,543.4030 24

30-DAY MONTH NOVEMBER 1,005 81 46 4,054.6725 22____________________ _____________ _____________ ____________ _________________ T O T A L 2,379 191 104 9,598.0755

Enfamil Prosobee 12.9 oz Powder Rebate amount per can 15.8490

ISSUE MONTH DECEMBER 8,161 2,057 1,234 129,343.6890 7

30-DAY MONTH NOVEMBER 5,218 1,299 861 82,700.0820 6

CLOSEOUT MONTH OCTOBER 208 53 42 3,296.5920 5____________________ _____________ _____________ ____________ _________________ T O T A L 13,587 3,409 2,137 215,340.3630

Enfamil Prosobee 32 oz Ready to Use Rebate amount per can 3.6000

ISSUE MONTH DECEMBER 14 1 1 50.4000 14____________________ _____________ _____________ ____________ _________________ T O T A L 14 1 1 50.4000

Enfamil Infant 13 oz Concentrate Rebate amount per can 4.1012

ISSUE MONTH DECEMBER 7,626 597 321 31,275.7512 24

30-DAY MONTH NOVEMBER 5,393 422 246 22,117.7716 22

CLOSEOUT MONTH OCTOBER 139 11 8 570.0668 17____________________ _____________ _____________ ____________ _________________ T O T A L 13,158 1,030 575 53,963.5896

Enfamil Infant 12.5 oz Powder Rebate amount per can 14.4742

ISSUE MONTH DECEMBER 77,065 19,331 11,216 1,115,454.2230 7

30-DAY MONTH NOVEMBER 45,998 11,515 7,142 665,784.2516 6

CLOSEOUT MONTH OCTOBER 1,706 422 295 24,692.9852 6____________________ _____________ _____________ ____________ _________________ T O T A L 124,769 31,268 18,653 1,805,931.4598

Enfamil Infant 32 oz Ready to Use Rebate amount per can 3.5550

ISSUE MONTH DECEMBER 578 50 31 2,054.7900 19

30-DAY MONTH NOVEMBER 338 30 22 1,201.5900 15____________________ _____________ _____________ ____________ _________________ T O T A L 916 80 53 3,256.3800

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 1/05/2017

CHECKS CASHED IN DECEMBER 2016 PAGE: 2

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Gentlease 12.4 oz Powder Rebate amount per can 15.0008

ISSUE MONTH DECEMBER 29,261 7,209 4,084 438,938.4088 7

30-DAY MONTH NOVEMBER 17,365 4,250 2,594 260,488.8920 7

CLOSEOUT MONTH OCTOBER 497 124 85 7,455.3976 6____________________ _____________ _____________ ____________ _________________ T O T A L 47,123 11,583 6,763 706,882.6984

Enfamil Gentlease 32-oz Ready-to-Use Rebate amount per can 3.4050

ISSUE MONTH DECEMBER 765 71 48 2,604.8250 16

30-DAY MONTH NOVEMBER 552 49 34 1,879.5600 16____________________ _____________ _____________ ____________ _________________ T O T A L 1,317 120 82 4,484.3850

8oz (6 packs) Prosobee Ready to Use Rebate amount per can 6.7330

ISSUE MONTH DECEMBER 39 6 4 262.5870 10

30-DAY MONTH NOVEMBER 19 3 2 127.9270 10____________________ _____________ _____________ ____________ _________________ T O T A L 58 9 6 390.5140

8oz (6 packs) Enfamil AR Ready to Use Rebate amount per can 6.7330

ISSUE MONTH DECEMBER 6 3 1 40.3980 6

30-DAY MONTH NOVEMBER 3 1 1 20.1990 3____________________ _____________ _____________ ____________ _________________ T O T A L 9 4 2 60.5970

Enfamil AR 12.9 oz Powder Rebate amount per can 15.3455

ISSUE MONTH DECEMBER 1,979 486 285 30,368.7445 7

30-DAY MONTH NOVEMBER 1,191 290 179 18,276.4905 7

CLOSEOUT MONTH OCTOBER 35 9 6 537.0925 6____________________ _____________ _____________ ____________ _________________ T O T A L 3,205 785 470 49,182.3275

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 1/05/2017

CHECKS CASHED IN DECEMBER 2016 PAGE: 3

STATE TOTALS

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________

ISSUE MONTH DECEMBER 126,868 29,921 17,283 1,755,937.2195 7

30-DAY MONTH NOVEMBER 77,082 17,940 11,127 1,056,651.4362 7

CLOSEOUT MONTH OCTOBER 2,585 619 436 36,552.1341 6____________________ _____________ _____________ ____________ _________________

T O T A L EXCLUDING OTHER MONTHS 206,535 48,480 28,846 2,849,140.7898

T O T A L INCLUDING OTHER MONTHS 206,535 48,480 28,846 2,849,140.7898

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 2/08/2017

INVOICE # 201701 RUN TIME: 1:52:40FORMULA REBATES

CHECKS CASHED IN JANUARY 2017 PAGE: 1

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Prosobee 13 oz Concentrate Rebate amount per can 4.0345

ISSUE MONTH JANUARY 1,296 106 54 5,228.7120 24

30-DAY MONTH DECEMBER 851 69 37 3,433.3595 23____________________ _____________ _____________ ____________ _________________ T O T A L 2,147 175 91 8,662.0715

Enfamil Prosobee 12.9 oz Powder Rebate amount per can 15.8490

ISSUE MONTH JANUARY 8,573 2,155 1,309 135,873.4770 7

30-DAY MONTH DECEMBER 5,063 1,263 849 80,243.4870 6

CLOSEOUT MONTH NOVEMBER 152 37 26 2,409.0480 6____________________ _____________ _____________ ____________ _________________ T O T A L 13,788 3,455 2,184 218,526.0120

Enfamil Prosobee 32 oz Ready to Use Rebate amount per can 3.6000

ISSUE MONTH JANUARY 14 1 1 50.4000 14____________________ _____________ _____________ ____________ _________________ T O T A L 14 1 1 50.4000

Enfamil Infant 13 oz Concentrate Rebate amount per can 4.1012

ISSUE MONTH JANUARY 7,755 601 333 31,804.8060 23

30-DAY MONTH DECEMBER 4,419 341 196 18,123.2028 23

CLOSEOUT MONTH NOVEMBER 165 13 11 676.6980 15____________________ _____________ _____________ ____________ _________________ T O T A L 12,339 955 540 50,604.7068

Enfamil Infant 12.5 oz Powder Rebate amount per can 14.4742

ISSUE MONTH JANUARY 82,126 20,595 11,883 1,188,708.1492 7

30-DAY MONTH DECEMBER 45,630 11,377 7,062 660,457.7460 6

CLOSEOUT MONTH NOVEMBER 1,610 405 279 23,303.4620 6____________________ _____________ _____________ ____________ _________________ T O T A L 129,366 32,377 19,224 1,872,469.3572

Enfamil Infant 32 oz Ready to Use Rebate amount per can 3.5550

ISSUE MONTH JANUARY 576 50 29 2,047.6800 20

30-DAY MONTH DECEMBER 330 29 21 1,173.1500 16____________________ _____________ _____________ ____________ _________________ T O T A L 906 79 50 3,220.8300

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 2/08/2017

CHECKS CASHED IN JANUARY 2017 PAGE: 2

STATE

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________ Enfamil Gentlease 12.4 oz Powder Rebate amount per can 15.0008

ISSUE MONTH JANUARY 32,004 7,861 4,432 480,085.6032 7

30-DAY MONTH DECEMBER 17,179 4,195 2,548 257,698.7432 7

CLOSEOUT MONTH NOVEMBER 471 116 77 7,065.3768 6____________________ _____________ _____________ ____________ _________________ T O T A L 49,654 12,172 7,057 744,849.7232

Enfamil Gentlease 32-oz Ready-to-Use Rebate amount per can 3.4050

ISSUE MONTH JANUARY 964 86 55 3,282.4200 18

30-DAY MONTH DECEMBER 621 55 41 2,114.5050 15

CLOSEOUT MONTH NOVEMBER 20 2 1 68.1000 20____________________ _____________ _____________ ____________ _________________ T O T A L 1,605 143 97 5,465.0250

8oz (6 packs) Prosobee Ready to Use Rebate amount per can 6.7330

ISSUE MONTH JANUARY 39 7 4 262.5870 10

30-DAY MONTH DECEMBER 18 3 3 121.1940 6____________________ _____________ _____________ ____________ _________________ T O T A L 57 10 7 383.7810

8oz (6 packs) Enfamil AR Ready to Use Rebate amount per can 6.7330

ISSUE MONTH JANUARY 14 6 4 94.2620 4

30-DAY MONTH DECEMBER 12 4 2 80.7960 6____________________ _____________ _____________ ____________ _________________ T O T A L 26 10 6 175.0580

Enfamil AR 12.9 oz Powder Rebate amount per can 15.3455

ISSUE MONTH JANUARY 2,153 527 311 33,038.8615 7

30-DAY MONTH DECEMBER 1,152 287 179 17,678.0160 6

CLOSEOUT MONTH NOVEMBER 30 7 4 460.3650 8____________________ _____________ _____________ ____________ _________________ T O T A L 3,335 821 494 51,177.2425

REPORT: NJFM100I-R01 STATE OF NEW JERSEY - DEPARTMENT OF HEALTH RUN DATE: 2/08/2017

CHECKS CASHED IN JANUARY 2017 PAGE: 3

STATE TOTALS

PARTICIPATION # OF CANS # OF FI # OF REBATE AVG # REDEEMED CANS

DESCRIPTION_________________________ MONTH_____________ REDEEMED_____________ REDEEMED_____________ PARTICIPANTS____________ AMOUNT_________________ PER PARTICIPANT_______________

ISSUE MONTH JANUARY 135,514 31,995 18,415 1,880,476.9579 7

30-DAY MONTH DECEMBER 75,275 17,623 10,938 1,041,124.1995 7

CLOSEOUT MONTH NOVEMBER 2,448 580 398 33,983.0498 6____________________ _____________ _____________ ____________ _________________

T O T A L EXCLUDING OTHER MONTHS 213,237 50,198 29,751 2,955,584.2072

T O T A L INCLUDING OTHER MONTHS 213,237 50,198 29,751 2,955,584.2072

November 2016 Infant Formula Rebate Invoice
December 2016 Infant Formula Rebate Invoice
January 2017 Infant Formula Rebate Invoice

File details come from the government source that posted it. Updated .