ATTACHMENT E - REPORTING TOOL - NX EQ PATIENT SCALES.xlsx

XLSX spreadsheet 41 KB Posted Dec 5, 2023

Attached to: 6515--NX Patient Scales (VA-23-00012823)
Solicitation number: 36C10G24Q0020
Issued by: Department of Veterans Affairs Headquarters

About this file

Written by GovTribe AI · Dec 21, 2023

This document contains a reporting template for a federal contract to supply patient scales to various VA medical centers. The contractor must provide quarterly reports using the template to detail the number of each item sold to each VISN and facility. There are 23 line items representing different VA networks and over 100 individual facilities requiring scales. The contractor must report the quantity of each item sold to each location, along with total quarterly and cumulative sales figures calculated with and without the SLA fee. The related federal contract opportunity provides additional context, with a solicitation number of 36C10G24Q0020 to supply 6515 NX Patient Scales for the VA, as issued by the Department of Veterans Affairs Headquarters.

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Other files

File	Type	Posted
ATTACHMENT C - CONTRACT CLAUSES - NX EQ PATIENT SCALES.docx	DOCX document	Dec 5, 2023
ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ PATIENT SCALES.docx	DOCX document	Dec 5, 2023
ATTACHMENT A - PRICE COST SCHEDULE - NX EQ PATIENT SCALES.xlsx	XLSX spreadsheet	Dec 5, 2023
ATTACHMENT B - CONTRACT ADMINISTRATION - NX EQ PATIENT SCALES.docx	DOCX document	Dec 5, 2023
36C10G24Q0020.docx	DOCX document	Dec 5, 2023

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Sheet2

11	7	9	32	6	6	9	20		30	10	10	25	25		14	26	13	21	11	15		7	5	5	7	10	5	10	18	26	7		31	15	21	33		5	16	7	12	11	21	14	14		18	16	14
1	1	1	1	1	1	1	1		2	2	2	2	2		3	3	3	3	3	3		4	4	4	4	4	4	4	4	4	4		5	5	5	5		6	6	6	6	6	6	6	6		7	7	7
402	405	518	523	608	631	650	689		528	528A5	528 A6	528A7	528 A8		526	561	620	630	630A4	632		460	503	529	540	542	562	595	642	646	693		512	512A5	613	688		517	558	565	590	637	652	658	659		508	509	521
Togus	White River Jct	Bedford	Boston (Roxbury and Brockton)	Manchester	Northhampton	Providence	VA Connecticut (Newington)	1	Buffalo (Batavia)	Canadaigua	Bath	Syracuse	Albany	2	Bronx	VA New Jersey (Lyons and East Orange)	VA Hudson Valley (CastlePoint and Montrose)	New York	Brooklyn	Northport	3	Wilmington	Altoona	Butler	Clarksburg	Coatesville	Erie	Lebanon	Philadelphia	VA Pittsburgh (Pittsburgh HD)	VAMC Wilkes-Barre	4	VA Maryland	Perry Point	Martinsburg	Washington	5	Beckley	Durham	Fayetteville	Hampton	Asheville	Richmond	Salem	Salisbury	6	Atlanta	Augusta	Birmingham (posted stock purchased and reported by Tuscaloosa)

Sheet3

Contractor

Contract Number:

Reporting Quarter: __ QTR FY 2023		Line Item(s)	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22
		CLIN Number:
		Description/Salient Characteristics
		Contract/Part Number:
		Price Inclusive of SLA Fee:
VISN	FACILITY	VA New England Healthcare System	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item	Quantity Sold of Item
1	402	Togus
1	405	White River Jct
1	518	Bedford
1	523	Boston (Roxbury and Brockton)
1	608	Manchester
1	631	Northampton
1	650	Providence
1	523	Jamaica Plain
1	689	VA Connecticut (Newington & West Haven)
New York/New Jersey VA Health Care Network
2	528	Buffalo (Batavia)
2	528A5	Canandaigua
2	528 A6	Bath
2	528A7	Syracuse
2	528 A8	Albany
2	526	Bronx
2	561	VA New Jersey (Lyons and East Orange)
2	620	VA Hudson Valley (Castle Point and Montrose)
2	630	New York
2	630A4	Brooklyn
2	632	Northport
VA Pittsburgh Healthcare System
4	460	Wilmington
4	503	Altoona
4	529	Butler
4	542	Coatesville
4	562	Erie
4	595	Lebanon
4	642	Philadelphia
4	646	VA Pittsburgh (Pittsburgh HD)
4	693	VAMC Wilkes-Barre
VA Capitol Health Care Network
5	512	VA Maryland
6	517	Beckley
5	512A5	Perry Point
5	512GB	Loch Raven
5	540	Clarksburg
5	581	Hershel
5	613	Martinsburg
5	688	Washington
VA Mid-Atlantic Health Care Network
6	558	Durham
6	565	Fayetteville
6	590	Hampton
6	637	Asheville
6	652	Richmond
6	658	Salem
6	659	Salisbury
VA Southeast Network
7	508	Atlanta
7	509	Augusta
7	521	Birmingham (posted stock purchased and reported by Tuscaloosa)
7	534	Charleston
7	544	Columbia
7	557	Dublin
7	619	CAVHCS ( Tuskegee and Montgomery)
7	679	Tuscaloosa
VA Sunshine Healthcare Network
8	516	Bay Pines
8	546	Miami
8	548	West Palm Beach
8	573	NF/SGVHS
8	672	San Juan
8	675	Orlando
8	673	Tampa and Annex
VA MidSouth Healthcare Network
9	581	Huntington
9	596	Lexington
9	603	Louisville
9	614	Memphis
9	621	Mountain Home
9	626	VA Tennessee
VA Health Care System
10	538	Chillicothe
10	539	Cincinnati
10	541	Cleveland
10	552	Dayton
10	757	Columbus
10	506	Ann Arbor
10	515	Battle Creek
10	550	Danville
10	553	Detroit
10	583	Indianapolis
10	610	VA Northern Indiana
10	655	Saginaw
VA Great Lakes Health Care System
12	537	VA Chicago Healthcare
12	556	North Chicago
12	578	Hines
12	550	Danville
12	585	Iron Mountain
12	607	Madison
12	676	Tomah
12	695	Milwaukee
VA Heartland Network
15	452	Wichita
15	543	Columbia
15	589	Kansas City
15	609	Marion
15	647	Poplar Bluff
15	657	St. Louis
15	677	VA Eastern Kansas ( Leavenworth)
South Central VA Health Care Network
16	502	Alexandria
16	520	VA Gulf Coast
16	564	Fayetteville
16	580	Houston
16	586	Jackson
16	598	Central Arkansas
16	623	Muskogee
16	629	New Orleans
16	635	Oklahoma City
16	667	Shreveport
VA Heart of Texas Health Care Network
17	549	North Texas (Dallas and Bonham)
17	504	Amarillo
17	671	South Texas ( San Antonio and Kerrville)
17	756	El Paso
17	519	Big Spring
17	740	Harlingen
17	674	Central Texas ( Temple, Waco and Marlin)

Rocky Mountain Network
19	442	Cheyenne
19	554	Denver
19	567	Southern Colorado
19	575	Grand Junction
19	623	Muskogee
19	666	Sheridan
Northwest Network
20	463	Alaska
20	531	Boise
20	648	Portland
20	653	Roseburg
20	663	VA Puget Sound ( Seattle and American Lake)
20	668	Spokane
20	687	Walla Walla
20	692	White City
Sierra Pacific Network
21	358	Manila
21	459	Honolulu
21	570	C. California
21	612	N. California
21	640	Palo Alto (Livermore)
21	654	Sierra Nevada
21	662	San Francisco
Desert Pacific Healthcare Network
22	593	Southern Nevada
22	501	Albuquerque
22	600	Long Beach
22	605	Loma Linda
22	664	San Diego
22	504	Amarillo
22	519	West Texas
22	644	Phoenix
22	649	Northern Arizona (Prescott)
22	678	Southern Arizona (Tucson)
22	756	El Paso
22	691	Greater Los Angeles ( Sepulveda and Los Angeles)
VA Midwest Health Care Network
23	437	Fargo
23	438	Sioux Falls
23	568	BHHCS (Black Hills and Hot Springs)
23	618	Minneapolis
23	656	St Cloud
23	636	NWIHCS (Omaha, Grand Island and Lincoln)
23	636A4	Grand Island
23	636 A6	CIHCS ( DM & Knx)
23	636 A8	Iowa City

Total Quarterly Quantity Sold	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
Total Quantity Sold of All Items	0
Total Quarterly Quantity Sold x Price	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Total Quarterly Sales inclusive of the SLA	$0.00
Anticipated SLA	$0.00
Total Sales amount without the SLA(Figure uploaded in Pay.gov)	$0.00
SLA Received (For HINES FISCAL ONLY)

&"Arial,Bold"&11 36C10G24Q0020

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File details come from the government source that posted it. Updated Dec 5, 2023.