The file's text, extracted by GovTribe without its formatting.
36C24618R0507
PAGE 1 OF
1. REQUISITION NO.
2. CONTRACT NO.
3. AWARD/EFFECTIVE DATE
4. ORDER NO.
5. SOLICITATION NUMBER
6. SOLICITATION ISSUE DATE
a. NAME
b. TELEPHONE NO. (No Collect Calls)
8. OFFER DUE DATE/LOCAL
TIME
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
UNRESTRICTED OR
SET ASIDE:
% FOR:
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS
(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS:
SIZE STANDARD:
11. DELIVERY FOR FOB DESTINA-
TION UNLESS BLOCK IS
MARKED
SEE SCHEDULE
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER
DPAS (15 CFR 700)
13b. RATING
14. METHOD OF SOLICITATION
RFQ
IFB
RFP
15. DELIVER TO
CODE
16. ADMINISTERED BY
CODE
17a. CONTRACTOR/OFFEROR
CODE
FACILITY CODE
18a. PAYMENT WILL BE MADE BY
CODE
TELEPHONE NO.
DUNS:
DUNS+4:
PHONE:
FAX:
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED
SEE ADDENDUM
19.
20.
21.
22.
23.
24.
ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED.
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________
29. AWARD OF CONTRACT: REF. ___________________________________ OFFER
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND
DATED ________________________________. YOUR OFFER ON SOLICITATION
DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED
SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 2/2012)
PREVIOUS EDITION IS NOT USABLE
Prescribed by GSA - FAR (48 CFR) 53.212
7. FOR SOLICITATION
INFORMATION CALL:
STANDARD FORM 1449
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
36C24618R0507 -2018 Mario L Santiago , Contracting Specialist 757-251-4254 -2018
4:00 PM EST
Marchelle Peyton Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 X X 532283 $32.5 Million Net 30 X N/A X Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667
Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971 The Department of Veterans Affairs Medical Center, VISN 6, has a need for a Contractor to provide Home Oxygen Services to all beneficiaries serviced by VISN 6. The Contractor shall provide all supplies, materials, equipment, transportation, equipment rental, labor, supervision, patient education, safety management, and infection control as necessary for patients on Home Respiratory Therapy.
These services will be required 24 hours a day, 7 days a week, including holidays.
See Attached Schedule Pages.
This Request For Proposal (RFP) is a Service Disabled Veteran Owned Small Business (SDVOSB) / Veteran Owned Small Business (VOSB) Set-Aside type solicitation.
X X X Marchelle Peyton Contracting Officer Table of Contents
| SECTION A | 1 |
| A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS | 1 |
| SECTION B - CONTINUATION OF SF 1449 BLOCKS | 4 |
| B.1 CONTRACT ADMINISTRATION DATA | 4 |
| B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) | 5 |
| B.3 SCHEDULE OF SUPPLIES OR SERVICES | 6 |
| B.4 PERFORMANCE WORK STATEMENT | 48 |
| B.5 SPECIAL CONTRACT REQUIREMENTS | 78 |
| SECTION C - CONTRACT CLAUSES | 97 |
| C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN 2017) | 97 |
| C.2 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) | 104 |
| C.3 52.216-18 ORDERING (OCT 1995) | 104 |
| C.4 52.216-19 ORDER LIMITATIONS (OCT 1995) | 105 |
| C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995) | 105 |
| C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) | 106 |
| C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) | 106 |
| C.8 SUPPLEMENTAL INSURANCE REQUIREMENTS | 106 |
| C.9 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) | 107 |
| C.10 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) | 107 |
| C.11 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) | 107 |
| C.12 VAAR 852.211-73 BRAND NAME OR EQUAL (JAN 2008) | 107 |
| C.13 852.219-10 VA NOTICE OF TOTAL SERVICE-DISABLED VETERAN-OWNED SMALL BUSINESS SET-ASIDE (JUL 2016) (DEVIATION) | 108 |
| C.14 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) | 110 |
| C.15 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) | 111 |
| C.16 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) | 112 |
| C.17 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (JAN 2018) | 112 |
| C.18 MANDATORY WRITTEN DISCLOSURES | 120 |
| SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS | 121 |
| D.1 ATTACHMENT A - GLOSSARY OF ACRONYMS/DEFINITIONS | 121 |
| D.2 ATTACHMENT B – FACILITY AND COR LISTING | 124 |
| D.3 ATTACHMENT C – Quality Assurance Surveillance Plan (QASP) | 125 |
| D.4 ATTACHMENT D - GEOGRAPHICAL AREAS OF COVERAGE | 139 |
| D.5 ATTACHMENT E - PAST PERFORMANCE QUESTIONNAIRE | 141 |
| D.6 ATTACHMENT F --- CONTRACTOR CERTIFICATION: IMMIGRATION AND NATIONALITY ACT OF 1952, AS AMENDED | 146 |
| D.7 ATTACHMENT G – DEPARTMENT OF LABOR WAGE DETERMINATION | 147 |
| D.8 ATTACHMENT H - VA CONTRACTOR RULES OF BEHAVIOR | 148 |
| D.9 ATTACHMENT I - ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008) | 152 |
| SECTION E - SOLICITATION PROVISIONS | 154 |
| E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017) | 154 |
| E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) | 158 |
E.3 SPECIFIC INSTRUCTIONS TO OFFERORS REGARDING PROPOSAL PREPARATION
SUBMISSION…………………………………………………………………………………..159
| E.4 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (FEB 2013) | 160 |
| E.5 52.216-1 TYPE OF CONTRACT (APR 1984) | 161 |
| E.6 52.233-2 SERVICE OF PROTEST (SEP 2006) | 162 |
| E.7 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008) | 162 |
| E.8 VAAR 852.211-72 TECHNICAL INDUSTRY STANDARDS (JAN 2008) | 163 |
| E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) | 163 |
| E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) | 164 |
| E.11 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) | 164 |
| E.12 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) | 164 |
| E.13 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003) | 165 |
| E.14 52.212-2 EVALUATION—COMMERCIAL ITEMS (OCT 2014) | 165 |
| E.15 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (NOV 2017) | 168 |
36C246-18-R-0507
SECTION B - CONTINUATION OF SF 1449 BLOCKS
B.1 CONTRACT ADMINISTRATION DATA
(continuation from Standard Form 1449, block 18A.)
1. Contract Administration: All contract administration matters will be handled by the following individuals:
a. CONTRACTOR:
b. GOVERNMENT: Marchelle Peyton Contracting Officer 36C246 Department of Veterans Affairs Network Contracting Office 6 100 Emancipation Drive Hampton VA 23667
2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:
[X] 52.232-33, Payment by Electronic Funds Transfer - System For Award Management, or
[] 52.232-36, Payment by Third Party
3. INVOICES: Invoices shall be submitted in arrears:
a. Quarterly []
b. Semi-Annually []
c. Other [X] Monthly in Arrears
4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address:
Department of Veterans Affairs Financial Services Center P.O. Box 149971 Austin TX 78714-9971
ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:
B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)
This solicitation includes FAR 52.219-14 Limitations on Subcontracting. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.
B.3 SCHEDULE OF SUPPLIES OR SERVICES
The Government intends to award a Firm Fixed-Price Indefinite-Delivery Indefinite-Quantity (FFP-IDIQ) type single award contract for the services specified, effective for the periods stated in the Schedule. All contract quantities are estimates only. However, the government is not obligated nor is the contractor guaranteed to be issued orders totaling the estimated quantities.
The guaranteed minimum order amount will be set at 100 orders per year, with a single item maximum order amount of $25,000.00 or a single order amount with multiple items set at $100,000.00 per order respectively.
The guaranteed maximum contract quantity, including the base year and any option years exercised, shall not exceed 50,250 orders with a single item maximum order amount of $25,000.00 per single order and a single order with multiple items at the maximum amount of $100,000.00 per order respectively.
In order to be eligible for a single award, an offeror must provide pricing for the base year and all four (4) option years for all of the facilities in the areas being proposed. Since a single award may be issued based on initial proposals received and without conducting discussions, an offeror who fails to provide all required pricing in its initial proposal may not be eligible for award.
To ensure uninterrupted timely delivery of Home Oxygen Services to VISN 6 Veteran beneficiaries, a transition period from 1 January 2019 through 31 March 2019 will be established to obtain warehouse space, hire personnel, inventory/replace equipment and to transfer Beneficiary information. Contract awardee(s) will be required to work with the incumbent contractor during this period to insure a smooth and orderly transition from the current contract to the new contract(s).
This Contract type is a single award Firm Fixed Price, Indefinite Quantity, Indefinite Delivery. (FFP) / (IDIQ). Contractors shall price base and option year (s) for all facilities listed.
* The guaranteed minimum order stated above will be issued by be authorized by the Ordering Officer representative for each Facility via a Task Orders for oxygen delivery services at time of contract award. *
BASE YEAR
Period of Performance – 01 Jan 2019 through 30 Sept 2019
AREA # 1 (LOCATIONS A & B)
CLIN
Item Description
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 0001 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
8,676
EA
| 0002 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0003 |
| Missed Patient Visit/Patient Refusal at Home |
| 36 |
| EA |
| $ ______ |
| $ ______ |
| 0004 |
| Emergency Visit |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0005 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $ ______ |
| $ ______ |
| 0006 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $ ______ |
| $ ______ |
| 0007 |
| Cylinder, size E refills E0443 |
| 4,644 |
| EA |
| $ ______ |
| $ ______ |
| 0008 |
| Cylinder, size D refills E0443 |
| 4,812 |
| EA |
| $ ______ |
| $ ______ |
| 0009 |
| Cylinder, size M6 refills E0443 |
| 804 |
| EA |
| $ ______ |
| $ ______ |
| 0010 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0014 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
EA
| 0015 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0016 |
| Relocation of equipment due to change in beneficiary’s residence |
| 24 |
| EA |
| $ ______ |
| $ ______ |
| 0017 |
| Annual Maintenance of VA owned concentrators |
| 425 |
| EA |
| $ ______ |
| $ ______ |
| ASHEVILLE BASE YEAR COST: |
| $ ______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 0003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 0004 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
2,136
EA
| 0005 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 0006 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0007 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0008 |
| Emergency Visit |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0009 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $ ______ |
| $ ______ |
| 0010 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $ ______ |
| $ ______ |
| 0011 |
| Cylinder, size E refills E0443 |
| 11,184 |
| EA |
| $ ______ |
| $ ______ |
| 0012 |
| Cylinder, size D refills E0443 |
| 1,296 |
| EA |
| $ ______ |
| $ ______ |
| 0013 |
| Cylinder, size M6 refills E0443 |
| 7,176 |
| EA |
| $ ______ |
| $ ______ |
| 0014 |
| Liquid oxygen per pound for item E0444 |
| 119,856 |
| LB |
| $ ______ |
| $ ______ |
| 0015 |
| Compressor - 50 psi - Rental |
| 60 |
| EA |
| $ ______ |
| $ ______ |
| 0016 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $ ______ |
| $ ______ |
| 0017 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0018 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| SALISBURY BASE YEAR COST: |
| $ ______ |
| AREA # 1 (ASHEVILLE & SALISBURY) BASE YEAR TOTAL COST |
| $ ______ |
AREA # 2 (LOCATIONS C & D)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
3,528
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 0003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
EA
| 0004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 0005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0007 |
| Emergency Visit |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0008 |
| Cylinder, size M or H set-up (primary) |
| 360 |
| EA |
| $ ______ |
| $ ______ |
| 0009 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $ ______ |
| $ ______ |
| 0010 |
| Cylinder, size E refills E0443 |
| 12,516 |
| EA |
| $ ______ |
| $ ______ |
| 0011 |
| Cylinder, size D refills E0443 |
| 2,628 |
| EA |
| $ ______ |
| $ ______ |
| 0012 |
| Cylinder, size M6 refills E0443 |
| 5,280 |
| EA |
| $ ______ |
| $ ______ |
| 0013 |
| Liquid oxygen per pound for item E0444 |
| 25,236 |
| LB |
| $ ______ |
| $ ______ |
| 0014 |
| Compressor - 50 psi - rental |
| 120 |
| EA |
| $ ______ |
| $ ______ |
| 0015 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $ ______ |
| $ ______ |
| 0016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
1,200
EA
| 0019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| DURHAM BASE YEAR COST: |
| $ ______ |
| Location D |
| Fayetteville, NC |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,284
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 0003 |
| Rental liquid oxygen system (initial setup & monthly maintenance) |
| 108 |
| EA |
| $ ______ |
| $ ______ |
| 0004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 0005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0006 |
| Missed Patient Visit/Patient Refusal at Home |
| 60 |
| EA |
| $ ______ |
| $ ______ |
| 0007 |
| Emergency Visit |
| 36 |
| EA |
| $ ______ |
| $ ______ |
| 0008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $ ______ |
| $ ______ |
| 0009 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $ ______ |
| $ ______ |
| 0010 |
| Cylinder, size E refills E0443 |
| 8,064 |
| EA |
| $ ______ |
| $ ______ |
| 0011 |
| Cylinder, size D refills E0443 |
| 3,552 |
| EA |
| $ ______ |
| $ ______ |
| 0012 |
| Cylinder, size M6 refills E0443 |
| 6,900 |
| EA |
| $ ______ |
| $ ______ |
| 0013 |
| Liquid oxygen per pound for item E0444 |
| 21,240 |
| LB |
| $ ______ |
| $ ______ |
| 0014 |
| Compressor - 50 psi - rental |
| 156 |
| EA |
| $ ______ |
| $ ______ |
| 0015 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0018 |
| Delivery of VA provided CPAP and BiPAP equipment, |
including setup and patient education.
EA
| 0019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $ ______ |
| $ ______ |
| 0020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| FAYETTEVILLE BASE YEAR COST: |
| $ ______ |
| AREA # 2 (DURHAM & FAYETTEVILLE) BASE YEAR TOTAL COST: |
| $ ______ |
AREA # 3 (LOCATIONS E & F)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
3,588
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 0003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 0004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 0005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 0009 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 0010 |
| Cylinder, size E refills E0443 |
| 7,308 |
| EA |
| $______ |
| $ ______ |
| 0011 |
| Cylinder, size D refills E0443 |
| 1,620 |
| EA |
| $______ |
| $ ______ |
| 0012 |
| Cylinder, size M6 refills E0443 |
| 7,560 |
| EA |
| $______ |
| $ ______ |
| 0013 |
| Liquid oxygen per pound for item E0444 |
| 21,984 |
| LB |
| $______ |
| $ ______ |
| 0014 |
| Compressor - 50 psi - rental |
| 108 |
| EA |
| $______ |
| $ ______ |
| 0015 |
| Humidifier, Heated - Rental |
| 48 |
| EA |
| $______ |
| $ ______ |
| 0016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
EA
| 0019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| HAMPTON BASE YEAR COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 0001 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
5,700
EA
| 0002 |
| Rental ventilator system (initial setup and monthly |
maintenance)
EA
| 0003 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 0004 |
| Missed Patient Visit/Patient Refusal at Home |
| 84 |
| EA |
| $______ |
| $ ______ |
| 0005 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0006 |
| Cylinder, size M or H set-up (primary) |
| 36 |
| EA |
| $______ |
| $ ______ |
| 0007 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 0008 |
| Cylinder, size E refills E0443 |
| 12,888 |
| EA |
| $______ |
| $ ______ |
| 0009 |
| Cylinder, size D refills E0443 |
| 11,520 |
| EA |
| $______ |
| $ ______ |
| 0010 |
| Cylinder, size M6 refills E0443 |
| 7,164 |
| EA |
| $______ |
| $ ______ |
| 0011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0014 |
| Recovery of VA owned equipment |
| 96 |
| EA |
| $______ |
| $ ______ |
| 0015 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| 0016 |
| Annual Maintenance of VA owned concentrators |
| 690 |
| EA |
| $______ |
| $ ______ |
| RICHMOND BASE YEAR COST: |
| $______ |
| AREA # 3 (HAMPTON & RICHMOND) BASE YEAR TOTAL COST: |
| $______ |
AREA # 4 (LOCATION G)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
7,896
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 0003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 0004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 0005 |
| Missed Patient Visit/Patient Refusal at Home |
| 24 |
| EA |
| $______ |
| $ ______ |
| 0006 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0007 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 0008 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 0009 |
| Cylinder, size E refills E0443 |
| 18,816 |
| EA |
| $______ |
| $ ______ |
| 0010 |
| Cylinder, size D refills E0443 |
| 12,960 |
| EA |
| $______ |
| $ ______ |
| 0011 |
| Cylinder, size M6 refills E0443 |
| 4,320 |
| EA |
| $______ |
| $ ______ |
| 0012 |
| Liquid oxygen per pound for item E0444 |
| 206,700 |
| LB |
| $______ |
| $ ______ |
| 0013 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0014 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0015 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 0016 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0017 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 0018 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| AREA # 4 (SALEM) BASE YEAR TOTAL COST: |
| $______ |
OPTION YEAR 1
Period of Performance: 01 Oct 2019 through 30 Sep 2020
AREA # 1 (LOCATIONS A & B)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 1001 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
9,540
EA
| 1002 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 1003 |
| Missed Patient Visit/Patient Refusal at Home |
| 36 |
| EA |
| $______ |
| $ ______ |
| 1004 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1005 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1006 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Cylinder, size E refills E0443 |
| 5,112 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size D refills E0443 |
| 5,292 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size M6 refills E0443 |
| 888 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1014 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
EA
| 1015 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1016 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| 1017 |
| Annual Maintenance of VA owned concentrators |
| 425 |
| EA |
| $______ |
| $ ______ |
| ASHEVILLE OPTION YEAR 1 COST: |
| $______ |
CLIN
Item Description
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
6,612
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 1003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 1,092 |
| EA |
| $______ |
| $ ______ |
| 1004 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
2,352
EA
| 1005 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 1006 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 1007 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Cylinder, size E refills E0443 |
| 12,300 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Cylinder, size D refills E0443 |
| 1,428 |
| EA |
| $______ |
| $ ______ |
| 1013 |
| Cylinder, size M6 refills E0443 |
| 7,896 |
| EA |
| $______ |
| $ ______ |
| 1014 |
| Liquid oxygen per pound for item E0444 |
| 131,844 |
| LB |
| $______ |
| $ ______ |
| 1015 |
| Compressor - 50 psi - Rental |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1016 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1017 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1018 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| SALISBURY OPTION YEAR 1 COST: |
| $______ |
| AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 1 COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
3,876
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 1003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
EA
| 1004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 1005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 1006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size M or H set-up (primary) |
| 396 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size E refills E0443 |
| 13,764 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Cylinder, size D refills E0443 |
| 2,892 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Cylinder, size M6 refills E0443 |
| 5,808 |
| EA |
| $______ |
| $ ______ |
| 1013 |
| Liquid oxygen per pound for item E0444 |
| 27,756 |
| LB |
| $______ |
| $ ______ |
| 1014 |
| Compressor - 50 psi - rental |
| 132 |
| EA |
| $______ |
| $ ______ |
| 1015 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
1,320
EA
| 1019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| DURHAM OPTION YEAR 1 COST: |
| $______ |
| Location D |
| Fayetteville, NC |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,740
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 1003 |
| Rental liquid oxygen system (initial setup & monthly maintenance) |
| 120 |
| EA |
| $______ |
| $ ______ |
| 1004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 1005 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 1006 |
| Missed Patient Visit/Patient Refusal at Home |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Emergency Visit |
| 36 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size E refills E0443 |
| 8,868 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Cylinder, size D refills E0443 |
| 3,912 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Cylinder, size M6 refills E0443 |
| 7,596 |
| EA |
| $______ |
| $ ______ |
| 1013 |
| Liquid oxygen per pound for item E0444 |
| 23,364 |
| LB |
| $______ |
| $ ______ |
| 1014 |
| Compressor - 50 psi - rental |
| 168 |
| EA |
| $______ |
| $ ______ |
| 1015 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1018 |
| Delivery of VA provided CPAP and BiPAP |
equipment, including setup and patient education.
EA
| 1019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| FAYETTEVILLE OPTION YEAR 1 COST: |
| $______ |
| AREA #2 (DURHAM & FAYETTEVILLE) OPTION YEAR 1 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 1001 |
| Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390 |
3,948
EA
| 1002 |
| Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390 |
EA
| 1003 |
| Rental liquid oxygen system (initial setup & |
monthly maintenance)
| 1004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 1005 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 1006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size E refills E0443 |
| 8,040 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Cylinder, size D refills E0443 |
| 1,776 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Cylinder, size M6 refills E0443 |
| 8,316 |
| EA |
| $______ |
| $ ______ |
| 1013 |
| Liquid oxygen per pound for item E0444 |
| 24,180 |
| LB |
| $______ |
| $ ______ |
| 1014 |
| Compressor - 50 psi - rental |
| 120 |
| EA |
| $______ |
| $ ______ |
| 1015 |
| Humidifier, Heated - Rental |
| 48 |
| EA |
| $______ |
| $ ______ |
| 1016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1018 |
| Delivery of VA provided CPAP and BiPAP |
equipment, including setup and patient education.
EA
| 1019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| HAMPTON OPTION YEAR 1 COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 1001 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
6,000
EA
| 1002 |
| Rental ventilator system (initial setup and monthly |
maintenance)
EA
| 1003 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 1004 |
| Missed Patient Visit/Patient Refusal at Home |
| 84 |
| EA |
| $______ |
| $ ______ |
| 1005 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1006 |
| Cylinder, size M or H set-up (primary) |
| 36 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size E refills E0443 |
| 14,172 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size D refills E0443 |
| 12,672 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size M6 refills E0443 |
| 7,884 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1014 |
| Recovery of VA owned equipment |
| 96 |
| EA |
| $______ |
| $ ______ |
| 1015 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| 1016 |
| Annual Maintenance of VA owned concentrators |
| 690 |
| EA |
| $______ |
| $ ______ |
| RICHMOND OPTION YEAR 1 COST: |
| $______ |
| AREA # 3 (HAMPTON & RICHMOND) OPTION YEAR 1 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
8,688
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 1003 |
| Rental liquid oxygen system (initial setup & |
monthly maintenance)
| 1004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 1005 |
| Missed Patient Visit/Patient Refusal at Home |
| 24 |
| EA |
| $______ |
| $ ______ |
| 1006 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1007 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 1008 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 1009 |
| Cylinder, size E refills E0443 |
| 20,700 |
| EA |
| $______ |
| $ ______ |
| 1010 |
| Cylinder, size D refills E0443 |
| 14,256 |
| EA |
| $______ |
| $ ______ |
| 1011 |
| Cylinder, size M6 refills E0443 |
| 4,752 |
| EA |
| $______ |
| $ ______ |
| 1012 |
| Liquid oxygen per pound for item E0444 |
| 227,364 |
| LB |
| $______ |
| $ ______ |
| 1013 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1014 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1015 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 1016 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1017 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 1018 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| AREA # 4 (SALEM) OPTION YEAR 1 TOTAL COST: |
| $______ |
OPTION YEAR 2
Period of Performance: 01 Oct 2020 through 30 Sep 2021
AREA # 1 (LOCATIONS A & B)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
7,272
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 2003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 1,200 |
| EA |
| $______ |
| $ ______ |
| 2004 |
| Initial setup and monthly maintenance for |
Government furnished concentrators
2,592
EA
| 2005 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 2006 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 2007 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Cylinder, size E refills E0443 |
| 13,536 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Cylinder, size D refills E0443 |
| 1,572 |
| EA |
| $______ |
| $ ______ |
| 2013 |
| Cylinder, size M6 refills E0443 |
| 8,688 |
| EA |
| $______ |
| $ ______ |
| 2014 |
| Liquid oxygen per pound for item E0444 |
| 145,032 |
| LB |
| $______ |
| $ ______ |
| 2015 |
| Compressor - 50 psi - Rental |
| 60 |
| EA |
| $______ |
| $ ______ |
| 2016 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 2017 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2018 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| SALISBURY OPTION YEAR 2 COST: |
| $______ |
| AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 2 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,260
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 2003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
EA
| 2004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 2005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 2006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Cylinder, size M or H set-up (primary) |
| 432 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size E refills E0443 |
| 15,144 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Cylinder, size D refills E0443 |
| 3,180 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Cylinder, size M6 refills E0443 |
| 6,384 |
| EA |
| $______ |
| $ ______ |
| 2013 |
| Liquid oxygen per pound for item E0444 |
| 30,528 |
| LB |
| $______ |
| $ ______ |
| 2014 |
| Compressor - 50 psi - rental |
| 132 |
| EA |
| $______ |
| $ ______ |
| 2015 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 2016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
1,452
EA
| 2019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| DURHAM OPTION YEAR 2 COST: |
| $______ |
| Location D |
| Fayetteville, NC |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
5,220
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 2003 |
| Rental liquid oxygen system (initial setup & monthly maintenance) |
| 120 |
| EA |
| $______ |
| $ ______ |
| 2004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 2005 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 2006 |
| Missed Patient Visit/Patient Refusal at Home |
| 60 |
| EA |
| $______ |
| $ ______ |
| 2007 |
| Emergency Visit |
| 36 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size E refills - E0443 |
| 9,756 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Cylinder, size D refills - E0443 |
| 4,308 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Cylinder, size M6 refills - E0443 |
| 8,352 |
| EA |
| $______ |
| $ ______ |
| 2013 |
| Liquid oxygen per pound for item E0444 |
| 25,704 |
| LB |
| $______ |
| $ ______ |
| 2014 |
| Compressor - 50 psi - rental |
| 168 |
| EA |
| $______ |
| $ ______ |
| 2015 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2018 |
| Delivery of VA provided CPAP and BiPAP |
equipment, including setup and patient education.
EA
| 2019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| FAYETTEVILLE OPTION YEAR 2 COST: |
| $______ |
| AREA #2 (DURHAM & FAYETTEVILLE) OPTION YEAR 2 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,344
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 2003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 2004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 2005 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 2006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size E refills - E0443 |
| 8,844 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Cylinder, size D refills - E0443 |
| 1,956 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Cylinder, size M6 refills - E0443 |
| 9,144 |
| EA |
| $______ |
| $ ______ |
| 2013 |
| Liquid oxygen per pound for item E0444 |
| 26,604 |
| LB |
| $______ |
| $ ______ |
| 2014 |
| Compressor - 50 psi - rental |
| 120 |
| EA |
| $______ |
| $ ______ |
| 2015 |
| Humidifier, Heated - Rental |
| 48 |
| EA |
| $______ |
| $ ______ |
| 2016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
EA
| 2019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| HAMPTON OPTION YEAR 2 COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 2001 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
6,600
EA
| 2002 |
| Rental ventilator system (initial setup and monthly |
maintenance)
EA
| 2003 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 2004 |
| Missed Patient Visit/Patient Refusal at Home |
| 84 |
| EA |
| $______ |
| $ ______ |
| 2005 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2006 |
| Cylinder, size M or H set-up (primary) |
| 36 |
| EA |
| $______ |
| $ ______ |
| 2007 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Cylinder, size E refills - E0443 |
| 15,588 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size D refills - E0443 |
| 13,944 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size M6 refills - E0443 |
| 8,676 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2014 |
| Recovery of VA owned equipment |
| 96 |
| EA |
| $______ |
| $ ______ |
| 2015 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| 2016 |
| Annual Maintenance of VA owned concentrators |
| 690 |
| EA |
| $______ |
| $ ______ |
| RICHMOND OPTION YEAR 2 COST: |
| $______ |
| AREA # 3 (HAMPTON & RICHMOND) OPTION YEAR 2 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
9,552
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 2003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 2004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
EA
| 2005 |
| Missed Patient Visit/Patient Refusal at Home |
| 24 |
| EA |
| $______ |
| $ ______ |
| 2006 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2007 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 2008 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 2009 |
| Cylinder, size E refills - E0443 |
| 22,776 |
| EA |
| $______ |
| $ ______ |
| 2010 |
| Cylinder, size D refills - E0443 |
| 15,684 |
| EA |
| $______ |
| $ ______ |
| 2011 |
| Cylinder, size M6 refills - E0443 |
| 5,232 |
| EA |
| $______ |
| $ ______ |
| 2012 |
| Liquid oxygen per pound for item E0444 |
| 250,104 |
| LB |
| $______ |
| $ ______ |
| 2013 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2014 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2015 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 2016 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2017 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 2018 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| AREA # 4 (SALEM) OPTION YEAR 2 TOTAL COST: |
| $______ |
OPTION YEAR 3
Period of Performance: 01 Oct 2021 through 30 Sep 2022
AREA # 1 (LOCATIONS A & B)
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
| 3001 |
| Initial setup and monthly maintenance for |
Government furnished concentrators
11,556
EA
| 3002 |
| Initial setup and monthly maintenance for |
Government furnished ventilators
EA
| 3003 |
| Missed Patient Visit/Patient Refusal at Home |
| 36 |
| EA |
| $______ |
| $ ______ |
| 3004 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3005 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 3006 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $______ |
| $ ______ |
| 3007 |
| Cylinder, size E refills - E0443 |
| 6,192 |
| EA |
| $______ |
| $ ______ |
| 3008 |
| Cylinder, size D refills - E0443 |
| 6,408 |
| EA |
| $______ |
| $ ______ |
| 3009 |
| Cylinder, size M6 refills - E0443 |
| 1,068 |
| EA |
| $______ |
| $ ______ |
| 3010 |
| Compressor - 50 psi - rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3011 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3012 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 3013 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3014 |
| Delivery of VA provided CPAP and BiPAP |
equipment, including setup and patient education.
EA
| 3015 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3016 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| 3017 |
| Annual Maintenance of VA owned concentrators |
| 425 |
| EA |
| $______ |
| $ ______ |
| ASHEVILLE OPTION YEAR 3 COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
8,004
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 3003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 1,320 |
| EA |
| $______ |
| $ ______ |
| 3004 |
| Initial setup and monthly maintenance for Government |
furnished concentrators
2,856
EA
| 3005 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 3006 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 3007 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3008 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3009 |
| Cylinder, size M or H set-up (primary) |
| 60 |
| EA |
| $______ |
| $ ______ |
| 3010 |
| Cylinder, size M or H refill - E0443 |
| 120 |
| EA |
| $______ |
| $ ______ |
| 3011 |
| Cylinder, size E refills - E0443 |
| 14,892 |
| EA |
| $______ |
| $ ______ |
| 3012 |
| Cylinder, size D refills - E0443 |
| 1,728 |
| EA |
| $______ |
| $ ______ |
| 3013 |
| Cylinder, size M6 refills - E0443 |
| 9,552 |
| EA |
| $______ |
| $ ______ |
| 3014 |
| Liquid oxygen per pound for item E0444 |
| 157,380 |
| LB |
| $______ |
| $ ______ |
| 3015 |
| Compressor - 50 psi - Rental |
| 60 |
| EA |
| $______ |
| $ ______ |
| 3016 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 3017 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 3018 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| SALISBURY OPTION YEAR 3 COST: |
| $______ |
| AREA # 1 (ASHEVILLE & SALISBURY) OPTION YEAR 3 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,692
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 3003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
EA
| 3004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 3005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 3006 |
| Missed Patient Visit/Patient Refusal at Home |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3007 |
| Emergency Visit |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3008 |
| Cylinder, size M or H set-up (primary) |
| 480 |
| EA |
| $______ |
| $ ______ |
| 3009 |
| Cylinder, size M or H refill - E0443 |
| 132 |
| EA |
| $______ |
| $ ______ |
| 3010 |
| Cylinder, size E refills - E0443 |
| 1,6656 |
| EA |
| $______ |
| $ ______ |
| 3011 |
| Cylinder, size D refills - E0443 |
| 3,504 |
| EA |
| $______ |
| $ ______ |
| 3012 |
| Cylinder, size M6 refills - E0443 |
| 7,020 |
| EA |
| $______ |
| $ ______ |
| 3013 |
| Liquid oxygen per pound for item - E0444 |
| 33,576 |
| LB |
| $______ |
| $ ______ |
| 3014 |
| Compressor - 50 psi - rental |
| 132 |
| EA |
| $______ |
| $ ______ |
| 3015 |
| Humidifier, Heated - Rental |
| 24 |
| EA |
| $______ |
| $ ______ |
| 3016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 3017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3018 |
| Delivery of VA provided CPAP and BiPAP |
equipment, including setup and patient education.
1,596
EA
| 3019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| DURHAM OPTION YEAR 3 COST: |
| $______ |
| Location D |
| Fayetteville, NC |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
5,748
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 3003 |
| Rental liquid oxygen system (initial setup & monthly maintenance) |
| 120 |
| EA |
| $______ |
| $ ______ |
| 3004 |
| Rental ventilator system (initial setup and monthly |
maintenance)
| 3005 |
| Initial setup and monthly maintenance for Government |
furnished ventilators
EA
| 3006 |
| Missed Patient Visit/Patient Refusal at Home |
| 60 |
| EA |
| $______ |
| $ ______ |
| 3007 |
| Emergency Visit |
| 36 |
| EA |
| $______ |
| $ ______ |
| 3008 |
| Cylinder, size M or H set-up (primary) |
| 24 |
| EA |
| $______ |
| $ ______ |
| 3009 |
| Cylinder, size M or H refill - E0443 |
| 60 |
| EA |
| $______ |
| $ ______ |
| 3010 |
| Cylinder, size E refills - E0443 |
| 10,728 |
| EA |
| $______ |
| $ ______ |
| 3011 |
| Cylinder, size D refills - E0443 |
| 4,740 |
| EA |
| $______ |
| $ ______ |
| 3012 |
| Cylinder, size M6 refills - E0443 |
| 9,192 |
| EA |
| $______ |
| $ ______ |
| 3013 |
| Liquid oxygen per pound for item E0444 |
| 28,272 |
| LB |
| $______ |
| $ ______ |
| 3014 |
| Compressor - 50 psi - rental |
| 168 |
| EA |
| $______ |
| $ ______ |
| 3015 |
| Humidifier, Heated - Rental |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3016 |
| Demand Nasal Cannula (e.g. Oximyzer) Reservoir or pendant/equivalent. VA111 |
EA
| 3017 |
| Pulse Conserver Device (purchase) |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3018 |
| Delivery of VA provided CPAP and BiPAP equipment, including setup and patient education. |
EA
| 3019 |
| Recovery of VA owned equipment |
| 12 |
| EA |
| $______ |
| $ ______ |
| 3020 |
| Relocation of equipment due to change in beneficiary’s residence |
EA
| FAYETTEVILLE OPTION YEAR 3 COST: |
| $______ |
| AREA #2 (DURHAM & FAYETTEVILLE) OPTION YEAR 3 TOTAL COST: |
| $______ |
| CLIN |
| Item Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total Price |
Rental concentrator system – (initial setup & monthly maintenance) concentrator will have flow rate capacity up to 5LPM. E1390
4,776
EA
Rental concentrator system - (initial setup & monthly maintenance) concentrator must have flow rate capacity up to 10 LPM. E1390
EA
| 3003 |
| Rental liquid oxygen system (initial setup & monthly |
maintenance)
| 3004 |
| Rental ventilator system (initial setup and monthly |
mainte…
This is the start of the file's text. The full file is on GovTribe.
