36C24621Q0068 0001.docx

5. PROJECT NUMBER (if applicable)

CODE

7.

ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF

PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE

OF YOUR

ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO:

Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERE

D CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR

OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendmen t, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED

STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER

16A. NAME AND TITLE OF

CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF

SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) 11-20-2020 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 To all Offerors/Bidders

36C24621Q0068 11-20-2020

X X X November 24, 2020 @ 0700AM Eastern The purpose of this amendment is to adjust the quantities for FY25 for I-123 Sodium Iodide.

See amended SCHEDULE OF SUPPLIES / SERVICES below.

Cole J. Culley Contracting Officer

VA-VHA-RPOE-2019-369AC7BE

CONTINUATION PAGE

C. SCHEDULE OF SUPPLIES / SERVICES

Radiopharmaceutical Estimate 2021

Tracer

I-131 Thyroid Therapy per mCi for

Tc-99m Sestamibi 25 mCi per unit dose for Parathyroid

Tc-99m Mebrofenin unit dose for hepatobiliary imaging

I-123 Sodium Iodide per capsule for thyroid uptake and scan and wholebody imaging

Tc-99m Sulfur Colloid 1.0 mCi unit dose for Gastric Emptying

Tc-99m Filtered Sulfur Colloid 2.0 mCi unit dose for Lymph studies

Tc-99m Sulfur Colloid 2.0 mCi unit dose for Lymphatic Study

Tc-99m 200 mCi in a glass vial for calibrations per mCi pricing

Tc-99m up to 30 mCi unit dose for Meckel's, GI Bleed, MUGA

Tc-99m Medronate (MDP) 20 mCi Unit Dose

Tc-99m Tetrofosmin for Myocardial Perfusion Imaging 10 & 30 mCi Unit dose

Xe-133 Standing Order for Lung Ventilation 20 mCi

Tc-99m MAA 5 mCi unit dose for Lung Perfusion

Tc-99m DTPA for Lung Ventilation 40mCi Unit Dose

Tc-99m HMPAO Ceretec 25 mCi per unit dose for brain imaging

Tc-99m HMPAO Ceretec labeled Luekocytes 20 mCi per unit patient for WBC imaging

Tc-99 ECD (Neurolite) 25 mCi per patient for brain death imaging

Unit Dose Cold PYP (estimated)

Non-Radioactive Pyrophosphate (PYP) for Labeling RBC + Amyloid

Tc-99m MAG-3 (mertiatide) 5 mCi unit dose for Renal Studies

In-111 Pentreotide (Octreoscan) 6 mCI per unit dose syringe for Octreotide recepter imaging

Tl-201 Thallous Chloride, up to 5 mCi per unit dose syringe for Cardiac Viability imaging billed per mCi

Ga-67 Gallium Citrate for chronic infection 5 mCi Unit Dose billed per mCi.

I-123 MIBG 10 mCi unit dose for pheochromocytoma

In-111 oxine Labeled WBC 0.5 mCi per unit dose for infection

After Hours Delivery Fee

After Hours Callout

Co-57 20 mCi Source for For camera quality control

Co-57 5 mCi Bottle Source for Quality Control

1 cc Syringe Shield for Radiation protection

3 cc Syringe Shield for Radiation protection

5 cc Syringe Shield for Radiation protrection

10 cc Syringe Shield for Radation protection

Grand Total FY 2021

Radiopharmaceutical Estimate 2022

Tracer

I-131 Thyroid Therapy per mCi for

Tc-99m Sestamibi 25 mCi per unit dose for Parathyroid

Tc-99m Mebrofenin unit dose for hepatobiliary imaging

I-123 Sodium Iodide per capsule for thyroid uptake and scan and wholebody imaging

Tc-99m Sulfur Colloid 1.0 mCi unit dose for Gastric Emptying

Tc-99m Filtered Sulfur Colloid 2.0 mCi unit dose for Lymph studies

Tc-99m Sulfur Colloid 2.0 mCi unit dose for Lymphatic Study

Tc-99m 200 mCi in a glass vial for calibrations per mCi pricing

Tc-99m up to 30 mCi unit dose for Meckel's, GI Bleed, MUGA

Tc-99m Medronate (MDP) 20 mCi Unit Dose

Tc-99m Tetrofosmin for Myocardial Perfusion Imaging 10 & 30 mCi Unit dose

Xe-133 Standing Order for Lung Ventilation 20 mCi

Tc-99m MAA 5 mCi unit dose for Lung Perfusion

Tc-99m DTPA for Lung Ventilation 40mCi Unit Dose

Tc-99m HMPAO Ceretec 25 mCi per unit dose for brain imaging

Tc-99m HMPAO Ceretec labeled Luekocytes 20 mCi per unit patient for WBC imaging

Tc-99 ECD (Neurolite) 25 mCi per patient for brain death imaging

Unit Dose Cold PYP (estimated)

Non-Radioactive Pyrophosphate (PYP) for Labeling RBC + Amyloid

Tc-99m MAG-3 (mertiatide) 5 mCi unit dose for Renal Studies

In-111 Pentreotide (Octreoscan) 6 mCI per unit dose syringe for Octreotide recepter imaging

Tl-201 Thallous Chloride, up to 5 mCi per unit dose syringe for Cardiac Viability imaging billed per mCi

Ga-67 Gallium Citrate for chronic infection 5 mCi Unit Dose billed per mCi.

I-123 MIBG 10 mCi unit dose for pheochromocytoma

In-111 oxine Labeled WBC 0.5 mCi per unit dose for infection

After Hours Delivery Fee

After Hours Callout

Co-57 20 mCi Source for For camera quality control

Co-57 5 mCi Bottle Source for Quality Control

1 cc Syringe Shield for Radiation protection

3 cc Syringe Shield for Radiation protection

5 cc Syringe Shield for Radiation protrection

10 cc Syringe Shield for Radation protection

Grand Total

Radiopharmaceutical Estimate 2023

Tracer

I-131 Thyroid Therapy per mCi for

Tc-99m Sestamibi 25 mCi per unit dose for Parathyroid

Tc-99m Mebrofenin unit dose for hepatobiliary imaging

I-123 Sodium Iodide per capsule for thyroid uptake and scan and wholebody imaging

Tc-99m Sulfur Colloid 1.0 mCi unit dose for Gastric Emptying

Tc-99m Filtered Sulfur Colloid 2.0 mCi unit dose for Lymph studies

Tc-99m Sulfur Colloid 2.0 mCi unit dose for Lymphatic Study

Tc-99m 200 mCi in a glass vial for calibrations per mCi pricing

Tc-99m up to 30 mCi unit dose for Meckel's, GI Bleed, MUGA

Tc-99m Medronate (MDP) 20 mCi Unit Dose

Tc-99m Tetrofosmin for Myocardial Perfusion Imaging 10 & 30 mCi Unit dose

Xe-133 Standing Order for Lung Ventilation 20 mCi

Tc-99m MAA 5 mCi unit dose for Lung Perfusion

Tc-99m DTPA for Lung Ventilation 40mCi Unit Dose

Tc-99m HMPAO Ceretec 25 mCi per unit dose for brain imaging

Tc-99m HMPAO Ceretec labeled Luekocytes 20 mCi per unit patient for WBC imaging

Tc-99 ECD (Neurolite) 25 mCi per patient for brain death imaging

Unit Dose Cold PYP (estimated)

Non-Radioactive Pyrophosphate (PYP) for Labeling RBC + Amyloid

Tc-99m MAG-3 (mertiatide) 5 mCi unit dose for Renal Studies

In-111 Pentreotide (Octreoscan) 6 mCI per unit dose syringe for Octreotide recepter imaging

Tl-201 Thallous Chloride, up to 5 mCi per unit dose syringe for Cardiac Viability imaging billed per mCi

Ga-67 Gallium Citrate for chronic infection 5 mCi Unit Dose billed per mCi.

I-123 MIBG 10 mCi unit dose for pheochromocytoma

In-111 oxine Labeled WBC 0.5 mCi per unit dose for infection

After Hours Delivery Fee

After Hours Callout

Co-57 20 mCi Source for For camera quality control

Co-57 5 mCi Bottle Source for Quality Control

1 cc Syringe Shield for Radiation protection

3 cc Syringe Shield for Radiation protection

5 cc Syringe Shield for Radiation protrection

10 cc Syringe Shield for Radation protection

Grand Total 2023

Radiopharmaceutical Estimate 2024

Tracer

I-131 Thyroid Therapy per mCi for

Tc-99m Sestamibi 25 mCi per unit dose for Parathyroid

Tc-99m Mebrofenin unit dose for hepatobiliary imaging

I-123 Sodium Iodide per capsule for thyroid uptake and scan and wholebody imaging

Tc-99m Sulfur Colloid 1.0 mCi unit dose for Gastric Emptying

Tc-99m Filtered Sulfur Colloid 2.0 mCi unit dose for Lymph studies

Tc-99m Sulfur Colloid 2.0 mCi unit dose for Lymphatic Study

Tc-99m 200 mCi in a glass vial for calibrations per mCi pricing

Tc-99m up to 30 mCi unit dose for Meckel's, GI Bleed, MUGA

Tc-99m Medronate (MDP) 20 mCi Unit Dose

Tc-99m Tetrofosmin for Myocardial Perfusion Imaging 10 & 30 mCi Unit dose

Xe-133 Standing Order for Lung Ventilation 20 mCi

Tc-99m MAA 5 mCi unit dose for Lung Perfusion

Tc-99m DTPA for Lung Ventilation 40mCi Unit Dose

Tc-99m HMPAO Ceretec 25 mCi per unit dose for brain imaging

Tc-99m HMPAO Ceretec labeled Luekocytes 20 mCi per unit patient for WBC imaging

Tc-99 ECD (Neurolite) 25 mCi per patient for brain death imaging

Unit Dose Cold PYP (estimated)

Non-Radioactive Pyrophosphate (PYP) for Labeling RBC + Amyloid

Tc-99m MAG-3 (mertiatide) 5 mCi unit dose for Renal Studies

In-111 Pentreotide (Octreoscan) 6 mCI per unit dose syringe for Octreotide recepter imaging

Tl-201 Thallous Chloride, up to 5 mCi per unit dose syringe for Cardiac Viability imaging billed per mCi

Ga-67 Gallium Citrate for chronic infection 5 mCi Unit Dose billed per mCi.

I-123 MIBG 10 mCi unit dose for pheochromocytoma

In-111 oxine Labeled WBC 0.5 mCi per unit dose for infection

After Hours Delivery Fee

After Hours Callout

Co-57 20 mCi Source for For camera quality control

Co-57 5 mCi Bottle Source for Quality Control

1 cc Syringe Shield for Radiation protection

3 cc Syringe Shield for Radiation protection

5 cc Syringe Shield for Radiation protrection

10 cc Syringe Shield for Radation protection

Grand Total 2024

Radiopharmaceutical Estimate 2025

Tracer

I-131 Thyroid Therapy per mCi for

Tc-99m Sestamibi 25 mCi per unit dose for Parathyroid

Tc-99m Mebrofenin unit dose for hepatobiliary imaging

I-123 Sodium Iodide per capsule for thyroid uptake and scan and wholebody imaging

Tc-99m Sulfur Colloid 1.0 mCi unit dose for Gastric Emptying

Tc-99m Filtered Sulfur Colloid 2.0 mCi unit dose for Lymph studies

Tc-99m Sulfur Colloid 2.0 mCi unit dose for Lymphatic Study

Tc-99m 200 mCi in a glass vial for calibrations per mCi pricing

Tc-99m up to 30 mCi unit dose for Meckel's, GI Bleed, MUGA

Tc-99m Medronate (MDP) 20 mCi Unit Dose

Tc-99m Tetrofosmin for Myocardial Perfusion Imaging 10 & 30 mCi Unit dose

Xe-133 Standing Order for Lung Ventilation 20 mCi

Tc-99m MAA 5 mCi unit dose for Lung Perfusion

Tc-99m DTPA for Lung Ventilation 40mCi Unit Dose

Tc-99m HMPAO Ceretec 25 mCi per unit dose for brain imaging

Tc-99m HMPAO Ceretec labeled Luekocytes 20 mCi per unit patient for WBC imaging

Tc-99 ECD (Neurolite) 25 mCi per patient for brain death imaging

Unit Dose Cold PYP (estimated)

Non-Radioactive Pyrophosphate (PYP) for Labeling RBC + Amyloid

Tc-99m MAG-3 (mertiatide) 5 mCi unit dose for Renal Studies

In-111 Pentreotide (Octreoscan) 6 mCI per unit dose syringe for Octreotide recepter imaging

Tl-201 Thallous Chloride, up to 5 mCi per unit dose syringe for Cardiac Viability imaging billed per mCi

Ga-67 Gallium Citrate for chronic infection 5 mCi Unit Dose billed per mCi.

I-123 MIBG 10 mCi unit dose for pheochromocytoma

In-111 oxine Labeled WBC 0.5 mCi per unit dose for infection

After Hours Delivery Fee

After Hours Callout

Co-57 20 mCi Source for For camera quality control

Co-57 5 mCi Bottle Source for Quality Control

1 cc Syringe Shield for Radiation protection

3 cc Syringe Shield for Radiation protection

5 cc Syringe Shield for Radiation protrection

10 cc Syringe Shield for Radation protection

Grand Total 2025