Revised Price Schedule - Holly Springs.docx
DOCX document 25 KB Posted
- Attached to
- Q201--Holly Springs CBOC Services Federal contract opportunity
- Solicitation number
- 36C24924R0063
About this file
The document is a Revised Price Schedule for a Department of Veterans Affairs contract for healthcare services at the Holly Springs Community Based Outpatient Clinic (CBOC) in Mississippi. The solicitation (36C24924R0063) covers a comprehensive 10-year period from October 1, 2025, to September 30, 2035, with a base year and nine consecutive one-year option periods. The pricing structure includes three primary line items for each contract period: Primary Health Care Services (per member per month), Mental Health Care Services (per member per month), and Injectable Medications administered at the CBOC.
The contract is structured with gradually decreasing patient volumes across the base and option periods, starting at 1,410 patients for primary care and 335 for mental health services in the base year, and declining to 1,392 primary care and 326 mental health patients by the final option year. The contract falls under NAICS code 621498 for All Other Outpatient Care Centers and uses Product/Service Code Q201 for Medical - General Health Care. The pricing schedule allows for unit pricing to be filled in by the contractor, with the final grand total to be calculated based on the specified per member per month rates and quantities for each service category.
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Text version
B.2.1 PRICE SCHEDULE
| ITEM NUMBER |
| DESCRIPTION OF SERVICES |
| QUANTITY |
| UNIT |
| UNIT PRICE |
| ESTIMATED |
AMOUNT
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1410 PMPM Contract Period: Base POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 621498 - All Other Outpatient Care Centers PRODUCT/SERVICE CODE: Q201 - Medical - General Health Care
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 335 PMPM
POP Begin: 10-01-2025 POP End: 09-30-2026
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2025 POP End: 09-30-2026
Total Base Period
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1408 PMPM Contract Period: Option 1 POP Begin: 10-01-2026 POP End: 09-30-2027
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 334 PMPM
POP Begin: 10-01-2026 POP End: 09-30-2027
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2026 POP End: 09-30-2027
Total Option Period 1
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1406 PMPM Contract Period: Option 2 POP Begin: 10-01-2027 POP End: 09-30-2028
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 333 PMPM
POP Begin: 10-01-2027 POP End: 09-30-2028
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2027 POP End: 09-30-2028
Total Option Period 2
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1404 PMPM Contract Period: Option 3 POP Begin: 10-01-2028 POP End: 09-30-2029
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 332 PMPM
POP Begin: 10-01-2028 POP End: 09-30-2029
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2028 POP End: 09-30-2029
Total Option Period 3
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1402 PMPM Contract Period: Option 4 POP Begin: 10-01-2029 POP End: 09-30-2030
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 331 PMPM
POP Begin: 10-01-2029 POP End: 09-30-2030
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2029 POP End: 09-30-2030
Total Option Period 4
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1400 PMPM Contract Period: Option 5 POP Begin: 10-01-2030 POP End: 09-30-2031
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 330 PMPM
POP Begin: 10-01-2030 POP End: 09-30-2031
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2030 POP End: 09-30-2031
Total Option Period 5
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1398 PMPM Contract Period: Option 6 POP Begin: 10-01-2031 POP End: 09-30-2032
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 329 PMPM
POP Begin: 10-01-2031 POP End: 09-30-2032
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2031 POP End: 09-30-2032
Total Option Period 6
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1396 PMPM Contract Period: Option 7 POP Begin: 10-01-2032 POP End: 09-30-2033
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 328 PMPM
POP Begin: 10-01-2032 POP End: 09-30-2033
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2032 POP End: 09-30-2033
Total Option Period 7
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1394 PMPM Contract Period: Option 8 POP Begin: 10-01-2033 POP End: 09-30-2034
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 327 PMPM
POP Begin: 10-01-2033 POP End: 09-30-2034
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2033 POP End: 09-30-2034
Total Option Period 8
| 12.00 |
| MO |
| __________________ |
| __________________ |
Primary Health Care Services $______ x 1392 PMPM Contract Period: Option 9 POP Begin: 10-01-2034 POP End: 09-30-2035
| 12.00 |
| MO |
| __________________ |
| __________________ |
Mental Health Care Services $______ x 326 PMPM
POP Begin: 10-01-2034 POP End: 09-30-2035
| 1.00 |
| EA |
| 100% of Actual Cost to Contractor |
Injectable Medications administered at the CBOC which are not listed in Contract
POP Begin: 10-01-2034 POP End: 09-30-2035
Total Option Period 9
GRAND TOTAL
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