The file's text, extracted by GovTribe without its formatting.
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 NUMBERED 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 amendment, 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) A0001 03-21 -202 36C250 Department of Veterans Affairs Network Contracting Office 10 PO Box 492 Ann Arbor MI 48106 36C250 Department of Veterans Affairs Network Contracting Office 10 PO Box 492 Ann Arbor MI 4810648105 To all Offerors/Bidders
36C25020R0042 03-21-2022
X X X HOUR & DATE for Receipt of Offers is EXTENDED to: Thursday, 04-07-2022 @11:00am(Eastern X 1 (One) The purpose of this Amendment is to "Answer Vendor Questions", update the Price Schedule (Attached) to add "Battle Creek, VAMC, Remove Cleveland, VAMC, change some medical center quantities on Price Schedule from solicitation and change CPT Code 0297T (Holter Monitoring Service (14 days) to Holter Monitoring Service - up to 14 days under (CPT codes 93242 and 93246) and "Extend the Date that Proposals are due" from March 31,2022 to Thursday, April 7, 2022 at 11:00am(Eastern).
Vendors SHALL completed the Price Schedule attached to this Amendment.
**This Amendment Shall be Signed and Submitted with Proposal**
Michelle C. Ford Contracting Specialist
B.3 SCHEDULE OF SERVICES
Contractor shall provide Outpatient Cardiac Event and Holter monitoring services that includes equipment, monitoring, equipment processing and training for facilities located within the Veterans Integrated Service Network 10 (VISN 10). VISN 10 Healthcare System serves Veterans at 12 Medical Centers, and associated Community Based Outpatient Clinics (CBOCs), and satellite facilities throughout Ohio, Indiana, and Michigan. This Indefinite Delivery, Indefinite Quantity (IDIQ) contract shall be for five (5), one-year ordering periods from May 13, 2022, through May 12, 2027.
The quantities stated in this section represent the Government’s best estimate, based on historical usage and projected need. Please note that they are only estimates and are not a guarantee of future orders. The guaranteed minimum only applies to the Federal Government Fiscal Year in which the contract is awarded. The total minimum amount or guaranteed minimum monitoring services for this contract is 650 inclusive of CPT Codes 93271, 93229, 93226 and 0297T. The minimum guaranteed amount shall be expended in the initial fiscal year in which this contract is awarded.
The maximum monitoring services for this contract inclusive of all Ordering periods is 28,832 inclusive of CPT Codes 93271, 93229, 93226, 93242 and 93246. Individual task orders shall be funded annually. The Contracting Officer is the only authorized individual that can place annual task orders against this contract for the estimated amount of services for the specific timeframe, and the task orders shall be issued to the contractor. Offerors shall offer pricing for the entire estimated quantity for each CLIN.
Ordering Period 1 – May 13, 2022, through May 12, 2023
INDIANA FACILITIES
| Facility |
| Item No. | |
| Description | |
| Est. Qty. | |
| Unit | |
| Unit Price | |
| Total | |
Price
Richard L. Roudebush VA Medical Center (Indianapolis) 1481 W. 10th Street, Indianapolis, IN 46202
| 0001a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 0001b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 300 |
| EA |
| $______ |
| $_________ |
| 0001c |
| CPT Code 93226 – Holter Monitoring Service |
| 300 |
| EA |
| $______ |
| $_________ |
| 0001d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Northern Indiana Healthcare System (Fort Wayne & Marion) 2121 Lake Avenue, Fort Wayne, IN 46805
| 0002a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 40 |
| EA |
| $______ |
| $_________ |
| 0002b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 20 |
| EA |
| $______ |
| $_________ |
| 0002c |
| CPT Code 93226 – Holter Monitoring Service |
| 42 |
| EA |
| $______ |
| $_________ |
| 0002d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
MICHIGAN FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Ann Arbor Healthcare System 2215 Fuller Rd Ann Arbor, MI 48105
| 0003a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 100 |
| EA |
| $______ |
| $_________ |
| 0003b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 360 |
| EA |
| $______ |
| $_________ |
| 0003c |
| CPT Code 93226 – Holter Monitoring Service |
| 24 |
| EA |
| $______ |
| $_________ |
| 0003d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 120 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
John D. Dingell Healthcare System (Detroit) 4646 John R. Street, Detroit, MI 48201
| 0004a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 0 |
| EA |
| $______ |
| $_________ |
| 0004b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 180 |
| EA |
| $______ |
| $_________ |
| 0004c |
| CPT Code 93226 – Holter Monitoring Service |
| 212 |
| EA |
| $______ |
| $_________ |
| 0004d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Aleda E. Lutz Healthcare System (Saginaw) 1500 Weiss St Saginaw, MI 48602
| 0005a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 166 |
| EA |
| $______ |
| $_________ |
| 0005b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 166 |
| EA |
| $______ |
| $_________ |
| 0005c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 0005d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 360 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Battle Creek VA Healthcare System 5500 Armstrong Rd, Battle Creek, MI 49037
| 0006a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 0006b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 350 |
| EA |
| $______ |
| $_________ |
| 0006c |
| CPT Code 93226 – Holter Monitoring Service |
| 350 |
| EA |
| $______ |
| $_________ |
| 0006d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 100 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
OHIO FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Chillicothe VA Medical Center (Chillicothe) 17273 State Route 104 Chillicothe, OH 45601
| 0007a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 0007b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 0007c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 0007d |
| CPT Code 0297T – Holter Monitoring Service (14 days) |
| 0 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Cincinnati VA Medical Center (Cincinnati) 3200 Vine St. Cincinnati, OH 45220
| 0008a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 140 |
| 0008b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 10 |
| EA |
| $______ |
| $_________ |
| 0008c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 0008d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Chalmers P. Wylie VA Ambulatory Care Center (Columbus) 420 N. James Rd. Columbus, OH 43219
| 0009a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 62 |
| EA |
| $______ |
| $_________ |
| 0009b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 0009c |
| CPT Code 93226 – Holter Monitoring Service |
| 38 |
| EA |
| $______ |
| $_________ |
| 0009d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Dayton VA Medical Center (Dayton) 4100 W. Third St. Dayton, OH 45428
| 0010a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 0010b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 0010c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 0010d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
ORDERING PERIOD 1 ESTIMATED TOTAL
Ordering Period 2 – May 13, 2023, through May 12, 2024
INDIANA FACILITIES
| Facility |
| Item No. | |
| Description | |
| Est. Qty. | |
| Unit | |
| Unit Price | |
| Total | |
Price
Richard L. Roudebush VA Medical Center (Indianapolis) 1481 W. 10th Street, Indianapolis, IN 46202
| 1001a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 1001b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 300 |
| EA |
| $______ |
| $_________ |
| 1001c |
| CPT Code 93226 – Holter Monitoring Service |
| 300 |
| EA |
| $______ |
| $_________ |
| 1001d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Northern Indiana Healthcare System (Fort Wayne & Marion) 2121 Lake Avenue, Fort Wayne, IN 46805
| 1002a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 40 |
| EA |
| $______ |
| $_________ |
| 1002b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 20 |
| EA |
| $______ |
| $_________ |
| 1002c |
| CPT Code 93226 – Holter Monitoring Service |
| 42 |
| EA |
| $______ |
| $_________ |
| 1002d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
MICHIGAN FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Ann Arbor Healthcare System 2215 Fuller Rd Ann Arbor, MI 48105
| 1003a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 100 |
| EA |
| $______ |
| $_________ |
| 1003b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 360 |
| EA |
| $______ |
| $_________ |
| 1003c |
| CPT Code 93226 – Holter Monitoring Service |
| 24 |
| EA |
| $______ |
| $_________ |
| 1003d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 120 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
John D. Dingell Healthcare System (Detroit) 4646 John R. Street, Detroit, MI 48201
| 1004a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 0 |
| EA |
| $______ |
| $_________ |
| 1004b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 180 |
| EA |
| $______ |
| $_________ |
| 1004c |
| CPT Code 93226 – Holter Monitoring Service |
| 212 |
| EA |
| $______ |
| $_________ |
| 1004d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Aleda E. Lutz Healthcare System (Saginaw) 1500 Weiss St Saginaw, MI 48602
| 1005a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 166 |
| EA |
| $______ |
| $_________ |
| 1005b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 166 |
| EA |
| $______ |
| $_________ |
| 1005c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 1005d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 360 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Battle Creek VA Healthcare System 5500 Armstrong Rd, Battle Creek, MI 49037
| 1006a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 1006b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 350 |
| EA |
| $______ |
| $_________ |
| 1006c |
| CPT Code 93226 – Holter Monitoring Service |
| 350 |
| EA |
| $______ |
| $_________ |
| 1006d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 100 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
OHIO FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Chillicothe VA Medical Center (Chillicothe) 17273 State Route 104 Chillicothe, OH 45601
| 1007a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 1007b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 1007c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 1007d |
| CPT Code 0297T – Holter Monitoring Service (14 days) |
| 0 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Cincinnati VA Medical Center (Cincinnati) 3200 Vine St. Cincinnati, OH 45220
| 1008a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 140 |
| 1008b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 10 |
| EA |
| $______ |
| $_________ |
| 1008c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 1008d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Chalmers P. Wylie VA Ambulatory Care Center (Columbus) 420 N. James Rd. Columbus, OH 43219
| 1009a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 62 |
| EA |
| $______ |
| $_________ |
| 1009b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 1009c |
| CPT Code 93226 – Holter Monitoring Service |
| 38 |
| EA |
| $______ |
| $_________ |
| 1009d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Dayton VA Medical Center (Dayton) 4100 W. Third St. Dayton, OH 45428
| 1010a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 1010b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 1010c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 1010d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
ORDERING PERIOD 2 ESTIMATED TOTAL
Ordering Period 3 – May 13, 2024, through May 12, 2025
INDIANA FACILITIES
| Facility |
| Item No. | |
| Description | |
| Est. Qty. | |
| Unit | |
| Unit Price | |
| Total | |
Price
Richard L. Roudebush VA Medical Center (Indianapolis) 1481 W. 10th Street, Indianapolis, IN 46202
| 2001a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 2001b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 300 |
| EA |
| $______ |
| $_________ |
| 2001c |
| CPT Code 93226 – Holter Monitoring Service |
| 300 |
| EA |
| $______ |
| $_________ |
| 2001d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Northern Indiana Healthcare System (Fort Wayne & Marion) 2121 Lake Avenue, Fort Wayne, IN 46805
| 2002a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 40 |
| EA |
| $______ |
| $_________ |
| 2002b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 20 |
| EA |
| $______ |
| $_________ |
| 2002c |
| CPT Code 93226 – Holter Monitoring Service |
| 42 |
| EA |
| $______ |
| $_________ |
| 2002d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
MICHIGAN FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Ann Arbor Healthcare System 2215 Fuller Rd Ann Arbor, MI 48105
| 2003a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 100 |
| EA |
| $______ |
| $_________ |
| 2003b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 360 |
| EA |
| $______ |
| $_________ |
| 2003c |
| CPT Code 93226 – Holter Monitoring Service |
| 24 |
| EA |
| $______ |
| $_________ |
| 2003d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 120 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
John D. Dingell Healthcare System (Detroit) 4646 John R. Street, Detroit, MI 48201
| 2004a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 0 |
| EA |
| $______ |
| $_________ |
| 2004b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 180 |
| EA |
| $______ |
| $_________ |
| 2004c |
| CPT Code 93226 – Holter Monitoring Service |
| 212 |
| EA |
| $______ |
| $_________ |
| 2004d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Aleda E. Lutz Healthcare System (Saginaw) 1500 Weiss St Saginaw, MI 48602
| 2005a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 166 |
| EA |
| $______ |
| $_________ |
| 2005b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 166 |
| EA |
| $______ |
| $_________ |
| 2005c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 2005d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 360 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Battle Creek VA Healthcare System 5500 Armstrong Rd, Battle Creek, MI 49037
| 2006a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 2006b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 350 |
| EA |
| $______ |
| $_________ |
| 2006c |
| CPT Code 93226 – Holter Monitoring Service |
| 350 |
| EA |
| $______ |
| $_________ |
| 2006d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 100 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
OHIO FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Chillicothe VA Medical Center (Chillicothe) 17273 State Route 104 Chillicothe, OH 45601
| 2007a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 2007b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 2007c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 2007d |
| CPT Code 0297T – Holter Monitoring Service (14 days) |
| 0 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Cincinnati VA Medical Center (Cincinnati) 3200 Vine St. Cincinnati, OH 45220
| 2008a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 140 |
| 2008b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 10 |
| EA |
| $______ |
| $_________ |
| 2008c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 2008d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Chalmers P. Wylie VA Ambulatory Care Center (Columbus) 420 N. James Rd. Columbus, OH 43219
| 2009a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 62 |
| EA |
| $______ |
| $_________ |
| 2009b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 2009c |
| CPT Code 93226 – Holter Monitoring Service |
| 38 |
| EA |
| $______ |
| $_________ |
| 2009d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Dayton VA Medical Center (Dayton) 4100 W. Third St. Dayton, OH 45428
| 2010a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 2010b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 2010c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 2010d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
ORDERING PERIOD 3 ESTIMATED TOTAL
Ordering Period 4 – May 13, 2025, through May 12, 2026
INDIANA FACILITIES
| Facility |
| Item No. | |
| Description | |
| Est. Qty. | |
| Unit | |
| Unit Price | |
| Total | |
Price
Richard L. Roudebush VA Medical Center (Indianapolis) 1481 W. 10th Street, Indianapolis, IN 46202
| 3001a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 3001b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 300 |
| EA |
| $______ |
| $_________ |
| 3001c |
| CPT Code 93226 – Holter Monitoring Service |
| 300 |
| EA |
| $______ |
| $_________ |
| 3001d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Northern Indiana Healthcare System (Fort Wayne & Marion) 2121 Lake Avenue, Fort Wayne, IN 46805
| 3002a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 40 |
| EA |
| $______ |
| $_________ |
| 3002b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 20 |
| EA |
| $______ |
| $_________ |
| 3002c |
| CPT Code 93226 – Holter Monitoring Service |
| 42 |
| EA |
| $______ |
| $_________ |
| 3002d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
MICHIGAN FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Ann Arbor Healthcare System 2215 Fuller Rd Ann Arbor, MI 48105
| 3003a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 100 |
| EA |
| $______ |
| $_________ |
| 3003b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 360 |
| EA |
| $______ |
| $_________ |
| 3003c |
| CPT Code 93226 – Holter Monitoring Service |
| 24 |
| EA |
| $______ |
| $_________ |
| 3003d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 120 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
John D. Dingell Healthcare System (Detroit) 4646 John R. Street, Detroit, MI 48201
| 3004a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 0 |
| EA |
| $______ |
| $_________ |
| 3004b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 180 |
| EA |
| $______ |
| $_________ |
| 3004c |
| CPT Code 93226 – Holter Monitoring Service |
| 212 |
| EA |
| $______ |
| $_________ |
| 3004d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Aleda E. Lutz Healthcare System (Saginaw) 1500 Weiss St Saginaw, MI 48602
| 3005a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 166 |
| EA |
| $______ |
| $_________ |
| 3005b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 166 |
| EA |
| $______ |
| $_________ |
| 3005c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 3005d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 360 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Battle Creek VA Healthcare System 5500 Armstrong Rd, Battle Creek, MI 49037
| 3006a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 3006b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 350 |
| EA |
| $______ |
| $_________ |
| 3006c |
| CPT Code 93226 – Holter Monitoring Service |
| 350 |
| EA |
| $______ |
| $_________ |
| 3006d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 100 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
OHIO FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Chillicothe VA Medical Center (Chillicothe) 17273 State Route 104 Chillicothe, OH 45601
| 3007a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 4007b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 3007c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 3007d |
| CPT Code 0297T – Holter Monitoring Service (14 days) |
| 0 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Cincinnati VA Medical Center (Cincinnati) 3200 Vine St. Cincinnati, OH 45220
| 3008a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 140 |
| 3008b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 10 |
| EA |
| $______ |
| $_________ |
| 3008c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 3008d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Chalmers P. Wylie VA Ambulatory Care Center (Columbus) 420 N. James Rd. Columbus, OH 43219
| 3009a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 62 |
| EA |
| $______ |
| $_________ |
| 3009b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 3009c |
| CPT Code 93226 – Holter Monitoring Service |
| 38 |
| EA |
| $______ |
| $_________ |
| 3009d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Dayton VA Medical Center (Dayton) 4100 W. Third St. Dayton, OH 45428
| 3010a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 3010b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 3010c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 3010d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
ORDERING PERIOD 4 ESTIMATED TOTAL
Ordering Period 5 – May 13, 2026, through May 12, 2027
INDIANA FACILITIES
| Facility |
| Item No. | |
| Description | |
| Est. Qty. | |
| Unit | |
| Unit Price | |
| Total | |
Price
Richard L. Roudebush VA Medical Center (Indianapolis) 1481 W. 10th Street, Indianapolis, IN 46202
| 4001a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 4001b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 300 |
| EA |
| $______ |
| $_________ |
| 4001c |
| CPT Code 93226 – Holter Monitoring Service |
| 300 |
| EA |
| $______ |
| $_________ |
| 4001d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Northern Indiana Healthcare System (Fort Wayne & Marion) 2121 Lake Avenue, Fort Wayne, IN 46805
| 4002a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 40 |
| EA |
| $______ |
| $_________ |
| 4002b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 20 |
| EA |
| $______ |
| $_________ |
| 4002c |
| CPT Code 93226 – Holter Monitoring Service |
| 42 |
| EA |
| $______ |
| $_________ |
| 4002d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
MICHIGAN FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Ann Arbor Healthcare System 2215 Fuller Rd Ann Arbor, MI 48105
| 4003a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 100 |
| EA |
| $______ |
| $_________ |
| 4003b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 360 |
| EA |
| $______ |
| $_________ |
| 4003c |
| CPT Code 93226 – Holter Monitoring Service |
| 24 |
| EA |
| $______ |
| $_________ |
| 4003d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 120 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
John D. Dingell Healthcare System (Detroit) 4646 John R. Street, Detroit, MI 48201
| 4004a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 0 |
| EA |
| $______ |
| $_________ |
| 4004b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 180 |
| EA |
| $______ |
| $_________ |
| 4004c |
| CPT Code 93226 – Holter Monitoring Service |
| 212 |
| EA |
| $______ |
| $_________ |
| 4004d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Aleda E. Lutz Healthcare System (Saginaw) 1500 Weiss St Saginaw, MI 48602
| 4005a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 166 |
| EA |
| $______ |
| $_________ |
| 4005b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 166 |
| EA |
| $______ |
| $_________ |
| 4005c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 4005d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 360 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Battle Creek VA Healthcare System 5500 Armstrong Rd, Battle Creek, MI 49037
| 4006a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 4006b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 350 |
| EA |
| $______ |
| $_________ |
| 4006c |
| CPT Code 93226 – Holter Monitoring Service |
| 350 |
| EA |
| $______ |
| $_________ |
| 4006d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
| 100 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
OHIO FACILITIES
| Facility |
| Item No. |
| Description |
| Est. Qty. |
| Unit |
| Unit Price |
| Total |
Price
Chillicothe VA Medical Center (Chillicothe) 17273 State Route 104 Chillicothe, OH 45601
| 4007a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 150 |
| EA |
| $______ |
| $_________ |
| 4007b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 4007c |
| CPT Code 93226 – Holter Monitoring Service |
| 360 |
| EA |
| $______ |
| $_________ |
| 4007d |
| CPT Code 0297T – Holter Monitoring Service (14 days) |
| 0 |
| EA |
| $______ |
| $_________ |
ESTIMATED TOTAL
Cincinnati VA Medical Center (Cincinnati) 3200 Vine St. Cincinnati, OH 45220
| 4008a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 140 |
| 4008b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 10 |
| EA |
| $______ |
| $_________ |
| 4008c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 4008d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Chalmers P. Wylie VA Ambulatory Care Center (Columbus) 420 N. James Rd. Columbus, OH 43219
| 4009a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 62 |
| EA |
| $______ |
| $_________ |
| 4009b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 4009c |
| CPT Code 93226 – Holter Monitoring Service |
| 38 |
| EA |
| $______ |
| $_________ |
| 4009d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
Dayton VA Medical Center (Dayton) 4100 W. Third St. Dayton, OH 45428
| 4010a |
| CPT Code 93271 – Arrhythmia (event) Monitoring Svc. |
| 50 |
| EA |
| $______ |
| $_________ |
| 4010b |
| CPT Code 93229 – Mobile Outpatient Telemetry (up to 30 days) |
| 0 |
| EA |
| $______ |
| $_________ |
| 4010c |
| CPT Code 93226 – Holter Monitoring Service |
| 0 |
| EA |
| $______ |
| $_________ |
| 4010d |
| Holter Monitoring Service - up to 14 days |
(CPT codes 93242 and 93246)
ESTIMATED TOTAL
ORDERING PERIOD 5 ESTIMATED TOTAL
| ESTIMATED AGGREGATE TOTAL FOR BASE & ALL ORDERING PERIODS |
| $_______________ |
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