UPDATED 36C25025R0061 LineItems 12 12 25.xlsx
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- W065--VISN10 Home 02 Services (IN & MI)
- Solicitation number
- 36C25025R0061
About this file
This is a detailed line item pricing spreadsheet for a Veterans Health Administration (VHA) VISN 10 Home Oxygen Services contract covering medical oxygen equipment rental and related supplies for facilities in Indiana and Michigan. The contract spans five one-year ordering periods from February 1, 2026, to January 31, 2031, with consistent line items across six VA medical centers: Ann Arbor, Battle Creek, Detroit, Indianapolis, Northern Indiana Health Care System, and Aleda E. Lutz VAMC in Saginaw.
The line items include a comprehensive range of medical oxygen and respiratory equipment rentals, such as oxygen concentrators (with flow rates up to 5 and 10 LPM), portable oxygen systems, refillable oxygen cylinders, backup cylinder systems, portable oxygen concentrators, extra batteries, and various respiratory support equipment like suction machines, ventilators, humidifiers, tracheostomy care supplies, and specialized masks. Quantities vary by facility but generally range from 1-500 units per line item per year. Each facility has identical line item structures across the five-year contract period, suggesting a standardized approach to medical oxygen equipment procurement for VISN 10's Indiana and Michigan VA medical centers.
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| File | Type | Posted |
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| 36C25025R0061 0005.docx | DOCX document | |
| 36C25025R0061 0004.docx | DOCX document | |
| UPDATED 36C25025R0061 LineItems 11 18 25.xlsx | XLSX spreadsheet | |
| 36C25025R0061 0003.docx | DOCX document | |
| 36C25025R0061 0002.docx | DOCX document | |
| UPDATED 36C25025R0061 LineItems 10 22 25.xlsx | XLSX spreadsheet | |
| 36C25025R0061 0001.docx | DOCX document | |
| 36C25025R0061 LineItems 9 30 25.xlsx | XLSX spreadsheet | |
| SCHEDULE.xlsx | XLSX spreadsheet | |
| 36C25025R0061.docx | DOCX document |
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Text version
Action Line Item Information
| Action Type Name | Primary ID | Secondary ID | Mod Number | Title | Order Discount Type Name | Order Discount Type | Order Discount | |
| RFP | 36C25024R0147 | VISN10 Home 02 Services | ||||||
| (IN & MI) | Percent | 0 |
KB Version: FY24.09A
Items
| Item Number | SLIN | Description | Contract Period | Pop Begin | Pop End | Estimated Monthly Quantity | Unit Price | Units (Monthy is reoccuring and EA or Set or Pound is Single use/not reoccuring) | Total Price | HCPC | PRINCIPAL NAICS CODE | PRODUCT/SERVICE CODE | |
| 0001 | VA Ann Arbor Healthcare System - 2215 Fuller Road, Ann Arbor, MI 48105 | 621610 | W065 | ||||||||||
| 0001 | AA | Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 160 | 12 Months | E1390 | 621610 | W065 | |||
| 0001 | AB | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E1390 | 621610 | W065 | |||
| 0001 | AC | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 5 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 200 | 12 Months | E1390 | 621610 | W065 | |||
| 0001 | AD | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 75 | 12 Months | E1390 | 621610 | W065 | |||
| 0001 | AE | Refillable – type oxygen cylinder- Rental of additional re-fillable cylinders for patients who are assessed to have an extended need for oxygen portability due to high liter flow and/or increased patient activity outside of the home. E0443 | Ordering Period 1 | 2/1/26 | 1/31/27 | 500 | 12 Months | E0443 | 621610 | W065 | |||
| 0001 | B | Cylinder, size M or H set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies (emergency backup system or as primary) NOTICE: This shall be invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced with a full cylinder (reference CLIN C regarding refills or replacements). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0001 | C | Cylinder, size M or H refill/replacement (Backup/Primary) E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0001 | D | Portable system ONLY: prescription does not include concentrator consists of “E”, “D”, “B” (M6), or “C” (M9) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. NOTICE: This shall be | |||||||||||
| invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced (reference clins E-H regarding refills). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | EA | E0431 | 621610 | W065 | |||||
| 0001 | E | Cylinder, size “E” refill/replacement for CLIN D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0443 | 621610 | W065 | |||
| 0001 | F | Cylinder, size “D” (M15) refill/replacement for CLIN D; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0443 | 621610 | W065 | |||
| 0001 | G | Cylinder, size “B” (M6) refill/replacement for CLIN D; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0443 | 621610 | W065 | |||
| 0001 | H | Cylinder, size “C” refill/replacement for CLIN D; Aluminum (or metal of equivalent weight) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0443 | 621610 | W065 | |||
| 0001 | I | Demand Nasal Cannula (e.g. Oximeter) Reservoir or pendant/equivalent. VA111 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | VA111 | 621610 | W065 | |||
| 0001 | J | Removed | Ordering Period 1 | 2/1/26 | 1/31/27 | 0 | N/A | VA111 | 621610 | W065 | |||
| 0001 | K | Rental liquid oxygen system (90 –100 lbs.) stationary reservoir per patient. E0439; AND Rental portable liquid oxygen system per patient E0434 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0439 | 621610 | W065 | |||
| 0001 | L | Liquid oxygen per pound for portable liquid oxygen system under Item K. E0444 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | Pound | E0444 | 621610 | W065 | |||
| 0001 | M | Delivery for re-supply and/or relocation of equipment due to change in patient’s residence | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | 621610 | W065 | ||||
| 0001 | NA | Portable Concentrator- Rental portable oxygen concentrator E1392 | Ordering Period 1 | 2/1/26 | 1/31/27 | 230 | 12 Months | E1392 | 621610 | W065 | |||
| 0001 | NB | Extra Battery for Portable Oxygen Concentrator – Temporary rental to be used only during patient travel, when extended time away from a permanent power source is expected. E1356 | Ordering Period 1 | 2/1/26 | 1/31/27 | 100 | 12 Months | E1356 | 621610 | W065 | |||
| 0001 | O | Overnight Oximeter- Rental oximeter for overnight oximetry testing E0445 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0445 | 621610 | W065 | |||
| 0001 | P | Suction Machine- Rental suction machine E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E0600 | 621610 | W065 | |||
| 0001 | Q | Compressor 50 psi - Rental 50 psi air compressor E0565 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0565 | 621610 | W065 | |||
| 0001 | R | Ventilator Negative Pressure ventilator; portable or stationary; Rental negative pressure ventilator E0465 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0465 | 621610 | W065 | |||
| 0001 | S | Pressure support ventilator with volume control mode; may include pressure control mode; Rental pressure support ventilator | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E0465 | 621610 | W065 | |||
| 0001 | T | Oxygen Thermal Fuse (Fire Safe Cannula)- fuse to isolate oxygen supply in case of fire | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | Set | VA186 | 621610 | W065 | |||
| 0001 | U | Closed Suction Catheters – Contractor shall provide closed suction catheters to each ventilator patient each month, Catheters shall be replaced as needed during monthly visit by contractor RT. A4605 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4605 | 621610 | W065 | |||
| 0001 | V | Heated Humidifier- The contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. | Ordering Period 1 | 2/1/26 | 1/31/27 | 35 | 12 Months | E0562 | 621610 | W065 | |||
| 0001 | W | Portable Suction Machine- The contractor shall provide a portable suction machine equipped with an internal battery for use during transport to Veterans receiving mechanical ventilation only E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E0600 | 621610 | W065 | |||
| 0001 | X | Nebulizer with Compressor- The contractor will provide a nebulizer with compressor to ventilator patients only, as ordered by the VA. MONTHLY PRICE shall include spring loaded T-adapter, neb cups, tubing, masks, trach masks. E0570 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0570 | 621610 | W065 | |||
| 0001 | Y | Tracheostomy care supplies – The contractor shall provide supplies needed to properly clean and maintain trach and stoma to ventilator patients only. These supplies shall include, tracheostomy drain sponges A6402, basic tracheostomy care kits A4629, 3ml UNIT dose normal saline A4649, cuffed and uncuffed tracheostomy tubes A7521, A7520, tracheostomy inner cannulas A4623 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4623 | 621610 | W065 | |||
| 0001 | Z | Inline HME- The contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving noninvasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. A4483 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4483 | 621610 | W065 | |||
| 0001 | Z1 | PAP Pressure Valve- Contractor shall furnish a Positive Airway Pressure (PAP) Valve to each Veteran on nocturnal oxygen bled into a Positive Airway Pressure (PAP) Device when ordered by the VAMC. E1399 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E1399 | 621610 | W065 | |||
| 0001 | Z2 | Variable concentration mask, (such as oxytrach mask, oxymask, or like mask) - The contractor shall provide a variable concentration mask to Veterans, as ordered by VA Medical Center Staff. This shall include the mask and all mask components | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | EA | A4620 | 621610 | W065 | |||
| 0001 | Z3 | Rental Mouthpiece Ventilation (e.g., sip n puff, easyspeak) to include all disposable accessories required | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E1399 | 621610 | W065 | |||
| 0001 | Z4 | Combination Oral/Nasal Mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7027 | 621610 | W065 | |||
| 0001 | Z5 | Full Face PAP Mask - The contractor shall provide a full face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7030 | 621610 | W065 | |||
| 0001 | Z6 | Cough Stimulating Device - Notice this MONTHLY PRICE shall include all components required for operation of the device, both disposable and non-disposable components. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0482 | 621610 | W065 | |||
| 0002 | Battle Creek VA Medical Center - 5500 Armstrong Rd. Battle Creek, MI 49037 | ||||||||||||
| 0002 | AA | Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 200 | 12 Months | E1390 | 621610 | W065 | |||
| 0002 | AB | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E1390 | 621610 | W065 | |||
| 0002 | AC | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 5 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 200 | 12 Months | E1390 | 621610 | W065 | |||
| 0002 | AD | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 150 | 12 Months | E1390 | 621610 | W065 | |||
| 0002 | AE | Refillable – type oxygen cylinder- Rental of additional re-fillable cylinders for patients who are assessed to have an extended need for oxygen portability due to high liter flow and/or increased patient activity outside of the home. E0443 | Ordering Period 1 | 2/1/26 | 1/31/27 | 700 | 12 Months | E0443 | 621610 | W065 | |||
| 0002 | B | Cylinder, size M or H set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies (emergency backup system or as primary) NOTICE: This shall be invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced with a full cylinder (reference CLIN C regarding refills or replacements). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | E0424 | 621610 | W065 | |||
| 0002 | C | Cylinder, size M or H refill/replacement (Backup/Primary) E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0002 | D | Portable system ONLY: prescription does not include concentrator consists of “E”, “D”, “B” (M6), or “C” (M9) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. NOTICE: This shall be | |||||||||||
| invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced (reference clins E-H regarding refills). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | EA | E0431 | 621610 | W065 | |||||
| 0002 | E | Cylinder, size “E” refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0443 | 621610 | W065 | |||
| 0002 | F | Cylinder, size “D” (M15) refill/replacement for Item D above. Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0443 | 621610 | W065 | |||
| 0002 | G | Cylinder, size “B” (M6) refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0443 | 621610 | W065 | |||
| 0002 | H | Cylinder, size “C” refill/replacement for Item D above; Aluminum (or metal of equivalent weight) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0443 | 621610 | W065 | |||
| 0002 | I | Demand Nasal Cannula (e.g. Oximeter) Reservoir or pendant/equivalent. VA111 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | VA111 | 621610 | W065 | |||
| 0002 | J | Removed | Ordering Period 1 | 2/1/26 | 1/31/27 | 0 | N/A | VA111 | 621610 | W065 | |||
| 0002 | K | Rental liquid oxygen system (90 –100 lbs.) stationary reservoir per patient. E0439; AND Rental portable liquid oxygen system per patient E0434 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0439 | 621610 | W065 | |||
| 0002 | L | Liquid oxygen per pound for portable liquid oxygen system under Item K. E0444 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | Pound | E0444 | 621610 | W065 | |||
| 0002 | M | Delivery for re-supply and/or relocation of equipment due to change in patient’s residence | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | 621610 | W065 | ||||
| 0002 | NA | Portable Concentrator- Rental portable oxygen concentrator E1392 | Ordering Period 1 | 2/1/26 | 1/31/27 | 250 | 12 Months | E1392 | 621610 | W065 | |||
| 0002 | NB | Extra Battery for Portable Oxygen Concentrator – Temporary rental to be used only during patient travel, when extended time away from a permanent power source is expected. E1356 | Ordering Period 1 | 2/1/26 | 1/31/27 | 80 | 12 Months | E1356 | 621610 | W065 | |||
| 0002 | O | Overnight Oximeter- Rental oximeter for overnight oximetry testing E0445 | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E0445 | 621610 | W065 | |||
| 0002 | P | Suction Machine- Rental suction machine E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0600 | 621610 | W065 | |||
| 0002 | Q | Compressor 50 psi - Rental 50 psi air compressor E0565 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0565 | 621610 | W065 | |||
| 0002 | R | Ventilator Negative Pressure ventilator; portable or stationary; Rental negative pressure ventilator E0465 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0465 | 621610 | W065 | |||
| 0002 | S | Pressure support ventilator with volume control mode; may include pressure control mode; Rental pressure support ventilator | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E0465 | 621610 | W065 | |||
| 0002 | T | Oxygen Thermal Fuse (Fire Safe Cannula)- fuse to isolate oxygen supply in case of fire | Ordering Period 1 | 2/1/26 | 1/31/27 | 60 | Set | VA186 | 621610 | W065 | |||
| 0002 | U | Closed Suction Catheters – Contractor shall provide closed suction catheters to each ventilator patient each month, Catheters shall be replaced as needed during monthly visit by contractor RT. A4605 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | A4605 | 621610 | W065 | |||
| 0002 | V | Heated Humidifier- The contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0562 | 621610 | W065 | |||
| 0002 | W | Portable Suction Machine- The contractor shall provide a portable suction machine equipped with an internal battery for use during transport. E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0600 | 621610 | W065 | |||
| 0002 | X | Nebulizer with Compressor- The contractor will provide a nebulizer with compressor to ventilator patients only, as ordered by the VA. MONTHLY PRICE shall include spring loaded T-adapter, neb cups, tubing, masks, trach masks. E0570 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0570 | 621610 | W065 | |||
| 0002 | Y | Tracheostomy care supplies – The contractor shall provide supplies needed to properly clean and maintain trach and stoma to ventilator patients only. These supplies shall include, tracheostomy drain sponges A6402, basic tracheostomy care kits A4629, 3ml UNIT dose normal saline A4649, cuffed and uncuffed tracheostomy tubes A7521, A7520, tracheostomy inner cannulas A4623 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4623 | 621610 | W065 | |||
| 0002 | Z | Inline HME- The contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving noninvasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. A4483 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4483 | 621610 | W065 | |||
| 0002 | Z1 | PAP Pressure Valve- Contractor shall furnish a Positive Airway Pressure (PAP) Valve to each Veteran on nocturnal oxygen bled into a Positive Airway Pressure (PAP) Device when ordered by the VAMC. E1399 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E1399 | 621610 | W065 | |||
| 0002 | Z2 | Variable Concentration Trach Mask - The contractor shall provide a variable concentration trach mask to Veterans, as ordered by VA Medical Center Staff. This shall include the mask and all mask components | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | A4620 | 621610 | W065 | |||
| 0002 | Z3 | Rental Mouthpiece Ventilation (e.g., sip n puff, easyspeak) to include all disposable accessories required | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E1399 | 621610 | W065 | |||
| 0002 | Z4 | Combination Oral/Nasal Mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7027 | 621610 | W065 | |||
| 0002 | Z5 | Full Face PAP Mask - The contractor shall provide a full face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7030 | 621610 | W065 | |||
| 0002 | Z6 | Cough Stimulating Device - Notice this MONTHLY PRICE shall include all components required for operation of the device, both disposable and non-disposable components. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0482 | 621610 | W065 | |||
| 0003 | Detroit VAMC 4646 John R. St. Detroit, MI 48201 | ||||||||||||
| 0003 | AA | Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 165 | 12 Months | E1390 | 621610 | W065 | |||
| 0003 | AB | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E1390 | 621610 | W065 | |||
| 0003 | AC | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 5 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 180 | 12 Months | E1390 | 621610 | W065 | |||
| 0003 | AD | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 80 | 12 Months | E1390 | 621610 | W065 | |||
| 0003 | AE | Refillable – type oxygen cylinder- Rental of additional re-fillable cylinders for patients who are assessed to have an extended need for oxygen portability due to high liter flow and/or increased patient activity outside of the home. E0443 | Ordering Period 1 | 2/1/26 | 1/31/27 | 410 | 12 Months | E0443 | 621610 | W065 | |||
| 0003 | B | Cylinder, size M or H set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies (emergency backup system or as primary) NOTICE: This shall be invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced with a full cylinder (reference CLIN C regarding refills or replacements). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0003 | C | Cylinder, size M or H refill/replacement (Backup/Primary) E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0003 | D | Portable system ONLY: prescription does not include concentrator consists of “E”, “D”, “B” (M6), or “C” (M9) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. NOTICE: This shall be | |||||||||||
| invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced (reference clins E-H regarding refills). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | EA | E0431 | 621610 | W065 | |||||
| 0003 | E | Cylinder, size “E” refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0443 | 621610 | W065 | |||
| 0003 | F | Cylinder, size “D” (M15) refill/replacement for Item D above. Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0443 | 621610 | W065 | |||
| 0003 | G | Cylinder, size “B” (M6) refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0443 | 621610 | W065 | |||
| 0003 | H | Cylinder, size “C” refill/replacement for Item D above; Aluminum (or metal of equivalent weight) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0443 | 621610 | W065 | |||
| 0003 | I | Demand Nasal Cannula (e.g. Oximeter) Reservoir or pendant/equivalent. VA111 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | VA111 | 621610 | W065 | |||
| 0003 | J | Removed | Ordering Period 1 | 2/1/26 | 1/31/27 | 0 | N/A | VA111 | 621610 | W065 | |||
| 0003 | K | Rental liquid oxygen system (90 –100 lbs.) stationary reservoir per patient. E0439; AND Rental portable liquid oxygen system per patient E0434 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0439 | 621610 | W065 | |||
| 0003 | L | Liquid oxygen per pound for portable liquid oxygen system under Item K. E0444 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | Pound | E0444 | 621610 | W065 | |||
| 0003 | M | Delivery for re-supply and/or relocation of equipment due to change in patient’s residence | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | 621610 | W065 | ||||
| 0003 | NA | Portable Concentrator- Rental portable oxygen concentrator E1392 | Ordering Period 1 | 2/1/26 | 1/31/27 | 250 | 12 Months | E1392 | 621610 | W065 | |||
| 0003 | NB | Extra Battery for Portable Oxygen Concentrator – Temporary rental to be used only during patient travel, when extended time away from a permanent power source is expected. E1356 | Ordering Period 1 | 2/1/26 | 1/31/27 | 60 | 12 Months | E1356 | 621610 | W065 | |||
| 0003 | O | Overnight Oximeter- Rental oximeter for overnight oximetry testing E0445 | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E0445 | 621610 | W065 | |||
| 0003 | P | Suction Machine- Rental suction machine E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0600 | 621610 | W065 | |||
| 0003 | Q | Compressor 50 psi - Rental 50 psi air compressor E0565 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0565 | 621610 | W065 | |||
| 0003 | R | Ventilator Negative Pressure ventilator; portable or stationary; Rental negative pressure ventilator E0465 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0465 | 621610 | W065 | |||
| 0003 | S | Pressure support ventilator with volume control mode; may include pressure control mode; Rental pressure support ventilator | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0465 | 621610 | W065 | |||
| 0003 | T | Oxygen Thermal Fuse (Fire Safe Cannula)- fuse to isolate oxygen supply in case of fire | Ordering Period 1 | 2/1/26 | 1/31/27 | 60 | Set | VA186 | 621610 | W065 | |||
| 0003 | U | Closed Suction Catheters – Contractor shall provide closed suction catheters to each ventilator patient each month, Catheters shall be replaced as needed during monthly visit by contractor RT. A4605 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4605 | 621610 | W065 | |||
| 0003 | V | Heated Humidifier- The contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0562 | 621610 | W065 | |||
| 0003 | W | Portable Suction Machine- The contractor shall provide a portable suction machine equipped with an internal battery for use during transport to Veterans receiving mechanical ventilation only E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0600 | 621610 | W065 | |||
| 0003 | X | Nebulizer with Compressor- The contractor will provide a nebulizer with compressor to ventilator patients only, as ordered by the VA. MONTHLY PRICE shall include spring loaded T-adapter, neb cups, tubing, masks, trach masks. E0570 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0570 | 621610 | W065 | |||
| 0003 | Y | Tracheostomy care supplies – The contractor shall provide supplies needed to properly clean and maintain trach and stoma to ventilator patients only. These supplies shall include, tracheostomy drain sponges A6402, basic tracheostomy care kits A4629, 3ml UNIT dose normal saline A4649, cuffed and uncuffed tracheostomy tubes A7521, A7520, tracheostomy inner cannulas A4623 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4623 | 621610 | W065 | |||
| 0003 | Z | Inline HME- The contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving noninvasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. A4483 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | A4483 | 621610 | W065 | |||
| 0003 | Z1 | PAP Pressure Valve- Contractor shall furnish a Positive Airway Pressure (PAP) Valve to each Veteran on nocturnal oxygen bled into a Positive Airway Pressure (PAP) Device when ordered by the VAMC. E1399 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E1399 | 621610 | W065 | |||
| 0003 | Z2 | Variable Concentration Trach Mask - The contractor shall provide a variable concentration trach mask to Veterans, as ordered by VA Medical Center Staff. This shall include the mask and all mask components | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4620 | 621610 | W065 | |||
| 0003 | Z3 | Rental Mouthpiece Ventilation (e.g., sip n puff, easyspeak) to include all disposable accessories required | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E1399 | 621610 | W065 | |||
| 0003 | Z4 | Combination Oral/Nasal Mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7027 | 621610 | W065 | |||
| 0003 | Z5 | Full Face PAP Mask - The contractor shall provide a full face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to vetnilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7030 | |||||
| 0003 | Z6 | Cough Stimulating Device - Notice this MONTHLY PRICE shall include all components required for operation of the device, both disposable and non-disposable components. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0482 | 621610 | W065 | |||
| 0004 | Indianapolis VAMC 1481 W. 10th St. Indianapolis, IN 46202 | ||||||||||||
| 0004 | AA | Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 95 | 12 Months | E1390 | 621610 | W065 | |||
| 0004 | AB | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E1390 | 621610 | W065 | |||
| 0004 | AC | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 5 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 100 | 12 Months | E1390 | 621610 | W065 | |||
| 0004 | AD | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 65 | 12 Months | E1390 | 621610 | W065 | |||
| 0004 | AE | Refillable – type oxygen cylinder- Rental of additional re-fillable cylinders for patients who are assessed to have an extended need for oxygen portability due to high liter flow and/or increased patient activity outside of the home. E0443 | Ordering Period 1 | 2/1/26 | 1/31/27 | 280 | 12 Months | E0443 | 621610 | W065 | |||
| 0004 | B | Cylinder, size M or H set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies (emergency backup system or as primary) NOTICE: This shall be invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced with a full cylinder (reference CLIN C regarding refills or replacements). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | E0424 | 621610 | W065 | |||
| 0004 | C | Cylinder, size M or H refill/replacement (Backup/Primary) E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0004 | D | Portable system ONLY: prescription does not include concentrator consists of “E”, “D”, “B” (M6), or “C” (M9) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. NOTICE: This shall be | |||||||||||
| invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced (reference clins E-H regarding refills). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 35 | EA | E0431 | 621610 | W065 | |||||
| 0004 | E | Cylinder, size “E” refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0443 | 621610 | W065 | |||
| 0004 | F | Cylinder, size “D” (M15) refill/replacement for Item D above. Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0443 | 621610 | W065 | |||
| 0004 | G | Cylinder, size “B” (M6) refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0443 | 621610 | W065 | |||
| 0004 | H | Cylinder, size “C” refill/replacement for Item D above; Aluminum (or metal of equivalent weight) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0443 | 621610 | W065 | |||
| 0004 | I | Demand Nasal Cannula (e.g. Oximeter) Reservoir or pendant/equivalent. VA111 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | VA111 | 621610 | W065 | |||
| 0004 | J | Removed | Ordering Period 1 | 2/1/26 | 1/31/27 | 0 | N/A | VA111 | 621610 | W065 | |||
| 0004 | K | Rental liquid oxygen system (90 –100 lbs.) stationary reservoir per patient. E0439; AND Rental portable liquid oxygen system per patient E0434 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0439 | 621610 | W065 | |||
| 0004 | L | Liquid oxygen per pound for portable liquid oxygen system under Item K. E0444 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | Pound | E0444 | 621610 | W065 | |||
| 0004 | M | Delivery for re-supply and/or relocation of equipment due to change in patient’s residence | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | 621610 | W065 | ||||
| 0004 | NA | Portable Concentrator- Rental portable oxygen concentrator E1392 | Ordering Period 1 | 2/1/26 | 1/31/27 | 140 | 12 Months | E1392 | 621610 | W065 | |||
| 0004 | NB | Extra Battery for Portable Oxygen Concentrator – Temporary rental to be used only during patient travel, when extended time away from a permanent power source is expected. E1356 | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E1356 | 621610 | W065 | |||
| 0004 | O | Overnight Oximeter- Rental oximeter for overnight oximetry testing E0445 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0445 | 621610 | W065 | |||
| 0004 | P | Suction Machine- Rental suction machine E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E0600 | 621610 | W065 | |||
| 0004 | Q | Compressor 50 psi - Rental 50 psi air compressor E0565 | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | 12 Months | E0565 | 621610 | W065 | |||
| 0004 | R | Ventilator Negative Pressure ventilator; portable or stationary; Rental negative pressure ventilator E0465 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0465 | 621610 | W065 | |||
| 0004 | S | Pressure support ventilator with volume control mode; may include pressure control mode; Rental pressure support ventilator | Ordering Period 1 | 2/1/26 | 1/31/27 | 35 | 12 Months | E0465 | 621610 | W065 | |||
| 0004 | T | Oxygen Thermal Fuse (Fire Safe Cannula)- fuse to isolate oxygen supply in case of fire | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | Set | VA186 | 621610 | W065 | |||
| 0004 | U | Closed Suction Catheters – Contractor shall provide closed suction catheters to each ventilator patient each month, Catheters shall be replaced as needed during monthly visit by contractor RT. A4605 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4605 | 621610 | W065 | |||
| 0004 | V | Heated Humidifier- The contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0562 | 621610 | W065 | |||
| 0004 | W | Portable Suction Machine- The contractor shall provide a portable suction machine equipped with an internal battery for use during transport to Veterans receiving mechanical ventilation only E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0600 | 621610 | W065 | |||
| 0004 | X | Nebulizer with Compressor- The contractor will provide a nebulizer with compressor to ventilator patients only, as ordered by the VA. MONTHLY PRICE shall include spring loaded T-adapter, neb cups, tubing, masks, trach masks. E0570 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0570 | 621610 | W065 | |||
| 0004 | Y | Tracheostomy care supplies – The contractor shall provide supplies needed to properly clean and maintain trach and stoma to ventilator patients only. These supplies shall include, tracheostomy drain sponges A6402, basic tracheostomy care kits A4629, 3ml UNIT dose normal saline A4649, cuffed and uncuffed tracheostomy tubes A7521, A7520, tracheostomy inner cannulas A4623 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4623 | 621610 | W065 | |||
| 0004 | Z | Inline HME- The contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving noninvasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. A4483 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4483 | 621610 | W065 | |||
| 0004 | Z1 | PAP Pressure Valve- Contractor shall furnish a Positive Airway Pressure (PAP) Valve to each Veteran on nocturnal oxygen bled into a Positive Airway Pressure (PAP) Device when ordered by the VAMC. E1399 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | E1399 | 621610 | W065 | |||
| 0004 | Z2 | Variable Concentration Trach Mask - The contractor shall provide a variable concentration trach mask to Veterans, as ordered by VA Medical Center Staff. This shall include the mask and all mask components | Ordering Period 1 | 2/1/26 | 1/31/27 | 15 | EA | A4620 | 621610 | W065 | |||
| 0004 | Z3 | Rental Mouthpiece Ventilation (e.g., sip n puff, easyspeak) to include all disposable accessories required | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E1399 | 621610 | W065 | |||
| 0004 | Z4 | Combination Oral/Nasal Mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7027 | 621610 | W065 | |||
| 0004 | Z5 | Full Face PAP Mask - The contractor shall provide a full face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7030 | 621610 | W065 | |||
| 0004 | Z6 | Cough Stimulating Device - Notice this MONTHLY PRICE shall include all components required for operation of the device, both disposable and non-disposable components. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0482 | 621610 | W065 | |||
| 0005 | NIHCS VAMC 2121 Lake Ave. Fort Wayne, IN 46805 & 1700 E 38th St., Marion, IN 46953 | ||||||||||||
| 0005 | AA | Rental concentrator with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask and humidifier when specified). Concentrator will have flow rate capacity up to 5LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 100 | 12 Months | E1390 | 621610 | W065 | |||
| 0005 | AB | Rental concentrator with backup system consisting of compressed gas source, regulator, stand (nasal cannula or mask and humidifier when specified). Concentrator must have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | 12 Months | E1390 | 621610 | W065 | |||
| 0005 | AC | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 5 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 150 | 12 Months | E1390 | 621610 | W065 | |||
| 0005 | AD | Rental Concentrator with Portable Gaseous Oxygen System, home compressor used to fill portable oxygen cylinders- (2) self-filling -type oxygen cylinders, integrated oxygen conserving device, regulator, flow meter, humidifier, cannula or mask, tubing, cylinder carrier. Concentrator will have flow rate capacity up to 10 LPM. E1390 | Ordering Period 1 | 2/1/26 | 1/31/27 | 80 | 12 Months | E1390 | 621610 | W065 | |||
| 0005 | AE | Refillable – type oxygen cylinder- Rental of additional re-fillable cylinders for patients who are assessed to have an extended need for oxygen portability due to high liter flow and/or increased patient activity outside of the home. E0443 | Ordering Period 1 | 2/1/26 | 1/31/27 | 500 | 12 Months | E0443 | 621610 | W065 | |||
| 0005 | B | Cylinder, size M or H set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies (emergency backup system or as primary) NOTICE: This shall be invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced with a full cylinder (reference CLIN C regarding refills or replacements). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0005 | C | Cylinder, size M or H refill/replacement (Backup/Primary) E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment; backup system is provided at no cost | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | E0424 | 621610 | W065 | |||
| 0005 | D | Portable system ONLY: prescription does not include concentrator consists of “E”, “D”, “B” (M6), or “C” (M9) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. NOTICE: This shall be | |||||||||||
| invoiced per cylinder provided to the patient. This is NOT a recurring rental PRICE, charges will only incur when an empty cylinder is refilled or replaced (reference clins E-H regarding refills). SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | E0431 | 621610 | W065 | |||||
| 0005 | E | Cylinder, size “E” refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E0443 | 621610 | W065 | |||
| 0005 | F | Cylinder, size “D” (M15) refill/replacement for Item D above. Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 30 | 12 Months | E0443 | 621610 | W065 | |||
| 0005 | G | Cylinder, size “B” (M6) refill/replacement for Item D above; Aluminum (or metal of equivalent weight or less) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0443 | 621610 | W065 | |||
| 0005 | H | Cylinder, size “C” refill/replacement for Item D above; Aluminum (or metal of equivalent weight) tanks required E0443 SPECIAL NOTE: Regulators and Conserving devices shall be included in the monthly rental price for all applicable equipment | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0443 | 621610 | W065 | |||
| 0005 | I | Demand Nasal Cannula (e.g. Oximeter) Reservoir or pendant/equivalent. VA111 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | VA111 | 621610 | W065 | |||
| 0005 | J | Removed | Ordering Period 1 | 2/1/26 | 1/31/27 | 0 | N/A | VA111 | 621610 | W065 | |||
| 0005 | K | Rental liquid oxygen system (90 –100 lbs.) stationary reservoir per patient. E0439; AND Rental portable liquid oxygen system per patient E0434 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0439 | 621610 | W065 | |||
| 0005 | L | Liquid oxygen per pound for portable liquid oxygen system under Item K. E0444 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | Pound | E0444 | 621610 | W065 | |||
| 0005 | M | Delivery for re-supply and/or relocation of equipment due to change in patient’s residence | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | 621610 | W065 | ||||
| 0005 | NA | Portable Concentrator- Rental portable oxygen concentrator E1392 | Ordering Period 1 | 2/1/26 | 1/31/27 | 150 | 12 Months | E1392 | 621610 | W065 | |||
| 0005 | NB | Extra Battery for Portable Oxygen Concentrator – Temporary rental to be used only during patient travel, when extended time away from a permanent power source is expected. E1356 | Ordering Period 1 | 2/1/26 | 1/31/27 | 40 | 12 Months | E1356 | 621610 | W065 | |||
| 0005 | O | Overnight Oximeter- Rental oximeter for overnight oximetry testing E0445 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | 12 Months | E0445 | 621610 | W065 | |||
| 0005 | P | Suction Machine- Rental suction machine E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 20 | 12 Months | E0600 | 621610 | W065 | |||
| 0005 | Q | Compressor 50 psi - Rental 50 psi air compressor E0565 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0565 | 621610 | W065 | |||
| 0005 | R | Ventilator Negative Pressure ventilator; portable or stationary; Rental negative pressure ventilator E0465 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0465 | 621610 | W065 | |||
| 0005 | S | Pressure support ventilator with volume control mode; may include pressure control mode; Rental pressure support ventilator | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0465 | 621610 | W065 | |||
| 0005 | T | Oxygen Thermal Fuse (Fire Safe Cannula)- fuse to isolate oxygen supply in case of fire | Ordering Period 1 | 2/1/26 | 1/31/27 | 50 | Set | VA186 | 621610 | W065 | |||
| 0005 | U | Closed Suction Catheters – Contractor shall provide closed suction catheters to each ventilator patient each month, Catheters shall be replaced as needed during monthly visit by contractor RT. A4605 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | A4605 | 621610 | W065 | |||
| 0005 | V | Heated Humidifier- The contractor shall provide a heated humidifier to Veterans receiving mechanical ventilation to provide optimal levels of heat and moisture to the patient’s airway. | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0562 | 621610 | W065 | |||
| 0005 | W | Portable Suction Machine- The contractor shall provide a portable suction machine equipped with an internal battery for use during transport to Veterans receiving mechanical ventilation only E0600 | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | 12 Months | E0600 | 621610 | W065 | |||
| 0005 | X | Nebulizer with Compressor- The contractor will provide a nebulizer with compressor to ventilator patients only, as ordered by the VA. MONTHLY PRICE shall include spring loaded T-adapter, neb cups, tubing, masks, trach masks. E0570 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E0570 | 621610 | W065 | |||
| 0005 | Y | Tracheostomy care supplies – The contractor shall provide supplies needed to properly clean and maintain trach and stoma to ventilator patients only. These supplies shall include, tracheostomy drain sponges A6402, basic tracheostomy care kits A4629, 3ml UNIT dose normal saline A4649, cuffed and uncuffed tracheostomy tubes A7521, A7520, tracheostomy inner cannulas A4623 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A4623 | 621610 | W065 | |||
| 0005 | Z | Inline HME- The contractor shall provide an inline heated moisture exchanger (HME) to Veterans receiving noninvasive mechanical ventilation in order to provide optimal levels of heat and moisture to the patient’s airway. A4483 | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | EA | A4483 | 621610 | W065 | |||
| 0005 | Z1 | PAP Pressure Valve- Contractor shall furnish a Positive Airway Pressure (PAP) Valve to each Veteran on nocturnal oxygen bled into a Positive Airway Pressure (PAP) Device when ordered by the VAMC. E1399 | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | E1399 | 621610 | W065 | |||
| 0005 | Z2 | Variable Concentration Trach Mask - The contractor shall provide a variable concentration trach mask to Veterans, as ordered by VA Medical Center Staff. This shall include the mask and all mask components | Ordering Period 1 | 2/1/26 | 1/31/27 | 10 | EA | A4620 | 621610 | W065 | |||
| 0005 | Z3 | Rental Mouthpiece Ventilation (e.g., sip n puff, easyspeak) to include all disposable accessories required | Ordering Period 1 | 2/1/26 | 1/31/27 | 1 | 12 Months | E1399 | 621610 | W065 | |||
| 0005 | Z4 | Combination Oral/Nasal Mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to ventilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7027 | 621610 | W065 | |||
| 0005 | Z5 | Full Face PAP Mask - The contractor shall provide a full face mask to Veterans receiving non-invasive mechanical ventilation. This item is to be provided to vetnilator patients only. | Ordering Period 1 | 2/1/26 | 1/31/27 | 5 | EA | A7030 | 621610 | W065 |
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