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Complete by Vendor Estimated Quantities Per Year
First Option Year
| CLIN | Product Number | Material Description | Kansas City | Unit Price | Extended Price | Wichita | Unit Price | Extended Price | Quantity Total | Total Cost | Wichita |
| 00001 | | EPOC Reader | 0 | | | 2 | | | 2 | | |
| 00002 | | EDM Server | 0 | | | 1 | | | 1 | | |
| 00003 | | EPOC BGEM CREA TEST CARD [50 PK] | 118 | | | 10 | | | 128 | $ - 0 | 500-pats/50 QC |
| 00004 | | CV SET, BGEM, EUROTROL [20 VIALS] | 10 | | | 2.5 | | | 12.5 | $ - 0 | |
| 00005 | | CV SET, HCT, EUROTROL [20 VIALS] | 7 | | | 2.5 | | | 9.5 | $ - 0 | |
| 00006 | | QC FLUID, LVL1, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 | |
| 00007 | | QC FLUID, LVL3, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 | |
| 00008 | | QC FLUID, HCTA, EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 | |
| 00009 | | QC FLUID, HCTC EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 | |
| 00010 | | QC FLUID, HCTB EUROTROL [10X2.5ML] | 3 | | | 5 | | | 8 | $ - 0 | |
| 00011 | | EUROTROL GAS-ISE LEVEL 1 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 | |
| 00012 | | EUROTROL GAS-ISE LEVEL 3 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 | |
| TOTAL COST Base Year | $ - 0 |
| Estimated Quantities Per Year | | |
Option Year 1
| CLIN | Product Number | Material Description | Kansas City | Unit Price | Extended Price | Wichita | Unit Price | Extended Price | Quantity Total | Total Cost |
| 00001 | | EPOC Reader | 0 | | | 2 | | | 2 | |
| 00002 | | EDM Server | 0 | | | 1 | | | 1 | |
| 00003 | | EPOC BGEM CREA TEST CARD [50 PK] | 118 | | | 10 | | | 128 | $ - 0 |
| 00004 | | CV SET, BGEM, EUROTROL [20 VIALS] | 10 | | | 2.5 | | | 12.5 | $ - 0 |
| 00005 | | CV SET, HCT, EUROTROL [20 VIALS] | 7 | | | 2.5 | | | 9.5 | $ - 0 |
| 00006 | | QC FLUID, LVL1, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00007 | | QC FLUID, LVL3, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00008 | | QC FLUID, HCTA, EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00009 | | QC FLUID, HCTC EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00010 | | QC FLUID, HCTB EUROTROL [10X2.5ML] | 3 | | | 5 | | | 8 | $ - 0 |
| 00011 | | EUROTROL GAS-ISE LEVEL 1 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| 00012 | | EUROTROL GAS-ISE LEVEL 3 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| | TOTAL COST Option Year 1 | | | | | | | | $ - 0 |
Estimated Quantities Per Year
Option Year 2
| CLIN | Product Number | Material Description | Kansas City | Unit Price | Extended Price | Wichita | Unit Price | Extended Price | Quantity Total | Total Cost |
| 00001 | | EPOC Reader | 0 | | | 2 | | | 2 | |
| 00002 | | EDM Server | 0 | | | 1 | | | 1 | |
| 00003 | | EPOC BGEM CREA TEST CARD [50 PK] | 118 | | | 10 | | | 128 | $ - 0 |
| 00004 | | CV SET, BGEM, EUROTROL [20 VIALS] | 10 | | | 2.5 | | | 12.5 | $ - 0 |
| 00005 | | CV SET, HCT, EUROTROL [20 VIALS] | 7 | | | 2.5 | | | 9.5 | $ - 0 |
| 00006 | | QC FLUID, LVL1, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00007 | | QC FLUID, LVL3, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00008 | | QC FLUID, HCTA, EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00009 | | QC FLUID, HCTC EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00010 | | QC FLUID, HCTB EUROTROL [10X2.5ML] | 3 | | | 5 | | | 8 | $ - 0 |
| 00011 | | EUROTROL GAS-ISE LEVEL 1 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| 00012 | | EUROTROL GAS-ISE LEVEL 3 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| | TOTAL COST Option Year 2 | | | | | | | | $ - 0 |
| Estimated Quantities Per Year | | | | | | | | | | |
Option Year 3
| CLIN | Product Number | Material Description | Kansas City | Unit Price | Extended Price | Wichita | Unit Price | Extended Price | Quantity Total | Total Cost |
| 00001 | | EPOC Reader | 0 | | | 2 | | | 2 | |
| 00002 | | EDM Server | 0 | | | 1 | | | 1 | |
| 00003 | | EPOC BGEM CREA TEST CARD [50 PK] | 118 | | | 10 | | | 128 | $ - 0 |
| 00004 | | CV SET, BGEM, EUROTROL [20 VIALS] | 10 | | | 2.5 | | | 12.5 | $ - 0 |
| 00005 | | CV SET, HCT, EUROTROL [20 VIALS] | 7 | | | 2.5 | | | 9.5 | $ - 0 |
| 00006 | | QC FLUID, LVL1, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00007 | | QC FLUID, LVL3, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00008 | | QC FLUID, HCTA, EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00009 | | QC FLUID, HCTC EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00010 | | QC FLUID, HCTB EUROTROL [10X2.5ML] | 3 | | | 5 | | | 8 | $ - 0 |
| 00011 | | EUROTROL GAS-ISE LEVEL 1 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| 00012 | | EUROTROL GAS-ISE LEVEL 3 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| | TOTAL COST Option Year 3 | | | | | | | | $ - 0 |
| Estimated Quantities Per Year | | | | | | | | | | |
Option Year 4
| CLIN | Product Number | Material Description | Kansas City | Unit Price | Extended Price | Wichita | Unit Price | Extended Price | Quantity Total | Total Cost |
| 00001 | | EPOC Reader | 0 | | | 2 | | | 2 | |
| 00002 | | EDM Server | 0 | | | 1 | | | 1 | |
| 00003 | | EPOC BGEM CREA TEST CARD [50 PK] | 118 | | | 10 | | | 128 | $ - 0 |
| 00004 | | CV SET, BGEM, EUROTROL [20 VIALS] | 10 | | | 2.5 | | | 12.5 | $ - 0 |
| 00005 | | CV SET, HCT, EUROTROL [20 VIALS] | 7 | | | 2.5 | | | 9.5 | $ - 0 |
| 00006 | | QC FLUID, LVL1, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00007 | | QC FLUID, LVL3, EUROTROL [10X2.5ML] | 10 | | | 5 | | | 15 | $ - 0 |
| 00008 | | QC FLUID, HCTA, EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00009 | | QC FLUID, HCTC EUROTROL [10X2.5ML] | 6 | | | 5 | | | 11 | $ - 0 |
| 00010 | | QC FLUID, HCTB EUROTROL [10X2.5ML] | 3 | | | 5 | | | 8 | $ - 0 |
| 00011 | | EUROTROL GAS-ISE LEVEL 1 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| 00012 | | EUROTROL GAS-ISE LEVEL 3 QC FLUID [10/BOX] | 8 | | | 5 | | | 13 | $ - 0 |
| | TOTAL COST Option Year 4 | | | | | | | | $ - 0 |
Attachment B Test Count
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Kansas City VA Medical Center, Kansas City Missouri | | | | | | | | | | | | | | | | | |
| Base Year | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Kansas City | Green Top Tube | Waived or Moderate | Handheld | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | | |
| Total Cost Base Year | | | | | | | | | | | | | | | | |
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Kansas City VA Medical Center, Kansas City Missouri | | | | | | | | | | | | | | | | | |
| Option Year 1 Year | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Kansas City | Green Top Tube | Waived or Moderate | Handheld | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | | |
| TOTAL Cost Option Year 1 | | | | | | | | | | | | | | | | |
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Kansas City VA Medical Center, Kansas City Missouri | | | | | | | | | | | | | | | | | |
| Option Year 2 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Kansas City | Green Top Tube | Waived or Moderate | Handheld | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | | |
| Total Cost Option Year 2 | | | | | | | | | | | | | | | | |
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Kansas City VA Medical Center, Kansas City Missouri | | | | | | | | | | | | | | | | | |
| Option Year 3 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Kansas City | Green Top Tube | Waived or Moderate | Handheld | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | | |
| Total Cost Option Year 3 | | | | | | | | | | | | | | | | |
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Kansas City VA Medical Center, Kansas City Missouri | | | | | | | | | | | | | | | | | |
| Option Year 4 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Kansas City | Green Top Tube | Waived or Moderate | Handheld | NA | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | | |
| Total Cost Option Year 4 | | | | | | | | | | | | | | | | |
| Estimated Quantities Per Year | | | | | | | | | | | | | | | | | |
| Robert J Dole VA Medical Center, Wichita, Kansas | | | | | | | | | | | | | | | | | |
| Base Year | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Wichita | Green Top Tube | Waived or Moderate | Handheld | Radiology/MRI | 2 | 2 | 2 | 500 | 50 | 30 | 30 | 30 | 640 | | |
| Total Cost Base Year | | | | | | | | | | | | | | | | |
| Robert J Dole VA Medical Center, Wichita, Kansas | | | | | | | | | | | | | | | | | |
| Option Year 1 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Wichita | Green Top Tube | Waived or Moderate | Handheld | Radiology/MRI | 2 | 2 | 2 | 500 | 50 | 30 | 30 | 30 | 640 | | |
| Total Cost Option Year 1 | | | | | | | | | | | | | | | | |
| Robert J Dole VA Medical Center, Wichita, Kansas | | | | | | | | | | | | | | | | | |
| Option Year 2 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Wichita | Green Top Tube | Waived or Moderate | Handheld | Radiology/MRI | 2 | 2 | 2 | 500 | 50 | 30 | 30 | 30 | 640 | | |
| Total Cost Option Year 2 | | | | | | | | | | | | | | | | |
| Robert J Dole VA Medical Center, Wichita, Kansas | | | | | | | | | | | | | | | | | |
| Option Year 3 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Wichita | Green Top Tube | Waived or Moderate | Handheld | Radiology/MRI | 2 | 2 | 2 | 500 | 50 | 30 | 30 | 30 | 640 | | |
| Total Option Year 3 | | | | | | | | | | | | | | | | |
| Robert J Dole VA Medical Center, Wichita, Kansas | | | | | | | | | | | | | | | | | |
| Option Year 4 | | | | | | | | | | | | | | | | | |
| CLIN | ASSAY | FACILITY | Sample Type | CLIA Complexity | Device Type Based on Usage | Analyzer Locations | NUMBER OF ANALYZERS | Number of Downloaders/Chargers | Number of IP Addresses | TOTAL PATIENTS | CONTROLS | PROFICIENCY SAMPLES | VALIDATION SAMPLES | LOT TO LOT COMPARISON SAMPLES | TOTAL QUANTITY | COST | TOTAL COST |
| 001 | Creatinine with EGFR | Wichita | Green Top Tube | Waived or Moderate | Handheld | Radiology/MRI | 2 | 2 | 2 | 500 | 50 | 30 | 30 | 30 | 640 | | |
| Total Option Year 4 | | | | | | | | | | | | | | | | |