36C25524Q0065 0002.pdf

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)

1 2

None

36C255

Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway

Leavenworth KS 66048

36C255

Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway

Leavenworth KS 66048

To all Offerors/Bidders

36C25524Q0065

X

X X

See CONTINUATION Page

36C25524Q0065 - Pharmacy Benefit Services - Wichita VAMC

The purpose of this modification is to:

Amend the Price/Cost Delivery Schedule (B.3) on the RFQ to more accurately reflect fees/discounts that will be Provided.

Ronald D Castle Contracting Officer

B.3 PRICE/COST SCHEDULE

BASE YEAR: 01/04/2024 – 01/03/2025

CLIN 0001

Description: Provide Pharmacy Benefit Management Services as specified in this RFQ for VA Community Based Out-Patient Clinics and Home Based Patient Care Program beneficiaries located in the Robert J Dole Veterans Affairs Medical Center (RJDVAMC) primary service area as stated above.

Dispensing Fee

$_____ per Prescription.

Discount from AWP

___ % off generic drugs.

____% off brand name when no generic form exists.

Administration Fee, if any

$_____ per Prescription.

OPTION YEAR 1: 01/04/2025 – 01/03/2026

CLIN 1001

Description: Provide Pharmacy Benefit Management Services as specified in this RFQ for VA Community Based Out-Patient Clinics and Home Based Patient Care Program beneficiaries located in the Robert J Dole Veterans Affairs Medical Center (RJDVAMC) primary service area as stated above.

Dispensing Fee

$_____ per Prescription.

Discount from AWP

___ % off generic drugs.

____% off brand name when no generic form exists.

Administration Fee, if any

OPTION YEAR 2: 01/04/2026 – 01/03/2027

CLIN 2001

Description: Provide Pharmacy Benefit Management Services as specified in this RFQ for VA Community Based Out-Patient Clinics and Home Based Patient Care Program beneficiaries located in the Robert J Dole Veterans Affairs Medical Center (RJDVAMC) primary service area as stated above.

Dispensing Fee

$_____ per Prescription.

Discount from AWP

___ % off generic drugs.

____% off brand name when no generic form exists.

Administration Fee, if any

B.3 PRICE/COST SCHEDULE