Prescription - PRICE WORKSHEET.xlsx
XLSX spreadsheet 24 KB Posted
- Attached to
- Q517--Emergency Prescription Fill Service
- Solicitation number
- 36C25621Q1137
About this file
This document contains a price worksheet for prescription drugs and a notice for an emergency prescription fill service solicitation. The price worksheet lists generic and brand name drugs, including strengths, dosages, units, average wholesale prices and proposed discounted prices. The solicitation notice indicates the Department of Veterans Affairs Veterans Health Administration VISN 16 will issue a formal solicitation for an emergency prescription fill service, with no other details provided. The solicitation number is listed as 36C25621Q1137 and the name is for an emergency prescription fill service under opportunity number Q517.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25621Q1137 0002.docx | DOCX document | |
| Price Calculation Document.docx | DOCX document | |
| 36C25621Q1137 0001.docx | DOCX document | |
| Wage Determination LA.pdf | ||
| 36C25621Q1137.docx | DOCX document |
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Text version
Sheet1
| Generic Top 15 | |||||||||||||
| (14 day supply) | Strength | Dosage Form | Prescription | ||||||||||
| Total Units | AWP per unit | Total Prescriptions | AWP per prescription | % Discount | Price per Prescription | ||||||||
| (each w/ discount) | Unit Price Administrative Fee | Extended Price | NDC | ||||||||||
| Example ABC | 10mg | Tablet | 14 | $ 0.50 | 150 | $ 7.00 | 50% | $ 3.50 | $ 5.00 | $ 1,275.00 | |||
| AMLODIPINE BESYLATE | 10 mg | Tablet | 14 | 3300 | $ - 0 | $ - 0 | $ - 0 | 76282-0239-90 | |||||
| AMOXICILLIN | 500mg | Capsule | 42 | 3100 | $ - 0 | $ - 0 | $ - 0 | 00781-2613-05 | |||||
| AMOXICILLIN/CLAVULANATE POTASSIUM | 875mg/125mg | Tablet | 28 | 2500 | $ - 0 | $ - 0 | $ - 0 | 16714-0478-01 | |||||
| AZITHROMYCIN | 250mg | Tablet | 14 | 5100 | $ - 0 | $ - 0 | $ - 0 | 50111-0787-51 | |||||
| CEPHALEXIN | 250mg | Capsule | 56 | 3500 | $ - 0 | $ - 0 | $ - 0 | 42291-0208-50 | |||||
| CEPHALEXIN | 500mg | Capsule | 56 | 3500 | $ - 0 | $ - 0 | $ - 0 | 42291-0209-50 | |||||
| CIPROFLOXACIN HYDROCHLORIDE | 500mg | Tablet | 28 | 1500 | $ - 0 | $ - 0 | $ - 0 | 63629-1010-05 | |||||
| COLCHICINE VA Formulary colchicine tablets Utilized for Colcrys tablets | 0.6mg | Tablet | 14 | 200 | $ - 0 | $ - 0 | $ - 0 | 64764-0119-07 | |||||
| DOXYCYCLINE HYCLATE | 100mg | Capsule | 28 | 2700 | $ - 0 | $ - 0 | $ - 0 | 62135-0985-50 | |||||
| HYDROCHLOROTHIAZIDE | 50mg | Tablet | 14 | 1775 | $ - 0 | $ - 0 | $ - 0 | 60429-0890-01 | |||||
| IBUPROFEN | 800mg | Tablet | 42 | 1600 | $ - 0 | $ - 0 | $ - 0 | 42291-0339-50 | |||||
| LISINOPRIL | 40mg | Tablet | 14 | 3600 | $ - 0 | $ - 0 | $ - 0 | 76282-0422-90 | |||||
| LOSARTAN POTASSIUM | 100mg | Tablet | 14 | 2100 | $ - 0 | $ - 0 | $ - 0 | 60429-0865-10 | |||||
| ONDANSETRON | 4mg | Oral Disintegrating Tablet | 10 | 1000 | $ - 0 | $ - 0 | $ - 0 | 57237-0077-10 | |||||
| PREDNISONE | 20mg | Tablet | 14 | 3700 | $ - 0 | $ - 0 | $ - 0 | 00054-0018-29 | |||||
| SULFAMETHOXAZOLE/TRIMETHOPRIM DS | 800-160mg | Tablet | 28 | 3050 | $ - 0 | $ - 0 | $ - 0 | 42291-0759-01 | |||||
| TRIAMCINOLONE ACETONIDE (15 GRAM) | 0.10% | Topical Cream | 1 | 1250 | $ - 0 | $ - 0 | $ - 0 | 45802-0064-35 | |||||
| Aggregated Five Year Total (Generic ) | $ - 0 |
| Brand Name Top 8 | ||||||||||||
| (14 day supply) | Strength | Dosage Form | Prescription | |||||||||
| Total Units | AWP per unit | Total Prescriptions | AWP per prescription | % Discount | Price per Prescription | |||||||
| (each w/ discount) | Unit Price Administrative Fee | Extended Price | NDC | |||||||||
| Example ABC | 10mg | Tablet | 14 | $ 1.00 | 150 | $ 14.00 | 50% | $ 7.00 | $ 5.00 | $ 1,800.00 | ||
| ATROVENT HFA 1 inhaler (200 MDI) | 12.9gm | Inhaler | 1 | 150 | $ - 0 | $ - 0 | $ - 0 | 00597-0087-17 | ||||
| BD INSULIN SYRINGE ULTRA-FINE | 0.5ML/31G X 8MM | Supply | 14 | 200 | $ - 0 | $ - 0 | $ - 0 | 08290-3284-68 | ||||
| ELIQUIS | 5mg | Tablet | 28 | 200 | $ - 0 | $ - 0 | $ - 0 | 00003-0894-21 | ||||
| LANTUS INSULIN VIAL (1 vial - 10ML) | 100U/mL | Injectable | 1 | 450 | $ - 0 | $ - 0 | $ - 0 | 00088-2220-33 | ||||
| NOVOLOG MIX 70/30 (1 vial - 10ML) | 100U/mL | Injectable | 1 | 170 | $ - 0 | $ - 0 | $ - 0 | 00169-3685-12 | ||||
| PROAIR HFA VA Formulary albuterol inhaler Utilized for Albuterol HFA, Ventolin HFA | ||||||||||||
| (1 inhaler - 200 MDI) | 90mcg | Inhaler | 1 | 3430 | $ - 0 | $ - 0 | $ - 0 | 59310-0579-22 | ||||
| SYMBICORT MDI (1 inhaler - 120 MDI) | 160/4.5mcg | Inhaler | 1 | 150 | $ - 0 | $ - 0 | $ - 0 | 00186-0370-20 | ||||
| XARELTO | 20mg | Tablet | 14 | 300 | $ - 0 | $ - 0 | $ - 0 | 50458-0579-30 | ||||
| Aggregated Five Year Total (Brand Name ) | $ - 0 | |||||||||||
| Aggregated Five Year Total (Generic & Brand Name) | $ - 0 |
&"Arial,Regular"&10&K000000Data Class: &B&KF4911EConfidential &B&"Arial,Regular"&12&K000000
&"Arial,Regular"&10&K000000Data Class: &B&KF4911EConfidential &B&"Arial,Regular"&12&K000000
&"Arial,Regular"&10&K000000Data Class: &B&KF4911EConfidential &B&"Arial,Regular"&12&K000000
File details come from the government source that posted it. Updated .