Attachment 11 - Price Worksheet.xlsx

XLSX spreadsheet 5 MB Posted

Attached to
RFQ 36C25622Q0200, Amendment 0001 Federal contract opportunity
Solicitation number
36C25622Q0200
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

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Other files attached to RFQ 36C25622Q0200, Amendment 0001, newest first.
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36C25622Q0200 0001.pdf PDF
RFQ 36C25622Q0200.pdf PDF
Attachment 5 - Wage Determination 2015-5121 Revision 16 (10-20-2021).pdf PDF
Attachment 6 - Wage Determination 2015-5123 Revision 17 (10-20-2021).pdf PDF
Attachment 2 - Quality Assurance Surveillance Plan (QASP).pdf PDF
Attachment 4 - Wage Determination 2015-5117 Revision 17 (10-20-2021).pdf PDF
Attachment 8 - Wage Determination 2015-5137 Revision 17 (10-20-2021).pdf PDF
Attachment 3 - Wage Determination 2015-5113 Revision 15 (10-20-2021).pdf PDF
Attachment 9 - Wage Determination 2015-5139 Revision 17 (10-20-2021).pdf PDF
Attachment 1 - Statement of Work.pdf PDF
Attachment 7 - Wage Determination 2015-5133 Revision 17 (10-20-2021).pdf PDF
Attachment 10 - Business Assosiciate Agreement (Template).pdf PDF
Appendix A - Technical Capability Questionnaire.pdf PDF
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Sheet1 Per the evaluation criteria as described in solicitation provision E.6 - 52.212-2 Evaluation--Commercial Items, price shall be evaluated based on the proposed discounts and dispensing fees, calculated based on the sample set of prescription data contained in the following spreadsheet. The generic and brand name drugs listed below are representative of the most frequently prescribed drugs, over a 1 month ordering period as of the date the requirements package was developed.

INSTRUCTIONS:

Step 1 - Complete the AWP for each drug in column E

Step 2 - Insert the % discount off AWP for generic drugs in cell H16

Step 3 - Insert the % discount off AWP for brand name drugs in cell H36

Step 4 - Insert the dispensing fee in cell J16

Generic Drugs (14 day supply)StrengthDosage FormPrscription Total UnitsAWP (per unit)Total PrescriptionsAWP per prescription% DiscountPrice per Prescription (w/discount)Dispensing FeeExtended PriceNDC
Example ABC10mgTablet14$ 0.50150$ 7.0050%$ 3.50$ 2.00$ 825.00
AMLODIPINE BESYLATE10mgTablet149$ - 0$ - 0$ - 076282-0239-90
AMOXICILLIN500mgCapsule4212$ - 00%$ - 0$ - 0$ - 000781-2613-05
AMOXICILLIN/CLAVULANATE POTASSIUM875mg/125mgTablet2831$ - 00%$ - 0$ - 0$ - 016714-0478-01
AZITHROMYCIN250mgTablet1432$ - 00%$ - 0$ - 0$ - 050111-0787-51
CEPHALEXIN250mgCapsule5634$ - 00%$ - 0$ - 0$ - 042291-0208-50
CEPHALEXIN500mgCapsule5634$ - 00%$ - 0$ - 0$ - 042291-0209-50
CIPROFLOSACIN HYDROCHLORIDE500mgTablet2812$ - 00%$ - 0$ - 0$ - 063629-1010-05
DOXYCYCLINE HYCLATE100mgCapsule2831$ - 00%$ - 0$ - 0$ - 062135-0985-50
HYDROCLOROTHIAZIDE50mgTablet149$ - 00%$ - 0$ - 0$ - 060429-0890-01
IBUPROFEN800mgTablet4227$ - 00%$ - 0$ - 0$ - 042291-0339-50
LISINOPRIL40mgTablet1460$ - 00%$ - 0$ - 0$ - 076282-0422-90
LOSARTAN POTASSIUM100mgTablet1435$ - 00%$ - 0$ - 0$ - 060429-0865-10
PREDNISONE20mgTablet1435$ - 00%$ - 0$ - 0$ - 00054-0018-29
SULFAMETHOXAZOLE/TRIMETHOPRIM DS800-160mgTablet2810$ - 00%$ - 0$ - 0$ - 042291-0759-01
TRIAMCINOLONE ACETONIDE (15 GRAM)0.10%Topical Cream18$ - 00%$ - 0$ - 0$ - 045802-0064-35

Aggregate 1 Month Total (Generic) $ - 0

Brand Name Drugs (14 day supply)StrengthDosage FormPrscription Total UnitsAWP per unitTotal PrescriptionsAWP per prescription% DiscountPrice per Prescription (w/discount)Dispensing FeeExtended PriceNDC
Example ABC10mgTablet14$ 2.00150$ 28.0025%$ 21.00$ 2.00$ 3,450.00
ATROVENT HFA 1 INHALER (200 MDI)12.9mgInhaler13$ - 0$ - 0$ - 0$ - 000597-0087-17
BD INSULIN SYRINGE ULTRA-FINE0.5ML/31G X 8MMSupply143$ - 00%$ - 0$ - 0$ - 008290-3284-68
ELIQUIS5mgTablet283$ - 00%$ - 0$ - 0$ - 000003-0894-21
LANTUS INSULIN VIAL (1 VIAL - 10ML)100U/mLInjectable18$ - 00%$ - 0$ - 0$ - 000088-2220-33
NOVOLOG MIX 70/30 (1 VIAL -10ML100U/mLInjectable13$ - 00%$ - 0$ - 0$ - 0000169-3685-12
SYMBICORT MDI (1 INHALER - 120 MDI)160/4.5mcgInhaler13$ - 00%$ - 0$ - 0$ - 000186-0370-20
XARELTO20mgTablet145$ - 00%$ - 0$ - 0$ - 050458-0579-30

Aggregate 1 Month Total (Brand Name) $ - 0

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