Copy of Home O2 Price Schedule 9.26.22 w_Formulas.xlsx
XLSX spreadsheet 240 KB Posted
- Attached to
- Q999-- VISN16 Home Oxygen
- Solicitation number
- 36C25622R0128
About this file
This document provides details on a forthcoming solicitation for home oxygen services across five VA medical centers in VISN 16. The solicitation, numbered 36C25622R0128, will be issued by VA Network Contracting Office 16 to acquire home oxygen products and services for VA locations in Alexandria, Louisiana, Biloxi, Mississippi, Houston, Texas, New Orleans, Louisiana, and Shreveport, Louisiana. The resultant contract will cover oxygen concentrators, portable concentrators, cylinders, delivery, equipment setup and maintenance, relocation services, and patient education at the listed VA medical centers and their associated outpatient clinics. Pricing will be fixed for multiple option years. Responses to the solicitation are due based on the specified timeline.
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Other files
| File | Type | Posted |
|---|---|---|
| Copy of Home O2 Price Schedule 5 Station w_Formulas-Updt 10_27_22.xlsx | XLSX spreadsheet | |
| Clarification Questions 36C25622R0128 10_27_2022.docx | DOCX document | |
| 36C25622R0128 0002.docx | DOCX document | |
| 36C25622R0128_3.docx | DOCX document | |
| Amendment-36C25622R0128- 0001.docx | DOCX document | |
| 36C25622R0128 0001_1.docx | DOCX document | |
| Revised-36C25622R0128 Home O2 - 5 Stations RFP - 09.29.22.docx | DOCX document | |
| Sect D BAA.docx | DOCX document | |
| D.3+Reference+Contract+Worksheet Home O2--9.20.22.docx | DOCX document | |
| 36C25622R0128 Home O2 - 5 Stations RFP - 09.29.22.docx | DOCX document | |
| 36C25622R0128_2.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 |
| VHA-SUPPLIES-FSS-ORDER-MOD | V797P-7323A | 36C24921N0003 | P00001 | Percent | 0 |
KB Version: FY21.08A
LIN Price Schedule
| LIN | SLIN | Description | Unit of Issue | Estimated Annual Quantity | Unit Price | Estimated Annual Total Price | |
| BILOXI | |||||||
| 00001 | Biloxi, MS 5 LPM Concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up, by a Technician, of the oxygen concentrator, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of 5LPM Concentrator. | NSP | |||||
| 00001 | A | Biloxi, MS 5 LPM Concentrator with Backup System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 950 | $0.00 | $0.00 | |||
| 00001 | B | Biloxi, MS 5 LPM Concentrator with Backup System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 1000 | $0.00 | $0.00 | |||
| 00001 | C | Biloxi, MS 5 LPM Concentrator with Backup System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 1050 | $0.00 | $0.00 | |||
| 00001 | D | Biloxi, MS 5 LPM Concentrator with Backup System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 1100 | $0.00 | $0.00 | |||
| 00001 | E | Biloxi, MS 5 LPM Concentrator with Backup System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 1150 | $0.00 | $0.00 | |||
| 00002 | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental: This shall include Monthly Rental of 5 LPM Concentrator with Back-up System, all monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), and humidifiers as needed, and preventive maintenance | NSP | |||||
| 00002 | A | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 10450 | $0.00 | $0.00 | |||
| 00002 | B | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 11000 | $0.00 | $0.00 | |||
| 00002 | C | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 11550 | $0.00 | $0.00 | |||
| 00002 | D | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12100 | $0.00 | $0.00 | |||
| 00002 | E | Biloxi, MS 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12650 | $0.00 | $0.00 | |||
| 00003 | Biloxi, MS 10 LPM Concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system complete with regulator stand, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of 10 LPM Concentrator. | NSP | |||||
| 00003 | A | Biloxi, MS 10 LPM Concentrator with Backup System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 80 | $0.00 | $0.00 | |||
| 00003 | B | Biloxi, MS 10 LPM Concentrator with Backup System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 85 | $0.00 | $0.00 | |||
| 00003 | C | Biloxi, MS 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 90 | $0.00 | $0.00 | |||
| 00003 | D | Biloxi, MS 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 95 | $0.00 | $0.00 | |||
| 00003 | E | Biloxi, MS 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 100 | $0.00 | $0.00 | |||
| 00004 | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental: This shall include Monthly Rental of 10 LPM Concentrator with Back-up System, all monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), humidifiers as needed, and preventive maintenance | NSP | |||||
| 00004 | A | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 880 | $0.00 | $0.00 | |||
| 00004 | B | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental` | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 935 | $0.00 | $0.00 | |||
| 00004 | C | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 990 | $0.00 | $0.00 | |||
| 00004 | D | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 1045 | $0.00 | $0.00 | |||
| 00004 | E | Biloxi, MS 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 1100 | $0.00 | $0.00 | |||
| 00005 | Biloxi, MS: Stationary Cylinder Set-up - Size M or H- This shall include Initial home environment assessment, delivery and set-up by a Technician back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, cylinder stand to support each cylinder delivered, and patient education on functionality/features of equipment/cylinders. | NSP | |||||
| 00005 | A | Biloxi, MS: Stationary Cylinder Set-up - Size M or H | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 5 | $0.00 | $0.00 | |||
| 00005 | B | Biloxi, MS: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 7 | $0.00 | $0.00 | |||
| 00005 | C | Biloxi, MS: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 9 | $0.00 | $0.00 | |||
| 00005 | D | Biloxi, MS: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00005 | E | Biloxi, MS: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 15 | $0.00 | $0.00 | |||
| 00006 | Biloxi, MS: Cylinder - Size M or H Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||
| 00006 | A | Biloxi, MS: Cylinder - Size M or H Monthly Refill | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 55 | $0.00 | $0.00 | |||
| 00006 | B | Biloxi, MS: Cylinder - Size M or H Monthly Refill | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 77 | $0.00 | $0.00 | |||
| 00006 | C | Biloxi, MS: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 99 | $0.00 | $0.00 | |||
| 00006 | D | Biloxi, MS: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 132 | $0.00 | $0.00 | |||
| 00006 | E | Biloxi, MS: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 165 | $0.00 | $0.00 | |||
| 00007 | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 - This shall include Initial home environment assessment, delivery and set-up by a Technician, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies/resupply, tubing, cannulas, cylinder stand to support each cylinder delivered, and patient education on functionality/features of equipment/cylinders. | NSP | |||||
| 00007 | A | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 5 | $0.00 | $0.00 | |||
| 00007 | B | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 7 | $0.00 | $0.00 | |||
| 00007 | C | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 9 | $0.00 | $0.00 | |||
| 00007 | D | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00007 | E | Biloxi, MS: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 15 | $0.00 | $0.00 | |||
| 00008 | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||
| 00008 | A | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 4785 | $0.00 | $0.00 | |||
| 00008 | B | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 5280 | $0.00 | $0.00 | |||
| 00008 | C | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 5775 | $0.00 | $0.00 | |||
| 00008 | D | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 6270 | $0.00 | $0.00 | |||
| 00008 | E | Biloxi, MS: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 6765 | $0.00 | $0.00 | |||
| 00009 | Biloxi, MS: Demand Nasal Cannula | NSP | |||||
| 00009 | A | Biloxi, MS: Demand Nasal Cannula | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 48 | $0.00 | $0.00 | |||
| 00009 | B | Biloxi, MS: Demand Nasal Cannula | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 72 | $0.00 | $0.00 | |||
| 00009 | C | Biloxi, MS: Demand Nasal Cannula | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 96 | $0.00 | $0.00 | |||
| 00009 | D | Biloxi, MS: Demand Nasal Cannula | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 120 | $0.00 | $0.00 | |||
| 00009 | E | Biloxi, MS: Demand Nasal Cannula | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 144 | $0.00 | $0.00 | |||
| 00010 | Biloxi, MS: Demand Pulse Conserver Fee | NSP | |||||
| 00010 | A | Biloxi, MS: Demand Pulse Conserver Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 1800 | $0.00 | $0.00 | |||
| 00010 | B | Biloxi, MS: Demand Pulse Conserver Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 1980 | $0.00 | $0.00 | |||
| 00010 | C | Biloxi, MS: Demand Pulse Conserver Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 2160 | $0.00 | $0.00 | |||
| 00010 | D | Biloxi, MS: Demand Pulse Conserver Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 2340 | $0.00 | $0.00 | |||
| 00010 | E | Biloxi, MS: Demand Pulse Conserver Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 2520 | $0.00 | $0.00 | |||
| 00011 | Biloxi, MS: Liquid Oxygen System Fee | NSP | |||||
| 00011 | A | Biloxi, MS: Liquid Oxygen System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 120 | $0.00 | $0.00 | |||
| 00011 | B | Biloxi, MS: Liquid Oxygen System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 144 | $0.00 | $0.00 | |||
| 00011 | C | Biloxi, MS: Liquid Oxygen System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 168 | $0.00 | $0.00 | |||
| 00011 | D | Biloxi, MS: Liquid Oxygen System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 192 | $0.00 | $0.00 | |||
| 00011 | E | Biloxi, MS: Liquid Oxygen System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 216 | $0.00 | $0.00 | |||
| 00012 | Biloxi, MS: Portable Liquid Oxygen System Fee | NSP | |||||
| 00012 | A | Biloxi, MS: Portable Liquid Oxygen System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 120 | $0.00 | $0.00 | |||
| 00012 | B | Biloxi, MS: Portable Liquid Oxygen System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 144 | $0.00 | $0.00 | |||
| 00012 | C | Biloxi, MS: Portable Liquid Oxygen System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 168 | $0.00 | $0.00 | |||
| 00012 | D | Biloxi, MS: Portable Liquid Oxygen System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 192 | $0.00 | $0.00 | |||
| 00012 | E | Biloxi, MS: Portable Liquid Oxygen System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 216 | $0.00 | $0.00 | |||
| 00013 | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | NSP | |||||
| 00013 | A | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | |||||
| Base Year: November 30, 2022 to November 29, 2023 | LB | 6000 | $0.00 | $0.00 | |||
| 00013 | B | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | LB | 6600 | $0.00 | $0.00 | |||
| 00013 | C | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | LB | 7800 | $0.00 | $0.00 | |||
| 00013 | D | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | LB | 8400 | $0.00 | $0.00 | |||
| 00013 | E | Biloxi, MS: Liquid Oxygen per pound CLIN #00011 & #00012 | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | LB | 9000 | $0.00 | $0.00 | |||
| 00014 | Biloxi, MS: Permanent Relocation. This shall include all supplies, equipment, delivery and coordination for Permanent Relocation. | NSP | |||||
| 00014 | A | Biloxi, MS: Permanent Relocation | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 120 | $0.00 | $0.00 | |||
| 00014 | B | Biloxi, MS: Permanent Relocation | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 144 | $0.00 | $0.00 | |||
| 00014 | C | Biloxi, MS: Permanent Relocation | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 168 | $0.00 | $0.00 | |||
| 00014 | D | Biloxi, MS: Permanent Relocation | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 192 | $0.00 | $0.00 | |||
| 00014 | E | Biloxi, MS: Permanent Relocation | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 216 | $0.00 | $0.00 | |||
| 00015 | Biloxi, MS: Portable Concentrator -This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), batteries (min 2 based on patient requirements), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of Portable Concentrator. | NSP | |||||
| 00015 | A | Biloxi, MS: Portable Concentrator | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 630 | $0.00 | $0.00 | |||
| 00015 | B | Biloxi, MS: Portable Concentrator | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 680 | $0.00 | $0.00 | |||
| 00015 | C | Biloxi, MS: Portable Concentrator | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 730 | $0.00 | $0.00 | |||
| 00015 | D | Biloxi, MS: Portable Concentrator | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 780 | $0.00 | $0.00 | |||
| 00015 | E | Biloxi, MS: Portable Concentrator | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 930 | $0.00 | $0.00 | |||
| 00016 | Biloxi, MS: Portable Concentrator Monthly Rental: This shall include Monthly Rental of Portable Concentrator with Back-up System, monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), humidifiers as needed, and preventive maintenance | NSP | |||||
| 00016 | A | Biloxi, MS: Portable Concentrator Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 7560 | $0.00 | $0.00 | |||
| 00016 | B | Biloxi, MS: Portable Concentrator Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 8160 | $0.00 | $0.00 | |||
| 00016 | C | Biloxi, MS: Portable Concentrator Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 8760 | $0.00 | $0.00 | |||
| 00016 | D | Biloxi, MS: Portable Concentrator Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 9360 | $0.00 | $0.00 | |||
| 00016 | E | Biloxi, MS: Portable Concentrator Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 11160 | $0.00 | $0.00 | |||
| 00017 | Biloxi, MS: Oxygen Cylinder Refill Stations: This shall include- Delivery and set-up by a Technician of the Oxygen Cylinder Refill Station w/ transfer hose, related equipment, and patient education on equipment functionality. | NSP | |||||
| 00017 | A | Biloxi, MS: Oxygen Cylinder Refill Stations | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 5 | $0.00 | $0.00 | |||
| 00017 | B | Biloxi, MS: Oxygen Cylinder Refill Stations | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 5 | $0.00 | $0.00 | |||
| 00017 | C | Biloxi, MS: Oxygen Cylinder Refill Stations | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 5 | $0.00 | $0.00 | |||
| 00017 | D | Biloxi, MS: Oxygen Cylinder Refill Stations | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 5 | $0.00 | $0.00 | |||
| 00017 | E | Biloxi, MS: Oxygen Cylinder Refill Stations | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 5 | $0.00 | $0.00 | |||
| 00018 | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Rental | NSP | |||||
| 00018 | A | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 55 | $0.00 | $0.00 | |||
| 00018 | B | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 55 | $0.00 | $0.00 | |||
| 00018 | C | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Renta | |||||
| lOption Year Two: November 30, 2024 to November 29, 2025 | EA | 55 | $0.00 | $0.00 | |||
| 00018 | D | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 55 | $0.00 | $0.00 | |||
| 00018 | E | Biloxi, MS: Oxygen Cylinder Refill Stations- Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 55 | $0.00 | $0.00 | |||
| 00019 | Biloxi, MS: Liquid Oxygen Portable Helio System | NSP | |||||
| 00019 | A | Biloxi, MS: Liquid Oxygen Portable Helio System | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 60 | $0.00 | $0.00 | |||
| 00019 | B | Biloxi, MS: Liquid Oxygen Portable Helio System | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 60 | $0.00 | $0.00 | |||
| 00019 | C | Biloxi, MS: Liquid Oxygen Portable Helio System | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 60 | $0.00 | $0.00 | |||
| 00019 | D | Biloxi, MS: Liquid Oxygen Portable Helio System | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 60 | $0.00 | $0.00 | |||
| 00019 | E | Biloxi, MS: Liquid Oxygen Portable Helio System | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 60 | $0.00 | $0.00 | |||
| 00020 | Biloxi, MS: Ventilator (Ventilator settings prescribed only)- This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, cannula(s), valve(s), supplies, and patient education on functionality/features of Ventilator | NSP | |||||
| 00020 | A | Biloxi, MS: Ventilator (Ventilator settings prescribed only) | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 25 | $0.00 | $0.00 | |||
| 00020 | B | Biloxi, MS: Ventilator (Ventilator settings prescribed only) | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 35 | $0.00 | $0.00 | |||
| 00020 | C | Biloxi, MS: Ventilator (Ventilator settings prescribed only) | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 45 | $0.00 | $0.00 | |||
| 00020 | D | Biloxi, MS: Ventilator (Ventilator settings prescribed only) | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 55 | $0.00 | $0.00 | |||
| 00020 | E | Biloxi, MS: Ventilator (Ventilator settings prescribed only) | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 60 | $0.00 | $0.00 | |||
| 00021 | Biloxi, MS: Ventilator Rental - Monthly: This shall include- Monthly rental, supplies, resupply deliveries, tubing, filters, cannula(s), valve(s) as necessary, and preventive maintenance (Ventilator settings prescribed only) | NSP | |||||
| 00021 | A | Biloxi, MS: Ventilator Rental - Monthly | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 275 | $0.00 | $0.00 | |||
| 00021 | B | Biloxi, MS: Ventilator Rental - Monthly | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 385 | $0.00 | $0.00 | |||
| 00021 | C | Biloxi, MS: Ventilator Rental - Monthly | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 495 | $0.00 | $0.00 | |||
| 00021 | D | Biloxi, MS: Ventilator Rental - Monthly | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 605 | $0.00 | $0.00 | |||
| 00021 | E | Biloxi, MS: Ventilator Rental - Monthly | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 660 | $0.00 | $0.00 | |||
| 00022 | Biloxi, MS: Re-education (Sentinel Events) - In the event of a fire or explosion occurs with oxygen/concentrator users, Technician to visit patient and provide reeducation regarding smoking, and conduct a home environment safety evaluation | NSP | |||||
| 00022 | A | Biloxi, MS: Re-education (Sentinel Events) | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00022 | B | Biloxi, MS: Re-education (Sentinel Events) | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00022 | C | Biloxi, MS: Re-education (Sentinel Events) | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00022 | D | Biloxi, MS: Re-education (Sentinel Events) | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00022 | E | Biloxi, MS: Re-education (Sentinel Events) | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00023 | Biloxi, MS: Delivery of Ventilator to local VA Facility | NSP | |||||
| 00023 | A | Biloxi, MS: Delivery of Ventilator to local VA Facility | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 12 | $0.00 | $0.00 | |||
| 00023 | B | Biloxi, MS: Delivery of Ventilator to local VA Facility | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 12 | $0.00 | $0.00 | |||
| 00023 | C | Biloxi, MS: Delivery of Ventilator to local VA Facility | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 12 | $0.00 | $0.00 | |||
| 00023 | D | Biloxi, MS: Delivery of Ventilator to local VA Facility | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00023 | E | Biloxi, MS: Delivery of Ventilator to local VA Facility | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 12 | $0.00 | $0.00 | |||
| 00024 | Biloxi, MS: Ventilator Roller Stand | NSP | |||||
| 00024 | A | Biloxi, MS: Ventilator Roller Stand | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00024 | B | Biloxi, MS: Ventilator Roller Stand | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00024 | C | Biloxi, MS: Ventilator Roller Stand | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00024 | D | Biloxi, MS: Ventilator Roller Stand | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00024 | E | Biloxi, MS: Ventilator Roller Stand | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00025 | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | NSP | |||||
| 00025 | A | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12000 | $0.00 | $0.00 | |||
| 00025 | B | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12000 | $0.00 | $0.00 | |||
| 00025 | C | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12000 | $0.00 | $0.00 | |||
| 00025 | D | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12000 | $0.00 | $0.00 | |||
| 00025 | E | Biloxi, MS: Oxygen Thermal Fuses Cannulas w/Connector | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12000 | $0.00 | $0.00 | |||
| 00026 | Biloxi, MS: Travel Concentrator Stationary | NSP | |||||
| 00026 | A | Biloxi, MS: Travel Concentrator Stationary | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00026 | B | Biloxi, MS: Travel Concentrator Stationary | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00026 | C | Biloxi, MS: Travel Concentrator Stationary | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00026 | D | Biloxi, MS: Travel Concentrator Stationary | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00026 | E | Biloxi, MS: Travel Concentrator Stationary | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00027 | Biloxi, MS: Travel Concerving Device | NSP | |||||
| 00027 | A | Biloxi, MS: Travel Concerving Device | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00027 | B | Biloxi, MS: Travel Concerving Device | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00027 | C | Biloxi, MS: Travel Concerving Device | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00027 | D | Biloxi, MS: Travel Concerving Device | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00027 | E | Biloxi, MS: Travel Concerving Device | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00028 | Biloxi, MS: 50 PSI Compressor | NSP | |||||
| 00028 | A | Biloxi, MS: 50 PSI Compressor | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00028 | B | Biloxi, MS: 50 PSI Compressor | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00028 | C | Biloxi, MS: 50 PSI Compressor | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00028 | D | Biloxi, MS: 50 PSI Compressor | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00028 | E | Biloxi, MS: 50 PSI Compressor | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00029 | Biloxi, MS: Heated Humidifer | NSP | |||||
| 00029 | A | Biloxi, MS: Heated Humidifer | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00029 | B | Biloxi, MS: Heated Humidifer | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00029 | C | Biloxi, MS: Heated Humidifer | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00029 | D | Biloxi, MS: Heated Humidifer | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00029 | E | Biloxi, MS: Heated Humidifer | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00030 | Biloxi, MS: POC Battery (additional) | NSP | |||||
| 00030 | A | Biloxi, MS: POC Battery (additional) | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00030 | B | Biloxi, MS: POC Battery (additional) | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00030 | C | Biloxi, MS: POC Battery (additional) | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00030 | D | Biloxi, MS: POC Battery (additional) | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00030 | E | Biloxi, MS: POC Battery (additional) | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00031 | Biloxi, MS: POC Desktop Battery Charger | NSP | |||||
| 00031 | A | Biloxi, MS: POC Desktop Battery Charger | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00031 | B | Biloxi, MS: POC Desktop Battery Charger | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00031 | C | Biloxi, MS: POC Desktop Battery Charger | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00031 | D | Biloxi, MS: POC Desktop Battery Charger | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00031 | E | Biloxi, MS: POC Desktop Battery Charger | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 00032 | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | NSP | |||||
| 00032 | A | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 12 | $0.00 | $0.00 | |||
| 00032 | B | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 12 | $0.00 | $0.00 | |||
| 00032 | C | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 12 | $0.00 | $0.00 | |||
| 00032 | D | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00032 | E | Biloxi, MS: Fee for deliveries/pick-ups made greater than 150 miles | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 12 | $0.00 | $0.00 | |||
| 00033 | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL: This shall include, environmental assessments monthly, and patient re-education on functionality/features of Ventilator during monthly home assessment visit, as necessary | NSP | |||||
| 00033 | A | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 12 | $0.00 | $0.00 | |||
| 00033 | B | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 12 | $0.00 | $0.00 | |||
| 00033 | C | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 12 | $0.00 | $0.00 | |||
| 00033 | D | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00033 | E | Biloxi, MS: Ventilator -RT Home Environment Assessment/Visit (Monthly) NON-CLINICAL | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 12 | $0.00 | $0.00 | |||
| 00034 | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL: This shall include, environmental assessments Semi-annually, and patient re-education on functionality/features of equipment for Oxygen and Concentrator users | NSP | |||||
| 00034 | A | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 12 | $0.00 | $0.00 | |||
| 00034 | B | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 12 | $0.00 | $0.00 | |||
| 00034 | C | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 12 | $0.00 | $0.00 | |||
| 00034 | D | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 12 | $0.00 | $0.00 | |||
| 00034 | E | Biloxi, MS: Technician Home Environment Assessment/Visit (Semi-annually) NON-CLINICAL | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 12 | $0.00 | $0.00 | |||
| 00035 | Biloxi, MS 12 LPM Concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of 12 LPM Concentrator. | NSP | |||||
| 00035 | A | Biloxi, MS 12 LPM Concentrator with Backup System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 1 | $0.00 | $0.00 | |||
| 00035 | B | Biloxi, MS 12 LPM Concentrator with Backup System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 1 | $0.00 | $0.00 | |||
| 00035 | C | Biloxi, MS 12 LPM Concentrator with Backup System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 1 | $0.00 | $0.00 | |||
| 00035 | D | Biloxi, MS 12 LPM Concentrator with Backup System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 1 | $0.00 | $0.00 | |||
| 00035 | E | Biloxi, MS 12 LPM Concentrator with Backup System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 1 | $0.00 | $0.00 | |||
| 00036 | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental: Monthly Rental of 12 LPM Concentrator with Back-up System, monthly supplies, resupply delivery, including cannulas, tubing, filter(s), and humidifiers as needed. | NSP | |||||
| 00036 | A | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 11 | $0.00 | $0.00 | |||
| 00036 | B | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 11 | $0.00 | $0.00 | |||
| 00036 | C | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 11 | $0.00 | $0.00 | |||
| 00036 | D | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 11 | $0.00 | $0.00 | |||
| 00036 | E | Biloxi, MS 12 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 11 | $0.00 | $0.00 | |||
| 00037 | Biloxi, MS: Heater Humidifer Chamber | NSP | |||||
| 00037 | A | Biloxi, MS: Heater Humidifer Chamber | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 00037 | B | Biloxi, MS: Heater Humidifer Chamber | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 00037 | C | Biloxi, MS: Heater Humidifer Chamber | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 00037 | D | Biloxi, MS: Heater Humidifer Chamber | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 00037 | E | Biloxi, MS: Heater Humidifer Chamber | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| ALEXANDRIA | |||||||
| 02001 | Alexandria. LA 5 LPM concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up, by a Technician, of the oxygen concentrator, back-up system complete with regulator, Oxygen Thermal fuses (i.e fire-safe, oxy-safe, or fire-break Cannulas w/connector, supplies, tubing, cannulas, Filter(s), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of 5LPM Concentrator | Not Separatly Priced (NSP) | |||||
| 02001 | A | Alexandria. LA 5 LPM concentrator with Backup System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 430 | $0.00 | $0.00 | |||
| 02001 | B | Alexandria. LA 5 LPM concentrator with Backup System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 430 | $0.00 | $0.00 | |||
| 02001 | C | Alexandria. LA 5 LPM concentrator with Backup System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 440 | $0.00 | $0.00 | |||
| 02001 | D | Alexandria. LA 5 LPM concentrator with Backup System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 440 | $0.00 | $0.00 | |||
| 02001 | E | Alexandria. LA 5 LPM concentrator with Backup System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 450 | $0.00 | $0.00 | |||
| 02002 | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental: This shall include Monthly Rental of 5 LPM Concentrator with Back-up System, all monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), and humidifiers as needed, and preventive maintenance | NSP | |||||
| 02002 | A | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 4730 | $0.00 | $0.00 | |||
| 02002 | B | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 4730 | $0.00 | $0.00 | |||
| 02002 | C | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 4840 | $0.00 | $0.00 | |||
| 02002 | D | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 4840 | $0.00 | $0.00 | |||
| 02002 | E | Alexandria, LA 5 LPM Concentrator with Back-up System- Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 4950 | $0.00 | $0.00 | |||
| 02003 | Alexandria, LA 10 LPM Concentrator with Backup System Fee: This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system complete with regulator stand, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of 10 LPM Concentrator | NSP | |||||
| 02003 | A | Alexandria, LA 10 LPM Concentrator with Backup System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 4 | $0.00 | $0.00 | |||
| 02003 | B | Alexandria, LA 10 LPM Concentrator with Backup System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 4 | $0.00 | $0.00 | |||
| 02003 | C | Alexandria, LA 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 6 | $0.00 | $0.00 | |||
| 02003 | D | Alexandria, LA 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 6 | $0.00 | $0.00 | |||
| 02003 | E | Alexandria, LA 10 LPM Concentrator with Backup System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 6 | $0.00 | $0.00 | |||
| 02004 | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental: This shall include Monthly Rental of 10 LPM Concentrator with Back-up System, all monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), humidifiers as needed, and preventive maintenance | NSP | |||||
| 02004 | A | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 44 | $0.00 | $0.00 | |||
| 02004 | B | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 44 | $0.00 | $0.00 | |||
| 02004 | C | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 66 | $0.00 | $0.00 | |||
| 02004 | D | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 66 | $0.00 | $0.00 | |||
| 02004 | E | Alexandria, LA 10 LPM Concentrator with Backup System - Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 66 | $0.00 | $0.00 | |||
| 02005 | Alexandria, LA: Stationary Cylinder Set-up - Size M or H- This shall include Initial home environment assessment, delivery and set-up by a Technician back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, cylinder stand to support each cylinder delivered, and patient education on functionality/features of equipment/cylinders | NSP | |||||
| 02005 | A | Alexandria, LA: Stationary Cylinder Set-up - Size M or H | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 300 | $0.00 | $0.00 | |||
| 02005 | B | Alexandria, LA: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 300 | $0.00 | $0.00 | |||
| 02005 | C | Alexandria, LA: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 325 | $0.00 | $0.00 | |||
| 02005 | D | Alexandria, LA: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 350 | $0.00 | $0.00 | |||
| 02005 | E | Alexandria, LA: Stationary Cylinder Set-up - Size M or H | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 350 | $0.00 | $0.00 | |||
| 02006 | Alexandria, LA: Cylinder - Size M or H Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||
| 02006 | A | Alexandria, LA: Cylinder - Size M or H Monthly Refill | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 3300 | $0.00 | $0.00 | |||
| 02006 | B | Alexandria, LA: Cylinder - Size M or H Monthly Refill | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 3300 | $0.00 | $0.00 | |||
| 02006 | C | Alexandria, LA: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 3575 | $0.00 | $0.00 | |||
| 02006 | D | Alexandria, LA: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 3850 | $0.00 | $0.00 | |||
| 02006 | E | Alexandria, LA: Cylinder - Size M or H Monthly Refill | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 3850 | $0.00 | $0.00 | |||
| 02007 | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 - This shall include Initial home environment assessment, delivery and set-up by a Technician, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, resupply delivery, tubing, cannulas, cylinder stand to support each cylinder delivered, and patient education on functionality/features of equipment/cylinders | NSP | |||||
| 02007 | A | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 3000 | $0.00 | $0.00 | |||
| 02007 | B | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 3000 | $0.00 | $0.00 | |||
| 02007 | C | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 3050 | $0.00 | $0.00 | |||
| 02007 | D | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 3050 | $0.00 | $0.00 | |||
| 02007 | E | Alexandria, LA: Stationary Cylinder Set-up -Size B/C/D/E/M6 | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 3050 | $0.00 | $0.00 | |||
| 02008 | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||
| 02008 | A | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 33000 | $0.00 | $0.00 | |||
| 02008 | B | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 33000 | $0.00 | $0.00 | |||
| 02008 | C | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 33550 | $0.00 | $0.00 | |||
| 02008 | D | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 33550 | $0.00 | $0.00 | |||
| 02008 | E | Alexandria, LA: Cylinder - Size B/C/D/E/M6 Monthly Refill | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 33550 | $0.00 | $0.00 | |||
| 02009 | Alexandria, LA: Demand Nasal Cannula | NSP | |||||
| 02009 | A | Alexandria, LA: Demand Nasal Cannula | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 12 | $0.00 | $0.00 | |||
| 02009 | B | Alexandria, LA: Demand Nasal Cannula | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 12 | $0.00 | $0.00 | |||
| 02009 | C | Alexandria, LA: Demand Nasal Cannula | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 12 | $0.00 | $0.00 | |||
| 02009 | D | Alexandria, LA: Demand Nasal Cannula | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 12 | $0.00 | $0.00 | |||
| 02009 | E | Alexandria, LA: Demand Nasal Cannula | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 12 | $0.00 | $0.00 | |||
| 02010 | Alexandria, LA: Demand Pulse Conserver Fee | NSP | |||||
| 02010 | A | Alexandria, LA: Demand Pulse Conserver Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 1800 | $0.00 | $0.00 | |||
| 02010 | B | Alexandria, LA: Demand Pulse Conserver Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 1800 | $0.00 | $0.00 | |||
| 02010 | C | Alexandria, LA: Demand Pulse Conserver Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 2100 | $0.00 | $0.00 | |||
| 02010 | D | Alexandria, LA: Demand Pulse Conserver Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 2400 | $0.00 | $0.00 | |||
| 02010 | E | Alexandria, LA: Demand Pulse Conserver Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 2400 | $0.00 | $0.00 | |||
| 02011 | Alexandria, LA: Liquid Oxygen System Fee | NSP | |||||
| 02011 | A | Alexandria, LA: Liquid Oxygen System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 48 | $0.00 | $0.00 | |||
| 02011 | B | Alexandria, LA: Liquid Oxygen System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 48 | $0.00 | $0.00 | |||
| 02011 | C | Alexandria, LA: Liquid Oxygen System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 48 | $0.00 | $0.00 | |||
| 02011 | D | Alexandria, LA: Liquid Oxygen System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 48 | $0.00 | $0.00 | |||
| 02011 | E | Alexandria, LA: Liquid Oxygen System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 48 | $0.00 | $0.00 | |||
| 02012 | Alexandria, LA: Portable Liquid Oxygen System Fee | NSP | |||||
| 02012 | A | Alexandria, LA: Portable Liquid Oxygen System Fee | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 48 | $0.00 | $0.00 | |||
| 02012 | B | Alexandria, LA: Portable Liquid Oxygen System Fee | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 48 | $0.00 | $0.00 | |||
| 02012 | C | Alexandria, LA: Portable Liquid Oxygen System Fee | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 48 | $0.00 | $0.00 | |||
| 02012 | D | Alexandria, LA: Portable Liquid Oxygen System Fee | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 48 | $0.00 | $0.00 | |||
| 02012 | E | Alexandria, LA: Portable Liquid Oxygen System Fee | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 48 | $0.00 | $0.00 | |||
| 02013 | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | NSP | |||||
| 02013 | A | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | |||||
| Base Year: November 30, 2022 to November 29, 2023 | LB | 1200 | $0.00 | $0.00 | |||
| 02013 | B | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | LB | 1200 | $0.00 | $0.00 | |||
| 02013 | C | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | LB | 1200 | $0.00 | $0.00 | |||
| 02013 | D | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | LB | 1200 | $0.00 | $0.00 | |||
| 02013 | E | Alexandria, LA: Liquid Oxygen per pound for CLIN #02011 & #02012 | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | LB | 1200 | $0.00 | $0.00 | |||
| 02014 | Alexandria, LA: Permanent Relocation: This shall include all supplies, equipment, delivery and vendor coordination for Permanent Relocation | NSP | |||||
| 02014 | A | Alexandria, LA: Permanent Relocation | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 120 | $0.00 | $0.00 | |||
| 02014 | B | Alexandria, LA: Permanent Relocation | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 120 | $0.00 | $0.00 | |||
| 02014 | C | Alexandria, LA: Permanent Relocation | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 120 | $0.00 | $0.00 | |||
| 02014 | D | Alexandria, LA: Permanent Relocation | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 120 | $0.00 | $0.00 | |||
| 02014 | E | Alexandria, LA: Permanent Relocation | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 120 | $0.00 | $0.00 | |||
| 02015 | Alexandria, LA: Portable Concentrator -This shall include- Initial home environment assessment, delivery and set-up by a Technician of the oxygen concentrator, back-up system complete with regulator, Oxygen Thermal fuses (i.e. fire-safe, oxy-safe, or fire-break). Cannulas w/connector, supplies, tubing, cannulas, Filter(s), batteries (min 2 based on patient requirements), humidifier as needed, four (4) portable cylinders with wheeled cart, regulator, cylinder stand to support each cylinder delivered, and patient education on functionality/features of Portable Concentrator | NSP | |||||
| 02015 | A | Alexandria, LA: Portable Concentrator | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 200 | $0.00 | $0.00 | |||
| 02015 | B | Alexandria, LA: Portable Concentrator | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 250 | $0.00 | $0.00 | |||
| 02015 | C | Alexandria, LA: Portable Concentrator | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 250 | $0.00 | $0.00 | |||
| 02015 | D | Alexandria, LA: Portable Concentrator | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 300 | $0.00 | $0.00 | |||
| 02015 | E | Alexandria, LA: Portable Concentrator | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 300 | $0.00 | $0.00 | |||
| 02016 | Alexandria, LA: Portable Concentrator Monthly Rental: This shall include Monthly Rental of Portable Concentrator with Back-up System, monthly supplies, resupply deliveries, including cannulas, tubing, filter(s), humidifiers as needed, and preventive maintenance | NSP | |||||
| 02016 | A | Alexandria, LA: Portable Concentrator Monthly Rental | |||||
| Base Year: November 30, 2022 to November 29, 2023 | EA | 2200 | $0.00 | $0.00 | |||
| 02016 | B | Alexandria, LA: Portable Concentrator Monthly Rental | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | EA | 2750 | $0.00 | $0.00 | |||
| 02016 | C | Alexandria, LA: Portable Concentrator Monthly Rental | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | EA | 2750 | $0.00 | $0.00 | |||
| 02016 | D | Alexandria, LA: Portable Concentrator Monthly Rental | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | EA | 3300 | $0.00 | $0.00 | |||
| 02016 | E | Alexandria, LA: Portable Concentrator Monthly Rental | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | EA | 3300 | $0.00 | $0.00 | |||
| 02017 | Alexandria, LA: Oxygen Cylinder Refill Stations: This shall include- Delivery and set-up by a Technician of the Oxygen Cylinder Refill Station w/ transfer hose, related equipment, and patient education on equipment functionality | NSP | |||||
| 02017 | A | Alexandria, LA: Oxygen Cylinder Refill Stations | |||||
| Base Year: November 30, 2022 to November 29, 2023 | JB | 1 | $0.00 | $0.00 | |||
| 02017 | B | Alexandria, LA: Oxygen Cylinder Refill Stations | |||||
| Option Year One: November 30, 2023 to November 29, 2024 | JB | 1 | $0.00 | $0.00 | |||
| 02017 | C | Alexandria, LA: Oxygen Cylinder Refill Stations | |||||
| Option Year Two: November 30, 2024 to November 29, 2025 | JB | 1 | $0.00 | $0.00 | |||
| 02017 | D | Alexandria, LA: Oxygen Cylinder Refill Stations | |||||
| Option Year Three: November 30, 2025 to November 29, 2026 | JB | 1 | $0.00 | $0.00 | |||
| 02017 | E | Alexandria, LA: Oxygen Cylinder Refill Stations | |||||
| Option Year Four: November 30, 2026 to November 29, 2027 | JB | 1 | $0.00 | $0.00 | |||
| 02018 | Alexandria, LA: Oxygen Cylinder Refill Stations- Monthly Rental | NSP | |||||
| 02018 | A | Alexandria, LA: Oxygen Cylinder Refill Stations- Monthly Rental |
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