UPDATED 9-15-26 - Attachment D_136C25626R0037 Pricing Schedule.xlsx
XLSX spreadsheet 1 MB Posted
- Attached to
- Home Oxygen and Ventilator Services - VISN 16
- Solicitation number
- 36C25626R0037
About this file
This is a pricing schedule attachment for a federal contract solicitation for Home Oxygen and Ventilator Services for VISN 16 (Department of Veterans Affairs Veterans Health Administration). The pricing schedule outlines 36 contract line items (CLINs) for services to be delivered in Fayetteville, Arkansas and Little Rock, Arkansas, covering the period from November 1, 2026 through November 29, 2031, with a base year and four option years. Services include oxygen concentrator equipment setup and monthly rentals (5 LPM and 10 LPM models), stationary and portable cylinder setups with monthly refills (various sizes), portable concentrators, ventilator equipment and monthly rentals, demand nasal cannulas, pulse conservers, liquid oxygen systems, oxygen refill stations, ancillary equipment and supplies (batteries, chargers, humidifiers, compressors, thermal fuses), and technician home environment assessments and re-education visits. All items are priced on a "Not Separately Priced" (NSP) basis, requiring vendors to include pricing details in their proposals rather than in this schedule. The contract includes estimated annual quantities for each service line ranging from 0 to 16,900 units depending on the CLIN, with job (JB) and equipment (EA) units of measure. Prices escalate across the four option years for most line items, reflecting anticipated inflation or usage increases over the contract performance period.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25626R0037 - Am 3.pdf | ||
| Technical Questions and Responses - 36C25626R0037.docx | DOCX document | |
| UPDATED - Attachment D_136C25626R0037 Pricing Schedule.xlsx | XLSX spreadsheet | |
| UPDATED - Performance Work Statement - Home Oxygen 3-station.pdf | ||
| 36C25626R0037 Amendment 0002.pdf | ||
| 36C25626R0037 Amendment 0001.pdf | ||
| Attch D_5 QUALITY ASSURANCE SURVEILLANCE PLAN 3-stations.pdf | ||
| 36C25626R0037 Final.pdf | ||
| Attch D_3 Reference Contract Worksheet Home O2.docx | DOCX document | |
| Copy of DELIVERY.xlsx | XLSX spreadsheet | |
| Attch D_1 36C25626R0037 Pricing Schedule.xlsx | XLSX spreadsheet | |
| Attch D_4 - Counties and Parishes.docx | DOCX document | |
| Attch D_2 Business Associate Agreement.pdf |
Show all 13
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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 Pricing Schedule LIN SLIN Description Ref CLIN Comment Include Comments in Document Contract Period Pop Begin Pop End Quantity Unit of Issue Packaging Multiple Estimated Annual Quantity Receipt Type Unit Price Estimated Annual Total Price Item Discount Type Name Item Discount Date Updated Address1 Address2 Address3 City State Zip Zip4 Country Mark For Contact Name Contact Phone Contact Email Delivery Date FOB Special Instructions Include Instructions/Comments in Document PRINCIPAL NAICS CODE PRODUCT/SERVICE CODE UNSPSC SIC CODE MANUFACTURER PART NUMBER (MPN) NATIONAL STOCK NUMBER LOCAL STOCK NUMBER DM DOC ID DELIVERY REF. COUNTER UNIT TEXT/DESCRIPTION DELIVERY REFERENCE ITEM MASTER FILE NUMBER EXPENDABLE/NON-EXPENDABLE QUANTITY REQUESTED UNIT OF PURCHASE CODE UNIT OF PURCHASE TEXT/DESC. NDC FOOD GROUP CODE NIF ITEM NUMBER MINIMUM ORDER QUANTITY MAXIMUM ORDER QUANTITY REQUIRED ORDER MULTIPLE UNIT CONVERSION FACTOR SPECIAL REMARKS CLINICAL DISCIPLINE ITEM PRICE ON BPA BASE OR OPTION PERIOD ITEM CONTROLLED SUBSTANCE BASE LINE ITEM NUMBER ENVIRONMENTAL ATTRIBUTE CODE ESTIMATED QUANTITY ITEM PRICE ON FSS/BOA ITEM PRICE ON FSS ITEM PRICE ON FSS (1-500 UNITS) ITEM PRICE ON FSS (501-1000 UNITS) ITEM PRICE ON FSS (1001-1500 UNITS) ITEM PRICE ON FSS (1500+ UNITS) EVALUATED ITEM PRICE ON FSS GPC ACCEPTED GREEN PRODUCT HAZARDOUS MATERIAL ITEM PART NAME ITEM PART NUMBER tc={C7D4309F-80DF-4295-96C6-A068BB3BC06B}: [Threaded comment]
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| item part number = distributor. Insert OEM part number of there isn't a distributor. | ITEM TYPE | ITEMS PER UNIT OF SALE (UOS) | LATEX FREE | ITEM MODEL NUMBER | OEM CAGE CODE | OEM COUNTRY OF ORIGIN | OEM DUNS NUMBER | OEM NAME | SALE START DATE | SALE END DATE | ITEM SALE PRICE | SALIENT CHARACTERISTIC | REFERENCED CONTRACT NUMBER | REFERENCED CONTRACT LINE NUMBER | REFERENCED CONTRACT SUB LINE NUMBER | DRAWING NUMBER | SPECIFICATION NUMBER | SERIAL NUMBER | MANUFACTURER NAME | YEAR OF MANUFACTURE | PROGRAM CODE | VENDOR PART NUMBER | TSP AUTHENTICATION CODE | TRANSPORTATION PRIORITY NUMBER | |||||||||||||||||||||||||
| FAYETTEVILLE | |||||||||||||||||||||||||||||||||||||||||||||||||
| 02001 | Fayetteville, AR 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 Separately Priced (NSP) | 01E01-21 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02001 | A | Base Year: November 1, 2026 to November 29, 2031 | JB | 360 | 01E01-21 | ||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 370 | 01E01-21 | |||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 380 | 01E01-21 | |||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 390 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 400 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| 02002 | Fayetteville, AR 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 16500 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 16600 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 16700 | 01E01-21 | |||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 16800 | 01E01-21 | |||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 16900 | 01E01-21 | |||||||||||||||||||||||||||||||||||||||||||||
| 02003 | Fayetteville, AR 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 | 01E01-21 | ||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 60 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 65 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 70 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 75 | 01E06-21 | |||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 80 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02004 | Fayetteville, AR 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 640 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 650 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 660 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 670 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 680 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02005 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 7 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 9 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 11 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02006 | Fayetteville, AR: Cylinder - Size M or H Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 25 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 40 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 45 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02007 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 6 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 7 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 8 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 9 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02008 | Fayetteville, AR: Cylinder - Size B/C/D/E/M6 Monthly Refill: This shall include all refills, supplies, resupply deliveries, including cannulas, tubing, and preventive maintenance | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 4200 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 4300 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 4400 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 4600 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02009 | Fayetteville, AR: Demand Nasal Cannula | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 15 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 20 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 25 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02010 | Fayetteville, AR: Demand Pulse Conserver Fee | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 4200 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 4400 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 4600 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 4800 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 5000 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02011 | Fayetteville, AR: Liquid Oxygen System Fee | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02012 | Fayetteville, AR: Portable Liquid Oxygen System Fee | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02013 | Fayetteville, AR: Liquid Oxygen per pound for CLIN #2011 & #2012 | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | LB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | LB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | LB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | LB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | LB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02014 | Fayetteville, AR: Permanent Relocation: This shall include all supplies, equipment, delivery and vendor coordination for Permanent Relocation | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 100 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 125 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 150 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 175 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 200 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02015 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02016 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 10200 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 10750 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 11500 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 12000 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 12500 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02017 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02018 | Fayetteville, AR: Oxygen Cylinder Refill Stations- Monthly Rental | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 120 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 125 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 130 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 135 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 140 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02019 | Fayetteville, AR: Liquid Oxygen Portable Helio System | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02020 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02021 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 300 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 300 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 300 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 300 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 300 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02022 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 10 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02023 | Fayetteville, AR: Delivery of Ventilator to local VA Facility | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 0 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02024 | Fayetteville, AR: Ventilator Roller Stand | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 5 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02025 | Fayetteville, AR: Oxygen Thermal Fuses Cannulas w/Connector | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 4500 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02026 | Fayetteville, AR: Travel Concentrator Stationary | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 25 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02027 | Fayetteville, AR: Travel Concerving Device | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 30 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 35 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02028 | Fayetteville, AR: 50 PSI Compressor | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 60 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 60 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 65 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 65 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 70 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02029 | Fayetteville, AR: Heated Humidifer | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02030 | Fayetteville, AR: POC Battery (additional) | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 360 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 375 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 390 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 400 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 410 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02031 | Fayetteville, AR: POC Desktop Battery Charger | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 150 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 175 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 200 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 200 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 200 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02032 | Fayetteville, AR: Fee for deliveries/pick-ups made greater than 150 miles | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 12 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02033 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 250 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02034 | Fayetteville, AR: 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 | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | JB | 2920 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | JB | 2920 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | JB | 2920 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | JB | 2920 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | JB | 2920 | ||||||||||||||||||||||||||||||||||||||||||||||
| 02035 | Fayetteville, AR: Heater Humidifer Chamber | NSP | |||||||||||||||||||||||||||||||||||||||||||||||
| A | Base Year: November 1, 2026 to November 29, 2031 | EA | 180 | ||||||||||||||||||||||||||||||||||||||||||||||
| B | Option Year One: November 30, 2027 to November 29, 2028 | EA | 180 | ||||||||||||||||||||||||||||||||||||||||||||||
| C | Option Year Two: November 30, 2028 to , November 29, 2029 | EA | 180 | ||||||||||||||||||||||||||||||||||||||||||||||
| D | Option Year Three: November 30, 2029 to November 29, 2030 | EA | 180 | ||||||||||||||||||||||||||||||||||||||||||||||
| E | Option Year Four: November 30, 2030 to November 29, 2031 | EA | 180 | ||||||||||||||||||||||||||||||||||||||||||||||
| 00036 | Fayetteville, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment | NSP | 00036 | Little Rock, AR: Liquid Oxygen Set-Up Fee - This shall include- Initial home environment assessment, delivery and set-up by a Licensed Respiratory Therapist (LRT), back-up system, filter(s), tubing, supplies, and patient education on functionality/features of Liquid Oxygen Equipment |
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