36C25719Q0430-006.xlsx
XLSX spreadsheet 25 KB Posted
- Solicitation number
- 36C25719Q0430
About this file
36C25719Q0430 Attachment 5 - Brand Name Price-Rate List - Annual Final.xlsx
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25719Q0430-003.pdf | ||
| 36C25719Q0430-002.pdf | ||
| 36C25719Q0430-004.pdf | ||
| 36C25719Q0430-005.pdf | ||
| 36C25719Q0430-007.xlsx | XLSX spreadsheet | |
| 36C25719Q0430-000.docx | DOCX document | |
| 36C25719Q0430-008.pdf | ||
| 36C25719Q0430-001.pdf |
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Text version
1st Year
| First Year Rates | |||||||||||
| Name Brand Prescription | |||||||||||
| I | II | III | IV | V | VI | VII | VIII | IX | X | ||
| QTY | AWP | Name Brand Prescription Minimum Discount from AWP | Multiply Column II times Column III | Contractor Brand Name Price | Total Claims | Dispensing fee per prescription | Multiply Column VI times Column VII | Multiply Column I times Column V | Add total of Column VIII and IX: Total Est. Annual Cost per Prescription | ||
| 1 | CIPRODEX OTIC SUSPENSION 7.5ML | 60 | $ 283.32 | 0% | $ - 0 | $ 283.32 | 10 | $ - 0 | $ - 0 | $ 16,999.20 | $ 16,999.20 |
| 2 | ELIQUIS TABLET 5MG | 500 | $ 533.00 | 0% | $ - 0 | $ 533.00 | 20 | $ - 0 | $ - 0 | $ 266,500.00 | $ 266,500.00 |
| 3 | LANTUS INSULIN 10ML VIAL | 75 | $ 340.27 | 0% | $ - 0 | $ 340.27 | 10 | $ - 0 | $ - 0 | $ 25,520.25 | $ 25,520.25 |
| 4 | ATROVENT 12.9GM | 50 | $ 465.72 | 0% | $ - 0 | $ 465.72 | 10 | $ - 0 | $ - 0 | $ 23,286.00 | $ 23,286.00 |
| 5 | NOVOLOG 10 ML VIAL | 50 | $ 360.14 | 0% | $ - 0 | $ 360.14 | 10 | $ - 0 | $ - 0 | $ 18,007.00 | $ 18,007.00 |
| 6 | SYMBICORT AEROSOL 160-4.5 MCG INHALER | 50 | $ 416.20 | 0% | $ - 0 | $ 416.20 | 10 | $ - 0 | $ - 0 | $ 20,810.00 | $ 20,810.00 |
Minimum discount rate for all other prescriptions 0% Dispensing Fee for all other prescriptions $ - 0
Prices shall be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet and the calculations below. Offerors are required to fill in the highlighted portions for the Discount and Dispensing Fee. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted. Please see the tabs below for the 2nd and 3rd year calculations. You are required to fill in the proposed values in order to calculate the Total Evaluated Price for all items and performance periods. This calculation table is for price evaluation purposes and does not reflect the actual prescriptions, quantities or associated costs that will be ordered under this BPA. As a reminder, the discount rates for the items listed above, as well as the dispensing fees for the items will not change for the corresponding performance period.
Attachment 5 Brand Name Price-Rate List 36C25719Q0430
2nd Year
| Second Year Rates | |||||||||||
| Name Brand Prescription | |||||||||||
| I | II | III | IV | V | VI | VII | VIII | IX | X | ||
| QTY | AWP | Name Brand Prescription Minimum Discount from AWP | Multiply Column II times Column III | Contractor Brand Name Price | Total Claims | Dispensing fee per prescription | Multiply Column VI times Column VII | Multiply Column I times Column V | Add total of Column VIII and IX: Total Est. Annual Cost per Prescription | ||
| 1 | CIPRODEX OTIC SUSPENSION 7.5ML | 60 | $ 283.32 | 0% | $ - 0 | $ 283.32 | 10 | $ - 0 | $ - 0 | $ 16,999.20 | $ 16,999.20 |
| 2 | ELIQUIS TABLET 5MG | 500 | $ 533.00 | 0% | $ - 0 | $ 533.00 | 20 | $ - 0 | $ - 0 | $ 266,500.00 | $ 266,500.00 |
| 3 | LANTUS INSULIN 10ML VIAL | 75 | $ 340.27 | 0% | $ - 0 | $ 340.27 | 10 | $ - 0 | $ - 0 | $ 25,520.25 | $ 25,520.25 |
| 4 | ATROVENT 12.9GM | 50 | $ 465.72 | 0% | $ - 0 | $ 465.72 | 10 | $ - 0 | $ - 0 | $ 23,286.00 | $ 23,286.00 |
| 5 | NOVOLOG 10 ML VIAL | 50 | $ 360.14 | 0% | $ - 0 | $ 360.14 | 10 | $ - 0 | $ - 0 | $ 18,007.00 | $ 18,007.00 |
| 6 | SYMBICORT AEROSOL 160-4.5 MCG INHALER | 50 | $ 416.20 | 0% | $ - 0 | $ 416.20 | 10 | $ - 0 | $ - 0 | $ 20,810.00 | $ 20,810.00 |
Minimum discount rate for all other prescriptions 0% Dispensing Fee for all other prescriptions $ - 0
Prices shall be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet and the calculations below. Offerors are required to fill in the highlighted portions for the Discount and Dispensing Fee. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted. Please see the tabs below for the 2nd and 3rd year calculations. You are required to fill in the proposed values in order to calculate the Total Evaluated Price for all items and performance periods. This calculation table is for price evaluation purposes and does not reflect the actual prescriptions, quantities or associated costs that will be ordered under this BPA. As a reminder, the discount rates for the items listed above, as well as the dispensing fees for the items will not change for the corresponding performance period.
3rd Year
| Third Year Rates | |||||||||||
| Name Brand Prescription | |||||||||||
| I | II | III | IV | V | VI | VII | VIII | IX | X | ||
| QTY | AWP | Name Brand Prescription Minimum Discount from AWP | Multiply Column II times Column III | Contractor Brand Name Price | Total Claims | Dispensing fee per prescription | Multiply Column VI times Column VII | Multiply Column I times Column V | Add total of Column VIII and IX: Total Est. Annual Cost per Prescription | ||
| 1 | CIPRODEX OTIC SUSPENSION 7.5ML | 60 | $ 283.32 | 0% | $ - 0 | $ 283.32 | 10 | $ - 0 | $ - 0 | $ 16,999.20 | $ 16,999.20 |
| 2 | ELIQUIS TABLET 5MG | 500 | $ 533.00 | 0% | $ - 0 | $ 533.00 | 20 | $ - 0 | $ - 0 | $ 266,500.00 | $ 266,500.00 |
| 3 | LANTUS INSULIN 10ML VIAL | 75 | $ 340.27 | 0% | $ - 0 | $ 340.27 | 10 | $ - 0 | $ - 0 | $ 25,520.25 | $ 25,520.25 |
| 4 | ATROVENT 12.9GM | 50 | $ 465.72 | 0% | $ - 0 | $ 465.72 | 10 | $ - 0 | $ - 0 | $ 23,286.00 | $ 23,286.00 |
| 5 | NOVOLOG 10 ML VIAL | 50 | $ 360.14 | 0% | $ - 0 | $ 360.14 | 10 | $ - 0 | $ - 0 | $ 18,007.00 | $ 18,007.00 |
| 6 | SYMBICORT AEROSOL 160-4.5 MCG INHALER | 50 | $ 416.20 | 0% | $ - 0 | $ 416.20 | 10 | $ - 0 | $ - 0 | $ 20,810.00 | $ 20,810.00 |
Minimum discount rate for all other prescriptions 0% Dispensing Fee for all other prescriptions $ - 0
Prices shall be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet and the calculations below. Offerors are required to fill in the highlighted portions for the Discount and Dispensing Fee. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted. Please see the tabs below for the 2nd and 3rd year calculations. You are required to fill in the proposed values in order to calculate the Total Evaluated Price for all items and performance periods. This calculation table is for price evaluation purposes and does not reflect the actual prescriptions, quantities or associated costs that will be ordered under this BPA. As a reminder, the discount rates for the items listed above, as well as the dispensing fees for the items will not change for the corresponding performance period.
52.217-8 Ext Rates
| 52.217-8 Extension Rates | |||||||||||
| Name Brand Prescription | |||||||||||
| 6-Month Period | I | II | III | IV | V | VI | VII | VIII | IX | X | |
| QTY | AWP | Name Brand Prescription Minimum Discount from AWP | Multiply Column II times Column III | Contractor Brand Name Price | Total Claims | Dispensing fee per prescription | Multiply Column VI times Column VII | Multiply Column I times Column V | Add total of Column VIII and IX: Total Est. Annual Cost per Prescription | ||
| 1 | CIPRODEX OTIC SUSPENSION 7.5ML | 60 | $ 283.32 | 0% | $ - 0 | $ 283.32 | 10 | $ - 0 | $ - 0 | $ 16,999.20 | $ 16,999.20 |
| 2 | ELIQUIS TABLET 5MG | 500 | $ 533.00 | 0% | $ - 0 | $ 533.00 | 20 | $ - 0 | $ - 0 | $ 266,500.00 | $ 266,500.00 |
| 3 | LANTUS INSULIN 10ML VIAL | 75 | $ 340.27 | 0% | $ - 0 | $ 340.27 | 10 | $ - 0 | $ - 0 | $ 25,520.25 | $ 25,520.25 |
| 4 | ATROVENT 12.9GM | 50 | $ 465.72 | 0% | $ - 0 | $ 465.72 | 10 | $ - 0 | $ - 0 | $ 23,286.00 | $ 23,286.00 |
| 5 | NOVOLOG 10 ML VIAL | 50 | $ 360.14 | 0% | $ - 0 | $ 360.14 | 10 | $ - 0 | $ - 0 | $ 18,007.00 | $ 18,007.00 |
| 6 | SYMBICORT AEROSOL 160-4.5 MCG INHALER | 50 | $ 416.20 | 0% | $ - 0 | $ 416.20 | 10 | $ - 0 | $ - 0 | $ 20,810.00 | $ 20,810.00 |
Minimum discount rate for all other prescriptions 0% Dispensing Fee for all other prescriptions $ - 0
Prices shall be evaluated based on the offeror's Proposed Discounts and Dispensing Fees and calculated based on the sample set of prescription data found in the worksheet and the calculations below. Offerors are required to fill in the highlighted portions for the Discount and Dispensing Fee. The minimum proposed discount rates and dispensing fees for the identified items above will not change for the period of performance you are quoting. However, higher discount rates may be offered at any time but at no time will be lower than the proposed rate for the period of performance quoted. Please see the tabs below for the 2nd and 3rd year calculations. You are required to fill in the proposed values in order to calculate the Total Evaluated Price for all items and performance periods. This calculation table is for price evaluation purposes and does not reflect the actual prescriptions, quantities or associated costs that will be ordered under this BPA. As a reminder, the discount rates for the items listed above, as well as the dispensing fees for the items will not change for the corresponding performance period.
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