Item Schedule- SF.xlsx

XLSX spreadsheet 46 KB Posted May 19, 2023

Attached to: VA SAN FRANCISCO HOME OXYGEN SERVICES
Solicitation number: 36C26123Q0379
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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Other files

File	Type	Posted
36C26123Q0379 VASFHCS.pdf	PDF	May 19, 2023
RFQ 36C26123Q0379 - VA San Francisco Home Oxygen Bridge.pdf	PDF	Apr 24, 2023
QASP - Home Oxygen.pdf	PDF	Apr 24, 2023
VA San Francisco Home Oxygen Item Schedule.xlsx	XLSX spreadsheet	Apr 24, 2023
Wage Determination 2015-5637.pdf	PDF	Apr 24, 2023

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SFVAMC

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
1	Rental of Contractor	E1392	Concentrator, Colored Tubing, Adapter	Base Period: July 1, 2023-Sept. 30, 2023	65	$ - 0	Month	$ - 0
	Owned Portable Concentrator		Humidifier (when required), Cannulas or	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	65	$ - 0	Month	$ - 0
	System		Masks and other required supplies and
			equipment, including back up systems.
	Priced Per Month		Perform Equipment Maintenance in
			accordance with manufacturer standards.
			At a minimum of once every 90 calendar
			days, visit and assess patient to assure
			equipment complinace, change filters and
			provide disposable supplies.

1a	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: July 1, 2023-Sept. 30, 2023	1225	$ - 0	Month	$ - 0
	Owned Low Decibel		maintenance and 90 calendar day visit as	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1225	$ - 0	Month	$ - 0
	Concentrator System		described in Item 1

Priced Per Month

1b	Rental of Contractor	K0738	To include all supplies, equipment	Base Period: July 1, 2023-Sept. 30, 2023	75	$ - 0	Month	$ - 0
	Owned Home Fill		maintenance and 90 calendar day visit as	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	75	$ - 0	Month	$ - 0
	Oxygen System		described in Item 1

Priced Per Month

1c	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: July 1, 2023-Sept. 30, 2023	80	$ - 0	Month	$ - 0
	Owned Hi Flow		maintenance and 90 calendar day visit as	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	80	$ - 0	Month	$ - 0
	Concentrator System		described in Item 1

Priced Per Month

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
2	Rental of Contractor	E0431	Portable System, Regulator,	Base Period: July 1, 2023-Sept. 30, 2023	925	$ - 0	Month	$ - 0
	Owned Portable O2		Flowmeter, Humidifier, Cannulas,	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	925	$ - 0	Month	$ - 0
	Gaseous System for		or Masks, Tubing,
	use with or without		Conserving Device and O2 Tank
	Stationary System		Cylinder Stands capable of holding
	Priced Per Month		12 cylinders, sizes E, D, C & M-6

3	Rental of Contractor	E0439	Resevoir, Regulator, Flowmeter,	Base Period: July 1, 2023-Sept. 30, 2023	28	$ - 0	Month	$ - 0
	Owned Stationary		Humidifier, Cannulas or Masks, and	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	28	$ - 0	Month	$ - 0
	Liquid O2 System		Colored Tubing.

Priced Per Month

4	Rental of Contractor	E0434	Portable Container, Refill Adapter	Base Period: July 1, 2023-Sept. 30, 2023	43	$ - 0	Month	$ - 0
	Owned Portable		Flowmeter, Cannulas or Masks, and	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	43	$ - 0	Month	$ - 0
	Liquid O2 System		Colored Tubing. Resevoir will be provided
			if another Stationary System (e.g.
	Priced Per Month		Concentrator) is rented.

5	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: July 1, 2023-Sept. 30, 2023	2	$ - 0	Each	$ - 0
	Airway Device		Government Owned CPAP in	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	2	$ - 0	Each	$ - 0
	(CPAP) Set-up		Patient's Home to include all supplies
			Mask will be provided by VA
	Priced Per Each

6	CPAP Maintenance	E0601	Maintenance of Government Owned	Base Period: July 1, 2023-Sept. 30, 2023	28	$ - 0	Each	$ - 0
	As Requested		CPAP, to include maintenance in	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	28	$ - 0	Each	$ - 0
			accordance with Manufacturer
	Priced Per Each		recommendation, replacement of
			Headgear, Chinstraps, Tubing, Mask
			& Filters Disposible/Non-Disposible
			in Patients Home
			Mask will be provided by VA
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
7	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: July 1, 2023-Sept. 30, 2023	2	$ - 0	Each	$ - 0
	Airway Device		Government Owned CPAP at the	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	2	$ - 0	Each	$ - 0
	(CPAP) Set-up		Contractors Facility to include all supplies
			Mask will be provided by VA
	Priced Per Each

8	Bilevel Positive Airway	E0470	Delivery, Set-up & Training of	Base Period: July 1, 2023-Sept. 30, 2023	2	$ - 0	Each	$ - 0
	Pressure Device		Government Owned BiLevel in	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	2	$ - 0	Each	$ - 0
	Set-up		Patient's Home to include all supplies
			Mask will be provided by VA
	Priced Per Each

9	BiLevel Maintenance	E0470	Maintenance of Government Owned	Base Period: July 1, 2023-Sept. 30, 2023	6	$ - 0	Each	$ - 0
	As Requested		BiLevel, to include maintenance in	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	6	$ - 0	Each	$ - 0
			accordance with Manufacturer
			recommendation, replacement of
	Priced Per Each		Headgear, Chinstraps, Tubing, Mask
			& Filters Disposible/Non-Disposible
			In Patients Home
			Mask will be provided by VA

10	BiLevel Set-up	E0470	Delivery, Set-up & Training of	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Each	$ - 0
			Government Owned BiLevel at the	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Each	$ - 0
			Contractors Facility to include all supplies
	Priced Per Each		Mask will be provided by VA

11	Nebulizers	E0570	Delivery, Set-up and Training of	Base Period: July 1, 2023-Sept. 30, 2023	3	$ - 0	Each	$ - 0
			Government Owned Nebulizer,	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	3	$ - 0	Each	$ - 0
			Compressor or Battery Powered as
	Priced Per Each		ordered

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
12	Suction Pump	E0600	Purchase, Delivery, Set-up and	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Each	$ - 0
			Training of Contractor Home Model	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Each	$ - 0
			Respiratory Suction Pump, portable
	Priced Per Each		or stationary electric to include all
			supplies

13	Suction Pump Rental	E0600	Delivery, Set-up, and Training of	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Each	$ - 0
			Contractor Owned Suction Pump to	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Each	$ - 0
			Include all supplies
	Priced Per Each

14	Rental of Contractor	E0465 & E0466	Delivery, Set-up, Training, and	Base Period: July 1, 2023-Sept. 30, 2023	13	$ - 0	Month	$ - 0
	Owned Volume		Maintenance of Contractor Owned	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	13	$ - 0	Month	$ - 0
	Ventilator		Stationary or Portable Ventilator, to
			include back up Ventilator and all supplies
	Priced Per Month

15a	Government Owned	E0465 & E0466	Delivery, Set-up, and Training of a	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Each	$ - 0
	Ventilator Set-up		Government Owned Ventilator	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Each	$ - 0
			to include all necessary supplies
	Priced Per Each

15b	Government Owned	E0465 & E0466	Delivery, Set-up, and Training of a	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Each	$ - 0
	Ventilator Set-up		Government Owned Ventilator	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Each	$ - 0
			to include all necessary VA-owned supplies
	Priced Per Each

16	Ventilator	E0465 & E0466	Maintenance of Government Owned	Base Period: July 1, 2023-Sept. 30, 2023	1	$ - 0	Month	$ - 0
	Maintenance		Ventilator Systems, to include all	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1	$ - 0	Month	$ - 0
			supplies
	Priced Per Month

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
17	Air Compressor	E0565	Rental of Contractor Owned and	Base Period: July 1, 2023-Sept. 30, 2023	2	$ - 0	Month	$ - 0
			Maintained continuous or intermittent	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	2	$ - 0	Month	$ - 0
			air compressor for use with
			equipment not self contained or
	Priced Per Month		cylinder driven, to include all
			associated supplies

18	Full Face Masks	A7030	CPAP/Bilevel Full Face Masks	Base Period: July 1, 2023-Sept. 30, 2023	6	$ - 0	Each	$ - 0
			Including Headgear	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	6	$ - 0	Each	$ - 0

Priced Per Each

19	Nasal Interface Mask	A7034	CPAP/Bilevel Masks, Nasal	Base Period: July 1, 2023-Sept. 30, 2023	11	$ - 0	Each	$ - 0
	or Cannula Type		Interface, Nasal Pillows & Nasal	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	11	$ - 0	Each	$ - 0
			Cushions (Mask or Cannula Type)
	Priced Per Each		Including Headgear

20	Delivery Charge	A9901	Deliveries not made under all other	Base Period: July 1, 2023-Sept. 30, 2023	0	$ - 0	Each	$ - 0
			line items	Option Period 1: Oct. 1, 2023-Dec. 31, 2023		$ - 0	Each	$ - 0

Priced Per Each

21	Respiratory Therapist	VA120	Government requested Respiratory	Base Period: July 1, 2023-Sept. 30, 2023	6	$ - 0	Each	$ - 0
	Visit		Therapist visit not covered by other	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	6	$ - 0	Each	$ - 0
			Line Items
	Priced Per Each

	San Francisco specific pricing instructions
	Line Items 1-1c Require Quarterly Maintenance Visits
	Line Items 5-10 - VA provided Mask
	Line Items 6 & 9 Maintenance upon request
				REFILLS - ALL QUANTITIES ARE MONTHLY		ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION		CONTRACT PERIOD	3-MONTH	CYLINDER	PURCHASE	ESTIMATED COST
		CODE				QUANTITIES	PRICE
R1	E Cylinder	E0443	E Cylinder Refill		Base Period: July 1, 2023-Sept. 30, 2023	800	$ - 0	Cylinder	$ - 0
					Option Period 1: Oct. 1, 2023-Dec. 31, 2023	800	$ - 0	Cylinder	$ - 0

R2	D Cylinder	E0443	D Cylinder Refill	Base Period: July 1, 2023-Sept. 30, 2023	140	$ - 0	Cylinder	$ - 0
				Option Period 1: Oct. 1, 2023-Dec. 31, 2023	140	$ - 0	Cylinder	$ - 0

R3	C Cylinder	E0443	C Cylinder Refill	Base Period: July 1, 2023-Sept. 30, 2023	140	$ - 0	Cylinder	$ - 0
				Option Period 1: Oct. 1, 2023-Dec. 31, 2023	140	$ - 0	Cylinder	$ - 0

R4	M-6 Cylinder	E0443	M-6 Cylinder Refill	Base Period: July 1, 2023-Sept. 30, 2023	1250	$ - 0	Cylinder	$ - 0
				Option Period 1: Oct. 1, 2023-Dec. 31, 2023	1250	$ - 0	Cylinder	$ - 0

R5	H Tank	E0443	H Tank Refill	Base Period: July 1, 2023-Sept. 30, 2023	11	$ - 0	Cylinder	$ - 0
				Option Period 1: Oct. 1, 2023-Dec. 31, 2023	11	$ - 0	Cylinder	$ - 0

						UNIT PER LB
						PRICE
R6	Liquide Oxygen	E0444	Liquide Oxygen	Base Period: July 1, 2023-Sept. 30, 2023	3250	$ - 0	LBS	$ - 0
			Refill	Option Period 1: Oct. 1, 2023-Dec. 31, 2023	3250	$ - 0	LBS	$ - 0

PRICING TOTAL PAGE

LINE ITEMS 1 THROUGH 19
TOTAL ESTIMATED ANNUAL PRICE - BASE PERIOD	$ - 0
TOTAL ESTIMATED ANNUAL PRICE - OPTION PERIOD 1	$ - 0

LINE ITEMS R1 - R6
TOTAL ESTIMATED ANNUAL PRICE - BASE PERIOD	$ - 0
TOTAL ESTIMATED ANNUAL PRICE - OPTION PERIOD 1	$ - 0

TOTAL ESTIMATED PRICE - BASE AND ALL OPTION PERIODS $ - 0

GRAND TOTAL $ - 0

File details come from the government source that posted it. Updated May 19, 2023.