Item Schedule- CCHCS.xlsx

XLSX spreadsheet 63 KB Posted May 19, 2023

Attached to: VA Home Oxygen Services for Central California
Solicitation number: 36C26123Q0583
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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File	Type	Posted
36C26123Q0583 VACCHS.pdf	PDF	May 19, 2023
WAGE DETERMINATIONS - Central Cal.pdf	PDF	May 8, 2023
QASP - Home Oxygen.pdf	PDF	May 8, 2023
Home Oxygen Item Schedule v2 SAM.xlsx	XLSX spreadsheet	May 8, 2023
RFQ 36C26123Q0583.pdf	PDF	May 8, 2023

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CCHCS

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: June 1, 2023-August 31, 2023	13	$ - 0	Month	$ - 0
	Owned Portable Concentrator		Humidifier (when required), Cannulas or	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	13	$ - 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: June 1, 2023-August 31, 2023	925	$ - 0	Month	$ - 0
	Owned Low Decibel		maintenance and 90 calendar day visit as	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	925	$ - 0	Month	$ - 0
	Concentrator System		described in Item 1

Priced Per Month

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

Priced Per Month

1c	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: June 1, 2023-August 31, 2023	1	$ - 0	Month	$ - 0
	Owned Hi Flow		maintenance and 90 calendar day visit as	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1	$ - 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: June 1, 2023-August 31, 2023	840	$ - 0	Month	$ - 0
	Owned Portable O2		Flowmeter, Humidifier, Cannulas,	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	840	$ - 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: June 1, 2023-August 31, 2023	3	$ - 0	Month	$ - 0
	Owned Stationary		Humidifier, Cannulas or Masks, and	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	3	$ - 0	Month	$ - 0
	Liquid O2 System		Colored Tubing.

Priced Per Month

4	Rental of Contractor	E0434	Portable Container, Refill Adapter	Base Period: June 1, 2023-August 31, 2023	0	$ - 0	Month	$ - 0
	Owned Portable		Flowmeter, Cannulas or Masks, and	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	0	$ - 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	Suction Pump	E0600	Purchase, Delivery, Set-up and	Base Period: June 1, 2023-August 31, 2023	9	$ - 0	Each	$ - 0
			Training of Contractor Home Model	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	9	$ - 0	Each	$ - 0
			Respiratory Suction Pump, portable
	Priced Per Each		or stationary electric to include all
			supplies

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

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
7	Rental of Contractor	E0465 & E0466	Delivery, Set-up, Training, and	Base Period: June 1, 2023-August 31, 2023	9	$ - 0	Month	$ - 0
	Owned Volume		Maintenance of Contractor Owned	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	9	$ - 0	Month	$ - 0
	Ventilator		Stationary or Portable Ventilator, to
			include back up Ventilator and all supplies
	Priced Per Month

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

9	Ventilator	E0465 & E0466	Maintenance of Government Owned	Base Period: June 1, 2023-August 31, 2023	0	$ - 0	Month	$ - 0
	Maintenance		Ventilator Systems, to include all	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	0	$ - 0	Month	$ - 0
			supplies
	Priced Per Month

10	Air Compressor	E0565	Rental of Contractor Owned and	Base Period: June 1, 2023-August 31, 2023	6	$ - 0	Month	$ - 0
			Maintained continuous or intermittent	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	6	$ - 0	Month	$ - 0
			air compressor for use with
			equipment not self contained or
	Priced Per Month		cylinder driven, to include all
			associated supplies

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD	ESTIMATED	UNIT	UNIT OF	TOTAL 3-MONTH
		CODE			3-MONTH	PRICE	PURCHASE	ESTIMATED COST
					QUANTITIES
11	Delivery Charge	A9901	Deliveries not made under all other	Base Period: June 1, 2023-August 31, 2023	0	$ - 0	Each	$ - 0
			line items	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	0	$ - 0	Each	$ - 0

Priced Per Each

12	Respiratory Therapist	VA120	Government requested Respiratory	Base Period: June 1, 2023-August 31, 2023	0	$ - 0	Each	$ - 0
	Visit		Therapist visit not covered by other	Option Period 1: Sept. 1, 2023-Nov. 30, 2023	0	$ - 0	Each	$ - 0
			Line Items
	Priced Per Each

Fresno specific pricing instructions

Line Items 1-1c Require Quarterly Maintenance Visits

				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: June 1, 2023-August 31, 2023	2283	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	2283	$ - 0	Cylinder	$ - 0

R2	D Cylinder	E0443	D Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	6	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	6	$ - 0	Cylinder	$ - 0

R3	C Cylinder	E0443	C Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	3	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	3	$ - 0	Cylinder	$ - 0

R4	M-6 Cylinder	E0443	M-6 Cylinder Refill	Base Period: June 1, 2023-August 31, 2023	1017	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	1017	$ - 0	Cylinder	$ - 0

R5	H Tank	E0443	H Tank Refill	Base Period: June 1, 2023-August 31, 2023	6	$ - 0	Cylinder	$ - 0
				Option Period 1: Sept. 1, 2023-Nov. 30, 2023	6	$ - 0	Cylinder	$ - 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.