36C26124Q0072 SNHCS Las Vegas Home Oxygen Supplies and Services Amendment 0003.pdf

5. PROJECT NUMBER (if applicable)

CODE7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE OF PAGES

10A. MODIFICATION OF CONTRACT/ORDER NUMBER

10B. DATED

BPA NO. 1. CONTRACT ID CODE

FACILITY CODECODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV. 11/2016)

is required to sign this document and return ___________ copies to the issuing office.is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITEM 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER

Contractor

16C. DATE SIGNED

14. DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER 16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30 PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243

(Type or print) (Type or print)

(Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code)

(If other than Item 6)

(Specify type of modification and authority)

(such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer)

0003 None

00261

Department of Veterans Affairs Network Contracting Office 21 VA Southern Nevada Healthcare System 6900 N. Pecos Road, Building 6 North Las Vegas NV 89086

00261

Department of Veterans Affairs Network Contracting Office 21 Southern Nevada Healthcare System 6900 N. Pecos Road, Building 6 North Las Vegas NV 89086

To all Offerors/Bidders

36C26124Q0072

01-10-2024

X

See CONTINUATION Page

The purpose of amendment 0003 is the following:

A. Extend the offer submission date to Monday, February 5th, 2024.

B. Provide Updated Addendum 52.212-1, noting follow up questions are due by Thursday, January 18th, 2024, at 17:00 PST.

C.Provide Updated Statement of Work.

D. Provide Updated Contract Line Items.

E. Provide responses to remaining questions.

CONTINUATION PAGE

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVIC

ES QUANTITY UNIT UNIT PRICE AMOUNT

0001 72.00 _____________

Delivery, Initial set-up, and education of Government-Owned Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, tubing, etc., when specified). Includes back up of minimum supply of oxygen which shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with litter flow 0 to 5 and 0 to 10 liters per minute. One time charge for new set-up/new patient.

Initial set-up is defined as those beneficiaries who have not been provided oxygen therapy delivery systems in the resident or nursing home on a previous occasion or have not used such a system continuously for the past sixty (60) days. Switch-out is defined as those beneficiaries who are presently using an oxygen delivery system or have used such a system continuously within the past sixty (60) days.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0002 1.00 _____________

If a request is received to deliver a Government owned concentrator and there is no Government inventory available, a vendor owned concentrator will be supplied at the vendor monthly rate (unit price).

Contract Period: Base

POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0003 1.00 _____________

In the event a patient needs to have the Government owned concentrator switched out and there is no Government owned inventory available, a vendor owned concentrator will be supplied and billed the vendor owned monthly rate (unit price).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0004 1.00 _____________

In the event a patient needs to have a Government owned concentrator switched out with another Government owned concentrator, the vendor shall bill the PST delivery rate (unit price).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0005 1.00 _____________

Preventive Maintenance Services (PMI) for Government owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PMI in accordance with manufactures instructions.)

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental

PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0006 6,696.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask humidifier, and tubing, etc., when specified).

(Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With flow rate of 0 – 5 liters per minute.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0007 372.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, and tubing, etc., when specified). (Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With a flow rate of 0-10 liters per minute.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0008 93.00 EA _____________

90 day Equipment Monitoring/Maintenance Visit every for concentrator patients.

Contract Period: Base

PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0009 1.00 _____________

Initial Set-ups states: For patients requiring portable oxygen concentrators for travel purposes, the Contractor shall be responsible for ensuring that an RRT or CRT performed set-up of portable oxygen concentrators within 24 hours of receiving the order from the VA. Contractor shall be responsible for all maintenance and storage of portable oxygen concentrators rented and/or purchased by VA.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0010 1.00 _____________

Portable oxygen concentrator (POC) Rental Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0011 1.00 _____________

Portable oxygen concentrator (POC) Rental Additional Battery Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical

MANUFACTURER PART NUMBER (MPN): NA

0012 1.00 _____________

Oxygen tubing as required/ordered, 6 foot in length Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0013 1.00 _____________

Oxygen tubing as required/ordered, 50 foot in length.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0014 1.00 _____________

Face masks as required/ordered.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0015 1.00 _____________

Standard nasal cannulas as required/ordered.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical

0016 1.00 _____________

Disposable humidifiers as required/ordered.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0017 1.00 _____________

Cylinder, size M60 or H. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. Primary set-up only. Includes delivery, setup, and education. This is a one-time equipment setup charge, and not a recurring monthly expense.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0018 1.00 _____________

If a patient requires a cylinder refill, the vendor shall bill for the cylinder refill rate per cylinder (unit price).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0019 1.00 _____________

Cylinder, size M60 or H refill (Backup/Primary) E0443 Contract Period: Base

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0020 396.00 _____________

Portable system for new set ups consists of “E”, “D”, “C”, or “B” (M6) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. EXCEPTIONS: Oxygen conserving devices are Government supplied.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0021 2,244.00 _____________

Cylinder, size “E” refill for #0016 above. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0022 372.00 _____________

Cylinder, size “D” refill for #0016 above. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Base POP Begin:

Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0023 1,908.00 _____________

Cylinder, size “C” refill for 0016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0024 912.00 _____________

Cylinder, size “M6) refill for 0016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0025 60.00 _____________

Demand Nasal Cannula (e.g. Oximyzer).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0026 1.00 _____________

“E” cylinders (aluminum, each) complete portable system (e.g.

tank, regulator, etc) for each Medical Center for availability to issue home oxygen beneficiaries who deplete their portable units during appointments or to send home with new start-up (e.g.

discharged from inpatient).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0027 1.00 _____________

Monthly rental liquid oxygen system (90 –100 lbs) with stationary reservoir per beneficiary E0439 Includes delivery, setup, education, and supplies.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0028 372.00 _____________

Monthly rental portable liquid oxygen system per beneficiary.

E0434 Includes delivery, setup, and education, and supplies.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0029 1.00 _____________

Liquid oxygen per pound for item CLIN 0027. E0444 Contract Period: Base POP Begin:

Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0030 1.00 _____________

Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0031 1.00 _____________

Home visit (non-clinical) by Respiratory Care Practitioner for reeducation.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0032 24.00 _____________

Home visit by Patient Services Technician for patients on Government-owned concentrators.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0033 564.00 _____________

All inclusive clinical Respiratory Services to include but not limited to: patient’s heart rate, blood pressure, breath sounds as well as pulse oximetry readings while on oxygen, room air at rest and while ambulating as tolerated. Periodic RT visits must address: prescribed liter flow compliance, equipment /patient safety (to include risk of open flames and smoking), and patient medication usage. Deficiencies shall be communicated to the COR or designee at the time of home visit or within 24 hours, using COR designated form. (Initial setup or every 6 months).

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0034 1.00 _____________

Fee for deliveries made for over 100 miles from the ordering VA facility, or from Contractors local facility, whichever is closer.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0035 936.00 _____________

Patient Safety Alert AL18-01 Use of Thermal Fuses on Home Oxygen Delivery Systems. Bidirectional oxygen thermal fuses.

Sometimes referred to as fire-safe, oxy-safe, or fire-break valves. Two thermal fuses must be provided and installed in each home oxygen delivery system (one at the patient end and one at the oxygen source). This must be done for the patient’s primary oxygen therapy equipment as well as any portable oxygen therapy equipment. Thermal fuses are not required for portable pulse dose/intermittent oxygen therapy equipment when the equipment does not have a continuous flow setting.

The fuses will be issued to all new patients that require them and replaced at the end of their expected life per manufacturer's guidelines.

Contract Period: Base POP Begin:

Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0036 1.00 _____________

Labor Fee for reconditioning/repair of VA owned equipment per manufacturer’s requirements. Contractor is required to notify the COR to obtain approval prior to fixing/repairing of VA equipment under this line item. $____ per .25 hour Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0037 1.00 _____________

Monthly equipment rental and management/monitoring of ventilators for continous ventilation patients, excludes scheduled preventatitve maintenance. Includes initial delivery, set-up, supplies, to include bag, value mask, education/training.

Monthly Licensed Respitory Therapist (LRT) visits to inspect equipment and environment, re-educate, and/or re-train caregiver, provide supplies as neccesary and perform routine preventative maintainance to include support of 2 ventilators per patient: 1 primary and 1 backup.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0038 1.00 _____________

Non-invasive ventilation patients; Monthly equipment rental and management/monitoring of ventilators for continuous ventilation patients, excludes scheduled preventative maintenance.

Includes initial delivery, set-up, supplies, to include bag, value mask, education/training. Monthly Licensed Respitory Therapist (LRT) visits to inspect equipment and environment, re-educate, and/or re-train caregiver, provide supplies as necessary and perform routine preventative maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

0039 1.00 _____________

Contractor shall provide all required service, maintenance, and repairs on all Contractor owned equipment in accordance with manufacturer standards and when required by this contract.

Contractor shall also provide service and maintenance on all Government Owned equipment, as required by the Ventilator Line Items, no additional maintenance or repairs are required.

Contract Period: Base POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1001 72.00 _____________

Delivery, Initial set-up, and education of Government-Owned Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, tubing, etc., when specified). Includes back up of minimum supply of oxygen which shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with litter flow 0 to 5 and 0 to 10 liters per minute. One time charge for new set-up/new patient.

Initial set-up is defined as those beneficiaries who have not been provided oxygen therapy delivery systems in the resident or nursing home on a previous occasion or have not used such a system continuously for the past sixty (60) days. Switch-out is defined as those beneficiaries who are presently using an oxygen delivery system or have used such a system continuously within the past sixty (60) days.

Contract Period: Option 1

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1002 1.00 _____________

If a request is received to deliver a Government owned concentrator and there is no Government inventory available, a vendor owned concentrator will be supplied at the vendor monthly rate (unit price).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1003 1.00 _____________

In the event a patient needs to have the Government owned concentrator switched out and there is no Government owned inventory available, a vendor owned concentrator will be supplied and billed the vendor owned monthly rate (unit price).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1004 1.00 _____________

In the event a patient needs to have a Government owned concentrator switched out with another Government owned concentrator, the vendor shall bill the PST delivery rate (unit price).

Contract Period: Option 1 POP Begin:

Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1005 1.00 _____________

Preventive Maintenance Services (PMI) for Government owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PMI in accordance with manufactures instructions.)

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1006 6,696.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask humidifier, and tubing, etc., when specified).

(Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With flow rate of 0 – 5 liters per minute.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1007 372.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, and tubing, etc., when specified). (Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With a flow rate of 0-10 liters per minute.

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1008 93.00 EA _____________

90 day Equipment Monitoring/Maintenance Visit every for concentrator patients.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1009 1.00 _____________

Initial Set-ups states: For patients requiring portable oxygen concentrators for travel purposes, the Contractor shall be responsible for ensuring that an RRT or CRT performed set-up of portable oxygen concentrators within 24 hours of receiving the order from the VA. Contractor shall be responsible for all maintenance and storage of portable oxygen concentrators rented and/or purchased by VA.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1010 1.00 _____________

Portable oxygen concentrator (POC) Rental Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment

1011 1.00 _____________

Portable oxygen concentrator (POC) Rental Additional Battery Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1012 1.00 _____________

Oxygen tubing as required/ordered, 6 foot in length Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1013 1.00 _____________

Oxygen tubing as required/ordered, 50 foot in length.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1014 1.00 _____________

Face masks as required/ordered.

Contract Period: Option 1 POP Begin:

POP End:

MANUFACTURER PART NUMBER (MPN): NA

1015 1.00 _____________

Standard nasal cannulas as required/ordered.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1016 1.00 _____________

Disposable humidifiers as required/ordered.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1017 1.00 _____________

Cylinder, size M60 or H. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. Primary set-up only. Includes delivery, setup, and education. This is a one-time equipment setup charge, and not a recurring monthly expense.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1018 1.00 _____________

If a patient requires a cylinder refill, the vendor shall bill for the cylinder refill rate per cylinder (unit price).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1019 1.00 _____________

Cylinder, size M60 or H refill (Backup/Primary) E0443 Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1020 396.00 _____________

Portable system for new set ups consists of “E”, “D”, “C”, or “B” (M6) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. EXCEPTIONS: Oxygen conserving devices are Government supplied.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1021 2,244.00 _____________

Cylinder, size “E” refill for #1016 above. Aluminum (or metal of equivalent weight) tanks required. E0443

Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1022 372.00 _____________

Cylinder, size “D” refill for 1016 above. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1023 1,908.00 _____________

Cylinder, size “C” refill for 1016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1024 912.00 _____________

Cylinder, size “M6) refill for 1016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical

1025 60.00 _____________

Demand Nasal Cannula (e.g. Oximyzer).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1026 1.00 _____________

“E” cylinders (aluminum, each) complete portable system (e.g.

tank, regulator, etc) for each Medical Center for availability to issue home oxygen beneficiaries who deplete their portable units during appointments or to send home with new start-up (e.g.

discharged from inpatient).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1027 1.00 _____________

Monthly rental liquid oxygen system (90 –100 lbs) with stationary reservoir per beneficiary E0439 Includes delivery, setup, education, and supplies.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1028 372.00 _____________

Monthly rental portable liquid oxygen system per beneficiary.

E0434 Includes delivery, setup, and education, and supplies.

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1029 1.00 _____________

Liquid oxygen per pound for item CLIN 1027. E0444 Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1030 1.00 _____________

Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1031 1.00 _____________

Home visit (non-clinical) by Respiratory Care Practitioner for reeducation.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical

1032 24.00 _____________

Home visit by Patient Services Technician for patients on Government-owned concentrators.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1033 564.00 _____________

All inclusive clinical Respiratory Services to include but not limited to: patient’s heart rate, blood pressure, breath sounds as well as pulse oximetry readings while on oxygen, room air at rest and while ambulating as tolerated. Periodic RT visits must address: prescribed liter flow compliance, equipment /patient safety (to include risk of open flames and smoking), and patient medication usage. Deficiencies shall be communicated to the COR or designee a t the time of home visit or within 24 hours, using COR designated form.

(Initial setup or every 6 months).

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1034 1.00 _____________

Fee for deliveries made for over 100 miles from the ordering VA facility, or from Contractors local facility, whichever is closer.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

1035 936.00 _____________ _____________

Patient Safety Alert AL18-01 Use of Thermal Fuses on Home Oxygen Delivery Systems. Bidirectional oxygen thermal fuses.

Sometimes referred to as fire-safe, oxy-safe, or fire-break valves. Two thermal fuses must be provided and installed in each home oxygen delivery system (one at the patient end and one at the oxygen source). This must be done for the patient’s primary oxygen therapy equipment as well as any portable oxygen therapy equipment. Thermal fuses are not required for portable pulse dose/intermittent oxygen therapy equipment when the equipment does not have a continuous flow setting.

The fuses will be issued to all new patients that require them and replaced at the end of their expected life per manufacturer's guidelines.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1036 1.00 _____________

Labor Fee for reconditioning/repair of VA owned equipment per manufacturer’s requirements. Contractor is required to notify the COR to obtain approval prior to fixing/repairing of VA equipment under this line item. $____ per .25 hour Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1037 1.00 _____________

Monthly equipment rental and management/monitoring of ventilators for continous ventilation patients, excludes scheduled preventatitve maintenance. Includes initial delivery, set-up, supplies, to include bag, value mask, education/training.

Monthly Licensed Respitory Therapist (LRT) visits to inspect equipment and environment, re-educate, and/or re-train caregiver, provide supplies as neccesary and perform routine preventative maintainance to include support of 2 ventilators per patient: 1 primary and 1 backup.

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1038 1.00 _____________

Non-invasive ventilation patients; Monthly equipment rental and management/monitoring of ventilators for continuous ventilation patients, excludes scheduled preventative maintenance.

Includes initial delivery, set-up, supplies, to include bag, value mask, education/training. Monthly Licensed Respitory Therapist (LRT) visits to inspect equipment and environment, re-educate, and/or re-train caregiver, provide supplies as necessary and perform routine preventative maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

1039 1.00 _____________

Contractor shall provide all required service, maintenance, and repairs on all Contractor owned equipment in accordance with manufacturer standards and when required by this contract.

Contractor shall also provide service and maintenance on all Government Owned equipment, as required by the Ventilator Line Items, no additional maintenance or repairs are required.

Contract Period: Option 1 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2001 72.00 _____________

Delivery, Initial set-up, and education of Government-Owned Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, tubing, etc., when specified). Includes back up of minimum supply of oxygen which shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with litter flow 0 to 5 and 0 to 10 liters per minute. One time charge for new set-up/new patient.

Initial set-up is defined as those beneficiaries who have not been provided oxygen therapy delivery systems in the resident or nursing home on a previous occasion or have not used such a system continuously for the past sixty (60) days. Switch-out is defined as those beneficiaries who are presently using an oxygen delivery system or have used such a system continuously within the past sixty (60) days.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2002 1.00 _____________

If a request is received to deliver a Government owned concentrator and there is no Government inventory available, a vendor owned concentrator will be supplied at the vendor monthly rate (unit price).

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2003 1.00 _____________

In the event a patient needs to have the Government owned concentrator switched out and there is no Government owned inventory available, a vendor owned concentrator will be supplied and billed the vendor owned monthly rate (unit price).

Contract Period: Option 2

Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2004 1.00 _____________

In the event a patient needs to have a Government owned concentrator switched out with another Government owned concentrator, the vendor shall bill the PST delivery rate (unit price).

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2005 1.00 _____________

Preventive Maintenance Services (PMI) for Government owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PMI in accordance with manufactures instructions.)

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2006 6,696.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask humidifier, and tubing, etc., when specified).

(Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With flow rate of 0 – 5 liters per minute.

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2007 372.00 _____________

Monthly Rental of Oxygen Concentrator System with backup system consisting of compressed gas source, regulator, stand, (nasal cannula or mask, humidifier, and tubing, etc., when specified). (Includes delivery, setup, and education). Back up minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. With a flow rate of 0-10 liters per minute.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2008 93.00 EA _____________

90 day Equipment Monitoring/Maintenance Visit every for concentrator patients.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2009 1.00 _____________

Initial Set-ups states: For patients requiring portable oxygen concentrators for travel purposes, the Contractor shall be responsible for ensuring that an RRT or CRT performed set-up of portable oxygen concentrators within 24 hours of receiving the order from the VA. Contractor shall be responsible for all maintenance and storage of portable oxygen concentrators rented and/or purchased by VA.

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2010 1.00 _____________

Portable oxygen concentrator (POC) Rental Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2011 1.00 _____________

Portable oxygen concentrator (POC) Rental Additional Battery Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2012 1.00 _____________

Oxygen tubing as required/ordered, 6 foot in length Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2013 1.00 _____________

Oxygen tubing as required/ordered, 50 foot in length.

POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2014 1.00 _____________

Face masks as required/ordered.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2015 1.00 _____________

Standard nasal cannulas as required/ordered.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2016 1.00 _____________

Disposable humidifiers as required/ordered.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

2017 1.00 _____________ _____________

Cylinder, size M60 or H. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. Primary set-up only. Includes delivery, setup, and education. This is a one-time equipment setup charge, and not a recurring monthly expense.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2018 1.00 _____________

If a patient requires a cylinder refill, the vendor shall bill for the cylinder refill rate per cylinder (unit price).

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2019 1.00 _____________

Cylinder, size M60 or H refill (Backup/Primary) E0443 Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2020 396.00 _____________

Portable system for new set ups consists of “E”, “D”, “C”, or “B” (M6) size aluminum (or equivalent weight metal) cylinder with regulator, flow meter, handcart, pouch and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. EXCEPTIONS: Oxygen conserving devices are Government supplied.

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2021 2,244.00 _____________

Cylinder, size “E” refill for #2016 above. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2022 372.00 _____________

Cylinder, size “D” refill for #2016 above. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2023 1,908.00 _____________

Cylinder, size “C” refill for 0016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 2 POP Begin:

POP End:

MANUFACTURER PART NUMBER (MPN): NA

2024 912.00 _____________

Cylinder, size “M6) refill for 2016. Aluminum (or metal of equivalent weight) tanks required. E0443 Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2025 60.00 _____________

Demand Nasal Cannula (e.g. Oximyzer).

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

MANUFACTURER PART NUMBER (MPN): NA

2026 1.00 _____________

“E” cylinders (aluminum, each) complete portable system (e.g.

tank, regulator, etc) for each Medical Center for availability to issue home oxygen beneficiaries who deplete their portable units during appointments or to send home with new start-up (e.g.

discharged from inpatient).

Contract Period: Option 2 POP Begin:

POP End:

PRINCIPAL NAICS CODE: 532283 - Home Health Equipment Rental PRODUCT/SERVICE CODE: 6515 - Medical and Surgical Instruments, Equipment, and Supplies

2027 1.00 _____________ _____________

Monthly rental liquid oxygen system (90 –100 lbs) with stationary reservoir…