36C26126Q0444 CLINS Price Per Unit.xlsx
XLSX spreadsheet 448 KB Posted
- Attached to
- Home Oxygen Services and Ventilation - VA Central California Healthcare System (VACCHCS)
- Solicitation number
- 36C26126Q0444
About this file
This file is a pricing template spreadsheet for CLINs (Contract Line Items) associated with a Home Oxygen Services and Ventilation solicitation for the VA Central California Healthcare System (VACCHCS).
The solicitation 36C26126Q0444 seeks pricing for home oxygen services to be provided over five ordering periods from October 1, 2026, through September 30, 2031. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21 is the procuring agency. Contractors must submit quotes by email to david.alvarez4@va.gov, with questions due by 10:00 AM PDT on April 1, 2026. The pricing template itself does not contain specific service requirements or detailed terms; rather, it provides the structure for vendors to input their unit pricing for the contract line items. Responses to previously submitted questions and supporting documentation are available in Amendment 0001, and no further questions or clarifications will be accepted after the specified deadline. Contractors should reference the Performance Work Statement for detailed requirements regarding the home oxygen services to be provided.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26126Q0444 0002 CANX.pdf | ||
| 36C26126Q0444 Questions and Responses.pdf | ||
| PP Questionnaire.docx | DOCX document | |
| Quality Assurance Surveillance Plan 4-3-2026.pdf | ||
| 36C26126Q0444 0001.pdf | ||
| Quality Assurance Surveillance Plan - VA Fresno.pdf | ||
| 36C26126Q0444.pdf | ||
| PP Questionnaire.docx | DOCX document |
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Text version
Action Line Item Information
| Action Type Name | Primary ID | Secondary ID | Mod Number | Title | Order Discount Type Name | Order Discount Type | Order Discount |
| RFQ | 36C26126Q0444 | Home Oxygen - Fresno VAMC | Percent | 0 |
KB Version: FY26.05A
Items
| ITEM NUMBER | DESCRIPTION | CONTRACT PERIOD | POP BEGIN | POP END | QUANTITY | UNIT OF MEASURE | PACKAGING MULTIPLE | RECEIPT TYPE | LINE ITEM IS | UNIT PRICE | ITEM DISCOUNT TYPE NAME | ITEM DISCOUNT | DATE UPDATED | ADDRESS1 | ADDRESS2 | ADDRESS3 | CITY | STATE | ZIP | ZIP4 | COUNTRY | MARK FRO | CONTACT NAME | CONTACT PHONE | CONTACT EMAIL | DELIVERY DATE | FOB | SPECIAL INSTRUCTIONS | INCLUDE INSTRUCTIONS/COMMENTS IN DOCUMENT | INCLUDE DATA VALUES 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 |
| 0001 | Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies. | Base | 10/1/26 | 9/30/27 | 5000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0002 | Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month. HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6. | Base | 10/1/26 | 9/30/27 | 3000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0003 | Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing. | Base | 10/1/26 | 9/30/27 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0004 | Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented. | Base | 10/1/26 | 9/30/27 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0005 | Suction Pump Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Base | 10/1/26 | 9/30/27 | 100 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0006 | Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Base | 10/1/26 | 9/30/27 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0007 | Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies. | Base | 10/1/26 | 9/30/27 | 80 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0008 | Government Owned Ventilator Set-up Priced Per Each. HCPCS CODE E0465. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies. | Base | 10/1/26 | 9/30/27 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0009 | REACT V+C ventilator Priced Per Month. HCPCS CODE E0468. Maintenance of Government Owned Ventilator Systems, to include all necessary supplies. | Base | 10/1/26 | 9/30/27 | 2 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0010 | Air Compressor Priced Per Month. HCPCS CODE E0465. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies. | Base | 10/1/26 | 9/30/27 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0011 | Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies | Base | 10/1/26 | 9/30/27 | 50 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0012 | Delivery Charge Priced Per Each. HCPCS CODE A9901. Deliveries not made under all other line items. | Base | 10/1/26 | 9/30/27 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0013 | Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items. | Base | 10/1/26 | 9/30/27 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1001 | Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies. | Option 1 | 10/1/27 | 9/30/28 | 5000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1002 | Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month. HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6. | Option 1 | 10/1/27 | 9/30/28 | 3000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1003 | Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing. | Option 1 | 10/1/27 | 9/30/28 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1004 | Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented. | Option 1 | 10/1/27 | 9/30/28 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1005 | Suction Pump Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 1 | 10/1/27 | 9/30/28 | 100 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1006 | Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 1 | 10/1/27 | 9/30/28 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1007 | Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465 & E0466. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies. | Option 1 | 10/1/27 | 9/30/28 | 80 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1008 | Government Owned Ventilator Set-up Priced Per Each. HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies. | Option 1 | 10/1/27 | 9/30/28 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1009 | Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies. | Option 1 | 10/1/27 | 9/30/28 | 2 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1010 | Air Compressor Priced Per Month. HCPCS CODE E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies. | Option 1 | 10/1/27 | 9/30/28 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1011 | Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies | Option 1 | 10/1/27 | 9/30/28 | 50 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1012 | Delivery Charge Priced Per Each. HCPCS CODE A9901. Deliveries not made under all other line items. | Option 1 | 10/1/27 | 9/30/28 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1013 | Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items. | Option 1 | 10/1/27 | 9/30/28 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2001 | Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies. | Option 2 | 10/1/28 | 9/30/29 | 5000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2002 | Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month. HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6. | Option 2 | 10/1/28 | 9/30/29 | 3000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2003 | Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing. | Option 2 | 10/1/28 | 9/30/29 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2004 | Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented. | Option 2 | 10/1/28 | 9/30/29 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2005 | Suction Pump Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 2 | 10/1/28 | 9/30/29 | 100 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2006 | Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 2 | 10/1/28 | 9/30/29 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2007 | Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465 & E0466. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies. | Option 2 | 10/1/28 | 9/30/29 | 80 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2008 | Government Owned Ventilator Set-up Priced Per Each. HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies. | Option 2 | 10/1/28 | 9/30/29 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2009 | Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies. | Option 2 | 10/1/28 | 9/30/29 | 2 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2010 | Air Compressor Priced Per Month. HCPCS CODE E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies. | Option 2 | 10/1/28 | 9/30/29 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2011 | Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies | Option 2 | 10/1/28 | 9/30/29 | 50 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2012 | Delivery Charge Priced Per Each. HCPCS CODE A9901. Deliveries not made under all other line items. | Option 2 | 10/1/28 | 9/30/29 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2013 | Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items. | Option 2 | 10/1/28 | 9/30/29 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3001 | Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies. | Option 3 | 10/1/29 | 9/30/30 | 5000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3002 | Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month. HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6. | Option 3 | 10/1/29 | 9/30/30 | 3000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3003 | Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing. | Option 3 | 10/1/29 | 9/30/30 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3004 | Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented. | Option 3 | 10/1/29 | 9/30/30 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3005 | Suction Pump Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 3 | 10/1/29 | 9/30/30 | 100 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3006 | Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 3 | 10/1/29 | 9/30/30 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3007 | Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465 & E0466. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies. | Option 3 | 10/1/29 | 9/30/30 | 80 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3008 | Government Owned Ventilator Set-up Priced Per Each. HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies. | Option 3 | 10/1/29 | 9/30/30 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3009 | Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies. | Option 3 | 10/1/29 | 9/30/30 | 2 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3010 | Air Compressor Priced Per Month. HCPCS CODE E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies. | Option 3 | 10/1/29 | 9/30/30 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3011 | Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies | Option 3 | 10/1/29 | 9/30/30 | 50 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3012 | Delivery Charge Priced Per Each. HCPCS CODE A9901. Deliveries not made under all other line items. | Option 3 | 10/1/29 | 9/30/30 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3013 | Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items. | Option 3 | 10/1/29 | 9/30/30 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4001 | Rental of Contractor Owned Portable Concentrator System Priced Per Month. HCPCS CODE E1390. Concentrator, Colored Tubing, Adapter Humidifier (when required), Cannulas or Masks and other required supplies and equipment, including back up systems. Perform Equipment Maintenance in accordance with manufacturer standards. At a minimum of once every 90 calendar days, visit and assess patient to assure equipment compliance, change filters and provide disposable supplies. | Option 4 | 10/1/30 | 9/30/31 | 5000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4002 | Rental of Contractor Owned Portable O2 Gaseous System for use with or without Stationary System Priced Per Month. HCPCS CODE E0431. Portable System, Regulator, Flowmeter, Humidifier, Cannulas, or Masks, Tubing, Conserving Device and O2 Tank Cylinder Stands capable of holding 12 cylinders, sizes E, D, C & M-6. | Option 4 | 10/1/30 | 9/30/31 | 3000 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4003 | Rental of Contractor Owned Stationary Liquid O2 System Priced Per Month. HCPCS CODE E0439. Reservoir, Regulator, Flowmeter, Humidifier, Cannulas or Masks, and Colored Tubing. | Option 4 | 10/1/30 | 9/30/31 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4004 | Rental of Contractor Owned Portable Liquid O2 System Priced Per Month. HCPCS CODE E0434. Portable Container, Refill Adapter Flowmeter, Cannulas or Masks, and Colored Tubing. Reservoir will be provided if another Stationary System (e.g. Concentrator) is rented. | Option 4 | 10/1/30 | 9/30/31 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4005 | Suction Pump Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 4 | 10/1/30 | 9/30/31 | 100 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4006 | Suction Pump Rental Priced Per Each. HCPCS CODE E0600. Purchase, Delivery, Set-up and Training of Contractor Home Model Respiratory Suction Pump, portable or stationary electric to include all supplies. | Option 4 | 10/1/30 | 9/30/31 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4007 | Rental of Contractor Owned Volume Ventilator Priced Per Month. HCPCS CODE E0465 & E0466. Delivery, Set-up, Training, and Maintenance of Contractor Owned Stationary or Portable Ventilator, to include back up Ventilator and all supplies. | Option 4 | 10/1/30 | 9/30/31 | 80 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4008 | Government Owned Ventilator Set-up Priced Per Each. HCPCS CODE E0465 & E0466. Delivery, Set-up, and Training of a Government Owned Ventilator to include all necessary supplies. | Option 4 | 10/1/30 | 9/30/31 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4009 | Ventilator Maintenance Priced Per Month. HCPCS CODE E0465 & E0466. Maintenance of Government Owned Ventilator Systems, to include all supplies. | Option 4 | 10/1/30 | 9/30/31 | 2 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4010 | Air Compressor Priced Per Month. HCPCS CODE E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies. | Option 4 | 10/1/30 | 9/30/31 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4011 | Priced Per Month. E0565. Rental of Contractor Owned and Maintained continuous or intermittent air compressor for use with equipment not self contained or cylinder driven, to include all associated supplies | Option 4 | 10/1/30 | 9/30/31 | 50 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4012 | Delivery Charge Priced Per Each. HCPCS CODE A9901. Deliveries not made under all other line items. | Option 4 | 10/1/30 | 9/30/31 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4013 | Respiratory Therapist Visit Priced Per Each. HCPCS CODE VA120. Government requested Respiratory Therapist visit not covered by other Line Items. | Option 4 | 10/1/30 | 9/30/31 | 0 | EA | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0001a | Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Base | 10/1/26 | 9/30/27 | 1 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0001b | Rental of Contractor Owned Home Fill Oxygen System. HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Base | 10/1/26 | 9/30/27 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 0001c | Rental of Contractor Owned Hi Flow Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Base | 10/1/26 | 9/30/27 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R1 | E Cylinder Refill. HCPCS CODE E0443 | Base | 10/1/26 | 9/30/27 | 6000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R2 | D Cylinder Refill. HCPCS CODE E0443 | Base | 10/1/26 | 9/30/27 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R3 | C Cylinder Refill. HCPCS CODE E0443 | Base | 10/1/26 | 9/30/27 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R4 | M-6 Cylinder Refill. HCPCS CODE E0443 | Base | 10/1/26 | 9/30/27 | 1000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R5 | H Tank Refill. HCPCS CODE E0443 | Base | 10/1/26 | 9/30/27 | 0 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 00R6 | Liquid Oxygen Refill. HCPCS CODE E0444 | Base | 10/1/26 | 9/30/27 | 0 | LB | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1001a | Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 1 | 10/1/27 | 9/30/28 | 1 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1001b | Rental of Contractor Owned Home Fill Oxygen System. HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 1 | 10/1/27 | 9/30/28 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 1001c | Rental of Contractor Owned Hi Flow Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 1 | 10/1/27 | 9/30/28 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R1 | E Cylinder Refill. HCPCS CODE E0443 | Option 1 | 10/1/27 | 9/30/28 | 6000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R2 | D Cylinder Refill. HCPCS CODE E0443 | Option 1 | 10/1/27 | 9/30/28 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R3 | C Cylinder Refill. HCPCS CODE E0443 | Option 1 | 10/1/27 | 9/30/28 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R4 | M-6 Cylinder Refill. HCPCS CODE E0443 | Option 1 | 10/1/27 | 9/30/28 | 1000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R5 | H Tank Refill. HCPCS CODE E0443 | Option 1 | 10/1/27 | 9/30/28 | 0 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 10R6 | Liquid Oxygen Refill. HCPCS CODE E0444 | Option 1 | 10/1/27 | 9/30/28 | 0 | LB | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2001a | Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 2 | 10/1/28 | 9/30/29 | 1 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2001b | Rental of Contractor Owned Home Fill Oxygen System. HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 2 | 10/1/28 | 9/30/29 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 2001c | Rental of Contractor Owned Hi Flow Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 2 | 10/1/28 | 9/30/29 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R1 | E Cylinder Refill. HCPCS CODE E0443 | Option 2 | 10/1/28 | 9/30/29 | 6000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R2 | D Cylinder Refill. HCPCS CODE E0443 | Option 2 | 10/1/28 | 9/30/29 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R3 | C Cylinder Refill. HCPCS CODE E0443 | Option 2 | 10/1/28 | 9/30/29 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R4 | M-6 Cylinder Refill. HCPCS CODE E0443 | Option 2 | 10/1/28 | 9/30/29 | 1000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R5 | H Tank Refill. HCPCS CODE E0443 | Option 2 | 10/1/28 | 9/30/29 | 0 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 20R6 | Liquid Oxygen Refill. HCPCS CODE E0444 | Option 2 | 10/1/28 | 9/30/29 | 0 | LB | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3001a | Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 3 | 10/1/29 | 9/30/30 | 1 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3001b | Rental of Contractor Owned Home Fill Oxygen System. HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 3 | 10/1/29 | 9/30/30 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 3001c | Rental of Contractor Owned Hi Flow Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 3 | 10/1/29 | 9/30/30 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R1 | E Cylinder Refill. HCPCS CODE E0443 | Option 3 | 10/1/29 | 9/30/30 | 6000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R2 | D Cylinder Refill. HCPCS CODE E0443 | Option 3 | 10/1/29 | 9/30/30 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R3 | C Cylinder Refill. HCPCS CODE E0443 | Option 3 | 10/1/29 | 9/30/30 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R4 | M-6 Cylinder Refill. HCPCS CODE E0443 | Option 3 | 10/1/29 | 9/30/30 | 1000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R5 | H Tank Refill. HCPCS CODE E0443 | Option 3 | 10/1/29 | 9/30/30 | 0 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 30R6 | Liquid Oxygen Refill. HCPCS CODE E0444 | Option 3 | 10/1/29 | 9/30/30 | 0 | LB | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4001a | Rental of Contractor Owned Low Decibel Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 4 | 10/1/30 | 9/30/31 | 1 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4001b | Rental of Contractor Owned Home Fill Oxygen System. HCPCS CODE K0738. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 4 | 10/1/30 | 9/30/31 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 4001c | Rental of Contractor Owned Hi Flow Concentrator System. HCPCS CODE E1390. To include all supplies, equipment maintenance and 90 calendar day visit as described in Item 1. | Option 4 | 10/1/30 | 9/30/31 | 0 | MO | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R1 | E Cylinder Refill. HCPCS CODE E0443 | Option 4 | 10/1/30 | 9/30/31 | 6000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R2 | D Cylinder Refill. HCPCS CODE E0443 | Option 4 | 10/1/30 | 9/30/31 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R3 | C Cylinder Refill. HCPCS CODE E0443 | Option 4 | 10/1/30 | 9/30/31 | 20 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R4 | M-6 Cylinder Refill. HCPCS CODE E0443 | Option 4 | 10/1/30 | 9/30/31 | 1000 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R5 | H Tank Refill. HCPCS CODE E0443 | Option 4 | 10/1/30 | 9/30/31 | 0 | CY | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A | |||||||||||||||||||||||||||||||
| 40R6 | Liquid Oxygen Refill. HCPCS CODE E0444 | Option 4 | 10/1/30 | 9/30/31 | 0 | LB | 1 | Quantity | Priced | 0 | Percent | 0 | NONE | No | No | 532283 | W065 | N/A |
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