36C26224R0118 0005.pdf

5. PROJECT NUMBER (if applicable)

CODE 7. ADMINISTERED BY

2. AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER 3. 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 CODE CODE

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)

1 9

04-17-2025

MSO-2023-COM-0007

36C262

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815

Department of Veterans Affairs Network Contracting Office 22 4811 Airport Plaza Drive Suite 600 Long Beach CA 90815

To all Offerors/Bidders

36C26224R0118

01-07-2025

X

X X

See CONTINUATION Page

X 1

Jarrod Washington Contracting Officer

The purpose of this amendment is to amend the solicitation to clarify requirements related to the price schedule and scope of services to ensure all offerors have a fair opportunity to revise and submit proposals accordingly.

Proposals must be submitted by April 25, 2025, 10:00 AM PST.

See page two (2) for details.

Solicitation: 36C26224R0118 Amendment: 0005

The solicitation is amended as follows:

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.3 SCHEDULE OF SERVICE AND PRICE

1. Subsection: Contract Guaranteed Minimum and Contract Minimum, (p. 7), is amended to decrease ceiling amount for the entire contract.

The fixed-price indefinite-delivery indefinite-quantity (IDIQ) contract will have a one (1) year base period with eight (8) 12-month option periods. All PMPM quantities are estimated. The total guaranteed minimum quantity of services that the Government will acquire under this indefinite delivery, indefinite quantity (IDIQ) contract is $1,000.00, which also represents a bona fide need of the current fiscal year. The guaranteed minimum award amount is for the entire contract duration.

The ceiling amount for the entire contract effort is $45,000,000.00 $49,000,000.00.

2. Table: Base Year through Option Year Eight (8), (p.7-9) is amended to reflect a revision in the contract line-item structure. Effective from the Base Year through Option Year Eight (8), will only have one (1) line item, see example below. This change applies uniformly across all years. See revised attached B.2 – Schedule of Service and Price – Amendment 0005. This must be completed as part of the Offeror’s response to Factor 4 – Price, (see Amendment 0003).

Example:

Base Year: 10/01/2025 – 09/30/2026

Total for Base Year: $_____________________

B.3 PERFORMANCE WORK STATEMENT (PWS)

3. Subsection 2.8 License and Accreditation: (p. 25), is amended to read.

“The contractor shall not permit any staff to begin work at an outpatient site of care prior to confirmation from the VA that the individual’s background investigation has been reviewed and released to the Defense Counterintelligence and Security Agency (DCSA) Office of Personnel Management (OPM), by the Personnel Security Adjudication Center (PSAC) Security and Investigations Center (SIC), and that credentialing and privileging requirements have been met. A copy of licenses shall be provided by the awarded contractor as part of the onboarding procedures and will be updated annually. Any changes related to the providers' licensing or credentials will be reported immediately to the VA Credentialing Office. In accordance with FAR 52.212-4 Contract Terms and Conditions – Commercial Products and Commercial Services failure to comply with these terms and conditions may result in any and all rights and remedies provided by law.”

4. Subsection 2.13 Rules of Behavior for Automated Information Systems: (p. 27), is amended to restructure paragraph:

Line Item Services Unit Estimated

Quantity Price per Unit Total Estimated Cost per month

Total Estimated Cost per year

Primary Care Services at capitation rates per member per month (PMPM)

PMPM

1,856.00

“Contractor staff having access to VA Information Systems are required to read and sign a Rules of Behavior statement which outlines rules of behavior related to VA Automated Information Systems. The COR will provide, through the facility information security officer, the Rules of Behavior to the contractor for the respective facility. A copy of the Rules of Behavior may also be found in the attachments section. See Section D - List of Attachments: D.2 - VA Rules of Behavior for Non-Organizational Users.”

5. Subsection 5.2 Women Veterans Health Care Services: (p. 35), is amended to revise the following paragraph to focus more on women-specific rather than gender-specific:

“The contractor shall provide comprehensive primary care in accordance with VHA Directive 1330.01(7) Health Care Services for Women Veterans (or subsequent policy). Comprehensive primary care for women Veterans is defined as the availability of complete primary care from one primary care provider at one site. The primary care provider should, in the context of a longitudinal relationship, fulfill all primary care needs, including acute and chronic illness, women-specific, preventative and mental health care. The full range of primary care needs for women Veterans includes: care for acute and chronic illness such as routine detection and management of disease such as acute upper respiratory illness, cardiovascular disorders, cancer of the breast, cervix, colon, and lung, diabetes mellitus, osteoporosis, thyroid disease, COPD, mental health conditions, etc.

Women-specific reproductive primary care encompasses contraception (including same day access to emergency contraception), preconception care, and pharmacologic issues related to pregnancy and lactation. Women-specific primary care also includes the initial evaluation and treatment of women-specific conditions such as pelvic and abdominal pain, abnormal vaginal bleeding, vaginal infections, management of menopause-related concerns and infertility, etc. Preventive care includes services such as age-appropriate cancer screening, weight management counseling, smoking cessation, immunizations, etc. The same primary care provider should screen and appropriately refer patients for military sexual trauma as well as evaluate and treat uncomplicated mental health disorders and substance use disorders.”

6. Subsection 5.2 Women Veterans Health Care Services: Transgender Veterans: (p. 40), is amended to remove the following paragraph:

“Patients will be addressed and referred to based on their self-identified gender. Room assignments and access to any facilities for which gender is normally a consideration will give preference to self-identified gender, or medical needs of the Veteran, irrespective of appearance and/or surgical history in a manner that respects the privacy needs of transgender and non-transgender patients.

For more information, please see VHA Directive 1341(3) Providing Health Care for Transgender and Intersex Veterans.”

7. Subsection 5.3 Pharmacy Services:, Medication Management: (p. 42), is amended to read.

“Reports of Adverse Drug Events (ADEs) will be documented in the VA EHR, with the specifics of the event documented as outlined in local VA policy. and forwarded to VA Pharmacy as they occur via encrypted E-mail to the outpatient pharmacist supervisor and the Associate Chief Pharmacy Service.”

“All medication errors and medication-related incidents shall be reported immediately to the Chief, Pharmacy Service or designee and submitted to the local VA Patient Safety on the local VA-approved Incident Report form.”

“Customer complaints regarding pharmacy services shall be addressed by the VA Pharmacy Service in collaboration with contract clinic management staff. Reports of such complaints shall be recorded and forwarded to the VA Chief, Pharmacy Service within two (2) business days .”

8. Subsection 5.3 Pharmacy Services:, Clinical Pharmacy Services: (p. 43), is amended to read.

“These services will be provided by NMVAHCS Clinical Pharmacist Practitioner (CPP). Note that NMVAHCS CPP personnel are assigned to CBOC PACT teams. As such NMVAHCS CPP will work in collaboration with contractor PCP/PACT team on a regular basis to provide these services.

Communications may be accomplished via phone, email, instant messaging, etc. to ensure timeliness of care and collaboration. The NMVAHCS CPP shall function in the capacity of an advanced practice provider (through a VA scope of practice) as their primary duty is to collaborate with providers to provide comprehensive medication management to patients. VA scope of practice shall adhere to pharmacy practice acts within that state and the VA Chief of Pharmacy. VA Chief of Staff, and Director shall work collaboratively to provide oversight for professional practice of the contracted CPP to include roles and responsibilities, VA Scope of Practice, and its oversight in accordance with VHA Handbook 1108.11(3) Clinical Pharmacy Services and facility policy. As such, NMVAHCS CPP may pro-actively collaborate directly with contractor personnel in providing these services.”

9. Subsection 5.3 Pharmacy Services:, Clinical Pharmacy Services: (p. 44), is amended to remove the following paragraph.

“Direct patient care activities are essential to the role of the contract CPP in impacting comprehensive medication management and optimal patient care outcomes in PACT. The CPP shall have an appropriate amount bookable appointment time per week per VA standards spending a minimum of 80% of their time in direct patient care. Direct patient care activities in PACT Pharmacy Clinics shall follow PBM Guidance Pharmacy Clinic Set Up and Stop Code position to ensure workload capture for clinical pharmacy services. Workload shall be documented by contract CPP staff via PhARMD tool from the National PBM Clinical Pharmacy Practice Office when possible.”

10. Subsection 5.3 Pharmacy Services:, Clinical Pharmacy Services: (p. 44), is amended to read.

“Direct patient care activities in PACT pharmacy clinics are provided by NMVAHCS in accordance with shall follow PBM Guidance Pharmacy Clinic Set Up and Stop Code to ensure workload capture for clinical pharmacy services. Click on the link; Clinical Pharmacy Practice - PBM Guidance Pharmacy Clinic Set Up and Stop Code or see Section D List of Attachments: D.7 - PBM Guidance: Pharmacy Clinic Set-up and Stop Code ). Direct patient care refers to patient care functions which are carried out by a pharmacist in an advanced practice role and are above and beyond those functions considered to be routine part of a pharmacist’s duties. Some examples of direct patient care activities include: comprehensive medication management of complex patients and chronic diseases (such as, but not limited to, anticoagulation, hypertension, diabetes, hyperlipidemia, COPD, heart failure, hepatitis C, pain management); Urgent or same day face-to-face patient visits including but not limited to patient medication review for polypharmacy, recent hospital discharges, co-managed care patients; Virtual Care modality visits such as Veteran requests through secure messaging, telephone-based care, CVT, HT; SMA; and DIGMAs. The PACT CPP and contractor providers will receive support from VA to address routine outpatient medication activities such as prescription verification, refill, renewal, and extension of medication, therapeutic substitutions and conversions, and other general pharmacy issues. Core privileges shall be established in the scope of practice for CPP to include medication prescriptive authority, assessments, laboratory, and other test ordering privileges in the most common primary care disease states (chronic diseases including, but not limited to, diabetes, hypertension, hyperlipidemia, smoking cessation, pain management, hepatitis C, osteoporosis).”

11. Subsection 5.5 Mental Health Services: Evidence-based Psychotherapy for Depression and Anxiety Disorders: (p. 53), is amended to restructure the paragraph.

“All Veterans with depression or anxiety disorders shall have access to Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), or Interpersonal Therapy when delivery of evidence-based psychotherapy is clinically indicated for patients. For conditions greater than moderate, the contractor shall enter an outpatient Behavioral Health consult in the EHR for NMVAHCS to provide the care.”

12. Subsection 5.5 Mental Health Services: Suicide Prevention: (p. 57), is amended to add:

“The contractor shall complete the following suicide prevention programming requirements described in this section to include requirements for suicide risk screening and evaluation, lethal means safety education and counseling training for relevant staff, reporting of suicidal behaviors, safety planning with patients at risk of suicide, management of patients identified through the REACH VET program and coordinating with the parent facility suicide prevention coordinator to manage patients with a high risk of suicide patient record flag. See Section D - List of Attachments:

D.11 – REACH Vet Predictive Model and D.12 – REACH VET Steps Provider .”

13. Subsection 5.5 Mental Health Services: Recovery Engagement and Coordination for Health Veterans Enhanced Treatment (REACH VET): (p. 59), is amended to restructure paragraph.

• If a contractor’s provider is identified as the REACH VET provider, the contractor’s provider shall review care provided for patients identified by the model, consider opportunities to enhance care, outreach to the patient to provide opportunities to modify the care plan, and use the national, standardized REACH VET PROVIDER progress note to document completed steps in the EHR.

NOTE: See Section D - List of Attachments: D.11 – REACH VET Predictive Model, D.12 – REACH VET Steps Provider, D.14 Risk ID Staff Specific Guidance, and D.15 – VA Suicide Prevention Safety Plan and Suicide Behavior and Overdose Report (SBOR) Templates Staff Specific Guidance for additional information.

14. Subsection 5.9 Communicating Test Results to Providers and Patients: (p. 64), is amended to read.

“Contractor shall communicate test results in accordance with VHA Directive 1088, Communicating Test Results to Providers and Patients. All test results requiring action shall be communicated by the ordering provider, or designee, to patients within no later than 7 calendar days from the date on which the results are available. For test results that require no action, results shall be communicated by the ordering provider, or designee, to patients within no later than 14 calendar days from the date on which the results are available. Depending on the clinical context, certain test results (such as emergent and imminently life-threatening and urgent not imminently life-threatening test results) may need review and communication to patients in shorter timeframes.

See VHA Directive 1088, Communicating Test Results to Providers and Patients for content and method of communication, documentation, service-level workflows, and other test results communication requirements.”

15. Subsection 5.12 Non-Emergency Transport Requests: (p. 66), is amended to remove “regular” and add “will review the request and if patient is eligible”.

“During regular business hours, the contractor shall contact the Travel Assistants at the Travel Office at (505) 265-1711 extension 7029 and the Patient Transportation Office will review the request and if patient is eligible make arrangements for either in-house or contract transportation.

The contractor shall complete VA Memorandum Form 2105, Request for Transportation, and fax to the Travel Office at (505) 767-6025. Calls regarding non-emergent transportation occurring after normal business hours should be made to the AOD at (505) 265-1711 extension 6409 who will forward the call to a ECC physician.”

16. Subsection 11. SPACE REQUIREMENTS: VA Signage Design Manual PG 18-12: (p. 76), is amended to add.

• H 18-8 Seismic Design Handbook (Seismic Facility Criticality Designation (FCD), based on the Program for Design, is defined as: Critical (Medical Center shall determine FCD based on the Program for Design, consult H-18-8 and the Seismic Program Manager if necessary).

• VA Physical Security and Resiliency Design Manual (VA PSRDM) and Appendix B of VA Handbook 0730.

• VA Enterprise Facility IT Support Infrastructure Standard,V2 Version 4.0: Telecom Data Center and Infrastructure Engineering Design Standards Service Catalog - Office of Construction & Facilities Management (va.gov).

• Building Prototypes, Community Based Outpatient Clinic

• PACT Space Module Design Guide

• Space Planning Criteria PG 18-9

• Room Templates, Leased Community Based Outpatient Clinics

17. Subsection 15. PERFORMANCE STANDARDS AND SURVEILLANCE: (p. 85-91), is amended to:

Domain: Access

Measure: New PC Appointments Completed Within 20 Calendar Days of Reference Date (RD) (New primary care appointments completed within 20 calendar days of RD.)

Performance Requirement: Contractor shall provide completed appointments for new PC patients within 20 calendar days of the RD.

Standard: Contractor shall provide completed appointments for new PC patients within 20 calendar days of the RD no less than 53% of the time.

Acceptable Quality Level: Contractor shall provide completed appointments for new PC patients within 20 calendar days of the RD no less than 60% of the time.

Surveillance Frequency and Method: VA will monitor progress performance quarterly by using data from the Appointments Cube. COR will send report to the contractor and CO quarterly to notify them of current performance.

Measure: Established PC Patient Appointments Completed Within 20 Calendar Days of Patient Indicated Date (PID) (Established primary care appointments completed within 20 calendar days of PID (patient desired date) or the clinically indicated date.)

Performance Requirement: Contractor shall provide completed appointments for established PC patients within 20 calendar days of the PID.

Standard: Contractor shall provide completed appointments for established PC patients within 20 calendar days of the PID no less than 93% of the time.

Acceptable Quality Level: Contractor shall provide completed appointments for established PC patients within 20 calendar days of the PID no less than 94% of the time.

Surveillance Frequency and Method: VA will monitor progress performance quarterly by using data from the Appointments Cube. COR will send report to the contractor and CO quarterly to notify them of current performance.

Measure: Same-Day Appts w/ PCP (Measures the percent of requested same day appointments with PCP.)

Performance Requirement: Contractor shall provide same day appointments with primary care provider.

Standard: Contractor’s same day appointments with PCP rate shall meet or exceed 43%.

Acceptable Quality Level: Contractor’s same day appointments with PCP rate shall meet or exceed 44%.

Surveillance Frequency and Method: VA will monitor progress performance quarterly by using data from the VSSC. COR will send report to the contractor and CO quarterly to notify them of current performance.

Domain: Quality of Care

Measure: Composite BH90 - Behavioral Health Screening (Composite of mdd40 -- Vets screened annually for major depression dx., ptsd51 -- PTSD screening using the PC-PTSD at required times sa17 -- Vets screened for alcohol misuse w/ score GE 5 w/ timely brief counselling sa7 -- Vets screened annually for alcohol misuse CSSRS1--Annual Suicide Risk Screen) Performance Requirement: Contractor shall complete all behavioral health screening and follow-up evaluations.

Standard: Contractor shall maintain a behavioral health composite score of at least 96%.

Acceptable Quality Level: Contractor shall maintain a behavioral health composite score of at least 96%.

Surveillance Frequency and Method: VA will monitor progress performance quarterly by using VA performance data sources (VSSC). COR will send report to the contractor and CO quarterly to notify them of current performance.

Domain: Panel Management

Measure: Percent of Teams with Core Teamlet Staffing Ratio 3 or More (PACT 22) (The total Core Primary Care Support Staff (administrative associate, RN care manager, and clinical associate) FTE divided by the total Primary Care Provider FTE entered in the PCMM Web Application) Performance Requirement: Contractor shall provide core teamlet staffing at a ratio of 3 or more.

FTE core teamlet members (RN care manager, clinical associate, administrative associate) for each

PCP FTE.

Standard: 100% of contractor’s primary care teams shall have a core teamlet staffing ratio of 3 or more.

Acceptable Quality Level: 99% of contractor’s primary care teams shall have a core teamlet staffing ratio of 3 or more.

Surveillance Frequency and Method: VA will monitor progress quarterly using data from the PACT Compass VSSC. COR will notify contractor and CO quarterly to notify them of current performance.

Domain: Veteran Satisfaction

Measure: Veteran Satisfaction (Overall rating of Primary Care Provider on question 32 of the SHEP/PCMH survey) Performance Requirement: The contractor’s PCPs shall provide care that patients rate as a 9 or 10 on question 32 of the SHEP/PCMH survey.

Standard: Contractor’s SHEP question 32 score shall meet or exceed 73%.

Acceptable Quality Level: Contractor’s SHEP question 32 score shall meet or exceed 73%.

Surveillance Frequency and Method: VA will monitor progress and provide SHEP results and VSignals data when they are available with contractor and CO. Any complaints or compliments voluntarily initiated by users and patients will be shared with the contractor and CO shortly after VA receives them and can be considered when evaluating Veteran satisfaction.

Domain: Coordination of Care

Measure: Post Discharge Contact by PACT Teamlet (The percent of assigned primary care patients discharged from any VA facility who have been contacted by PACT teamlet within two business days).

Performance Requirement: The contractor’s PACT teamlets shall contact their assigned patients within 2 business days of discharge from any VA facility.

Standard: Contractor’s rate of post discharge contact by PACT teamlet within 2 business days shall meet or exceed 61%.

Acceptable Quality Level: Contractor’s rate of post discharge contact by PACT teamlet within 2 business days shall meet or exceed 62%.

Surveillance Frequency and Method: VA will monitor progress performance quarterly by using data from the VSSC. COR will send reports to the contractor and CO quarterly to notify them of current performance.

Domain: Environment of Care (EOC)

Measure: Percentage of Deficiencies Identified During EOC Rounds that are Closed Timely (e5eoc1) (Percentage of deficiencies identified during EOC rounds that are closed within 14-business days or have a documented Plan for Action (PFA)).

Performance Requirement: Contractor shall address deficiencies identified in EOC rounds within 14 business days or have a documented PFA.

Standard: Contractor’s rate of EOC deficiencies that are closed within 14 business days or have a PFA shall meet or exceed 93%.

Acceptable Quality Level: Contractor’s rate of EOC deficiencies that are closed within 14 business days or have a PFA shall meet or exceed 93%.

Surveillance Frequency and Method: VA will monitor progress and provide EOC reports to the contractor and CO when they are made available by the EOC team.

Domain: Pharmacy

Measure: Medication Storage Area Inspections Performance Requirement: Contractor shall review medication storage areas monthly.

Standard: The contractor shall ensure that 100% of medication storage areas are inspected monthly and documented on VA Form 10-0053 (or VA parent facility form). Inspection documentation will be sent to the COR within 10 calendar days of the end of each month. Any issues discovered shall be resolved by the contractor and reported to the COR within 15 calendar days of the inspection date.

Acceptable Quality Level: The contractor shall ensure that 99% 100% of medication storage areas are inspected monthly and documented on VA Form 10-0053 (or VA parent facility form).

Inspection documentation will be sent to the COR within 10 calendar days of the end of each month. Any issues discovered are resolved by the contractor and reported to the COR within 15 calendar days of the inspection date.

Surveillance Frequency and Method: VA will monitor progress performance via receipt of VA Form 10-0053 (or local medical center form) and documented resolution of any issues discovered during inspections. COR will send reports to the contractor and CO quarterly to notify them of current performance.

SECTION C – CONTRACT CLAUSES

Section C.5 52.216-19 ORDER LIMITATIONS (OCT 1995)

18. (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $1,000.00, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor—

(1) Any order for a single item in excess $45,000,000.00 $49,000,000.00.

(2) Any order for a combination of items in excess of $45,000,000.00 $49,000,000.00; or

(3) A series of orders from the same ordering office within 30 days

SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENT

19. Section D – Contract Documents, Exhibits, or Attachments (p. 151) is revised as follows:

• Attachment D.7 - PBM Guidance: Pharmacy Clinic Set-up and Stop Code (attached) is removed from the solicitation.

• All remaining attachments are renumbered accordingly.

• A new attachment, NMVAHCS – MCP 136-12 – Medical Records Management, is added after the renumbering and is now Attachment 23.

• All references to D.7 through D.23 throughout the solicitation, including within the

Performance Work Statement (PWS), shall be interpreted to reflect the new numbering.

• See Amendment 0005 attachments for the revised Section D – Contract Documents, Exhibits, or Attachments.

(End of Solicitation Amendment)

Amendment 0005 attachments:

1. B.2 – Schedule of Service and Price (Revised) – Amendment 0005

2. D.23 – NMVAHCS – MCP 136-12 – Medical Records Management

3. Section D – Contract Documents, Exhibits, or Attachment (Revised) – Amendment 0005