36C26320Q0292-0001001.docx

Contract Opportunity Amendment to a Previous Combined Solicitation

CLASSIFICATION CODE

SUBJECT

CONTRACTING OFFICE'S

ZIP-CODE

SOLICITATION NUMBER

BASE NOTICE TYPE

RESPONSE DATE (MM-DD-YYYY)

ARCHIVE

DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS

SET-ASIDE

NAICS CODE

CONTRACTING OFFICE

ADDRESS

POINT OF CONTACT

(POC Information Automatically Filled from User Profile Unless Entered)

DESCRIPTION

See Attachment

AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

ADDRESS

EMAIL DESCRIPTION

ADDRESS

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

GENERAL INFORMATION

PLACE OF PERFORMANCE

* = Required Field Contract Opportunity Amendment to a Previous Combined Solicitation R408 Pharmacy Benefit Management (PBM) First Fill Services Central Iowa and Sioux Falls Period of Performance: 07-01-2020 to 06-30-2025 Solicitation Amendment 0001 to Update Estimated Quantities 57105 36C26320Q0292 04-03-2020 N

SDVOSBC

524292 Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105 Doug Reed Contracting Officer E-mail: douglas.reed3@va.gov Please Refer to Section B.3 (Statement of Work) in Solicitation for listing of locations.

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 CHAN

GES

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 alr eady 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, cou nty, 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) 03-06-2020 N/A; to be listed on task orders issued against BPA None Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105 Sioux Falls Services Team Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105 To all Offerors/Bidders

36C26320Q0292 03-06-2020

X X X N/A See CONTINUATION Page N/A; to be listed on task orders issued against Blanket Purchase Agreement (BPA).

Pharmacy Benefit Management First Fill Services to support the VA Central Iowa Health Care System and Sioux Falls VA Health Care System.

Period of Performance: 07-01-2020 to 06-30-2025 Solicitation is hereby amended to revise estimated quantities listed in Section B.2 (Price Schedule); please see attached for detail.

All others terms and conditions of the solicitation remain UNCHANGED.

Contracting Officer

VA-VHA-SAOC-2016-AC23EC83

CONTINUATION PAGE

B.2 PRICE SCHEDULE

ITEM INFORMATION

Pharmacy Benefit Management Services VA Central Iowa Health Care System Ordering Period 1: 07-01-2020 to 06-30-2021 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage __________ - AWP% Brand Name _________ - AWP% Generic

Pharmacy Benefit Management Services Sioux Falls VA Health Care System Ordering Period 1: 07-01-2020 to 06-30-2021 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 2: 07-01-2021 to 06-30-2022 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 2: 07-01-2021 to 06-30-2022 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 3: 07-01-2022 to 06-30-2023 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 3: 07-01-2022 to 06-30-2023 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 4: 07-01-2023 to 06-30-2024 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 4: 07-01-2023 to 06-30-2024 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 5: 07-01-2024 to 06-30-2025 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage

Pharmacy Benefit Management Services

Ordering Period 5: 07-01-2024 to 06-30-2025 Firm Fixed Price Dispensing Fee Plus Discounted AWP Percentage