36C26323Q0882 0001 SF30 AMENDMENT DOCUMENT.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 4

656-23-3-045-0434

N/A

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105 John Becker john.becker3@va.gov

Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

2501 W. 22nd St.

Sioux Falls SD 57105

To all Offerors/Bidders

36C26323Q0882

09-29-2023

X

X X

Tuesday, October 3, 2023, 11:00 AM CST

See CONTINUATION Page 656-3630160-045-8224002636-010022400 656-23-3-045-0434

X one (1)

The purpose of this solicitation amendment is to clarify the evaluation factors, update the Statement of Work, and to extend the hour and date for receipt of offers.

Offerors shall use the attached Revised Price/Cost Schedule.

The Statement of Work is revised to include four (4) locations: St Cloud, Alexandria, Brainerd, and Montevideo MN.

The dispensing locations must be located within ten (10) miles of the VA facilities listed above.

The evaluation factors are clarified. Offerors shall identify the discount for Brand and Generic pharmaceuticals, and include the offerors cost for dispensing fee per prescription. Award will be made upon the lowest priced technically acceptable. Three (3) factors affect lowest price. The percentage discount will combined for an overall discount percentage and then converted to a number. Then, the lowest dispensing fee will be subtracted from the discount number for a total amount. The highest number will reflect the lowest price offer. Continued on next page.

John Becker Contracting Officer

VA-VHA-2020-BEE57D1B

CONTINUATION PAGE

Lowest Price Computation Evaluation Example:

AWP Discount %: 10 (Brand) AWP Discount %: 20 (Generic) Dispensing Fee: $ 5.00 per prescription.

Total of AWP Discount: 30 Total of Dispensing Fee: 5 Subtract the Dispensing Fee from the AWP discount.

The calculated number is: 25 The Lowest Price computation is reflected as 25.

The highest number of all quotes as computed above, is identified as the lowest priced offer.

The government will fund the contract for the following amounts as these amounts are estimated based upon prior year expenditures. The government will only pay for medications dispensed. This amount is not guaranteed and may be deobligated based upon medications dispensed.

Base Period $86,000.00 Option Period 1 $87,000.00 Option Period 2 $88,000.00 Option Period 3 $89,000.00 Option Period 4 $90,000.00

Statement of Work

First Fill Prescription Service

The St. Cloud VAHCS has a firm fixed rate need for first fill prescription services for the Veterans seen at our main facility (St. Cloud) and in our Community Based Outpatient Clinics of Alexandria, Brainerd and Montevideo, Minnesota.

1. SCOPE

a. The contractor is to fill first time prescriptions for VA patients seen at the main facility and Alexandria, Brainerd and Montevideo, Minnesota Community Based Outpatient Clinics (CBOCs).

b. Provide medication counseling per requirements.

c. Prices are to be offered with respect to Average Wholesale Price (AWP). The contractor must be located within 10 miles of the above-named clinics. This contract is to provide pharmacy benefit management services.

d. The least expensive Generic drugs are to be dispensed unless a drug is not available generically.

e. Reimbursement shall be determined by the average wholesale price (AWP) discounted by the applicable percentage plus the applicable dispensing fee. The total price charged to the VA SHALL NOT EXCEED that charged to the general public and shall not exceed the price charged by the contractor’s lowest third-party reimbursement plan.

f. Quantities: The St. Cloud VAHCS makes no guarantees as to quantities of items that will be ordered under this agreement and is obligated only to the extent of authorized purchases actually made under this agreement.

2. DESCRIPTION

a. The contractor is to fill first time prescriptions for VA patients seen at the main facility and CBOC clinics. The prescriptions are to be written by VA physicians assigned to the Veterans Affairs main facility and community Based Outpatient Clinic (CBOCs).

b. The CBOC operating hours are normally 8AM-4:30PM Monday thru Friday, excluding Federal holidays.

c. The contractor’s pharmacies shall fill and dispense medications from original prescriptions written by VA or VA contracted providers assigned to the particular medical center or CBOC. Dispensing pharmacies must be able to accept the written prescription on VA Form 10-2577F, Security Prescription Form. If the dispensing pharmacy operates in a state that requires a form other than the VA Form 10-2577F, Security Prescription Form, it will be the contractor’s responsibility to provide the St. Cloud VAHCS Pharmacy Chief with the proper security form.

d. Prescriptions filled and dispensed through emergent fill contracts will be limited to medications of urgent need as determined by VA clinical staff and will follow safe and effective formulary management principles practiced within the VA. This may include adjudication of medications on a case-by-case basis as defined by St. Cloud VAHCS procedure. The above categories will also be limited to those drugs on the formulary “Drug List” authorized by the St. Cloud VAHCS. The St. Cloud VAHCS formulary “Drug List” will be emailed to the contractor at time of contract award and after each UPDATE by the Chief, Pharmacy, or his/her designee. If non-formulary items are prescribed, the Contractor will contact the Primary Care Provider who wrote the prescription to determine an acceptable substitute.

e. Prescriptions will be filled and limited to a maximum of 10 (ten) days. An initial one-time course of medication (i.e. antibiotics or pain meds) is to be for a full course of therapy.

All prescription refills will be transferred to the St. Cloud VAHCS. Prescription must be written by a St. Cloud VAHCS or CBOC provider, the VA will provide a list of authorized VA providers to the pharmacy.

f. No refills will be authorized. The contractor shall fill NEW PRESCRIPTIONS ONLY!

g. Prescriptions filled under this contract shall be the least expensive generic drugs only, with minor exceptions. Prescriptions shall be filled with generic drugs to the extent permitted by law. Generic drugs shall be dispensed, if in the professional judgment of the pharmacist, the substitute product is available, safe, effective and to the greatest extent possible, contains the same chemical ingredients of the same strength, quantity, and dosage of the brand name. All generic products used bust be in compliance with Federal and State requirements. Brand name drugs will ONLY be reimbursed if NO GENERIC FORM of the drug exists in the marketplace.

h. VA beneficiaries will pick up their own prescriptions at the dispensing pharmacy. No prescriptions are to be mailed. No prescriptions are to be delivered. Veterans eligible to have prescriptions filled under this contract will present their enrollment card along with their prescription written by a Primary Care provider from the VA’s main facility or CBOC.

i. The VA shall randomly audit all prescription fills. The Department of Veterans Affairs shall have free access during regular business hours, and upon reasonable notice, to such books, records, invoices and prescription files as deemed necessary to verify claim information, prescription volume, and the usual and customary charges to the general public for covered prescriptions. The contractor shall make all prescription records and invoices available at the time of audit.

j. All prescriptions must have the proper auxiliary labels attached and appropriate counseling and drug interaction sheets provided. The Pharmacy will provide patient education to the patient/caregiver for all new medications or as requested by the patient/caregiver. The Pharmacy will send a copy of the documentation of the education to the appropriate main facility or CBOC clinic, so that it may be included in the patient’s medical record.

k. Pharmacies authorized to fill prescriptions under the contractor’s plan must agree to the following conditions:

(1) All information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws. The Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) applies to the procurement.

(2) Representatives of the VA are authorized to visit the contractor’s site and the premises of any pharmacy filling VA prescriptions during regular business hours for the purposes of auditing and evaluation, which may include the inspection of clinical records.

(3) The contractor shall report all adverse drug events reported by VA beneficiaries to the Chief, Pharmacy Service, VA Health Care System, St. Cloud Minnesota, and to the prescribing VA provider.

(4) Pharmaceutical service provided to VA beneficiaries under this contract shall meet all standards applicable to Medicaid recipients in the state where services are provided and standards set forth in the current Joint Commission of Accreditation Hospital Organization (JCAHO) accreditation manual for Ambulatory Care/Pharmaceutical Services.

l. The contractor shall accept a call from the main facility or CBOC MSA clerk advising him/her of all existing and/or new VA physician’s state license number and his/her federal and/or state drug license number. The contractor shall immediately notify its contract pharmacies of the physician information so as to avoid delay in patient services.

Notification of physician information may occur on either the day the VA physician fills in or prior to duty as time allows.

m. The Government reserves the right to fill any prescription covered under this contract through the use of its own resources and/or staff.

n. The contractor cannot store patient information on a mobile device and verbal contract is sufficient to obtain prior authorization when needed. The contractor is prohibited from transferring Personnel Health Information (PHI) by fax or email to and/or from a VA Medical facility.

o. The C&A requirements do not apply, a Security Accreditation Package is not required.

3. SPECIAL CONTRACT REQUIREMENTS The contractor agrees, in accordance with the terms and conditions stated herein, to furnish to and at the Department of Veterans Affairs hereinafter called the VAHCS, St. Cloud Minnesota and their applicable Community Based Outpatient Clinics (CBOCs) the services specified. The initial listing of services to be furnished and the prices for same are identified in Schedule of Items and Description/Specifications/Work Statement.

a. RESOURCES:

(1) The services specified in Schedule of Items, Description/Specifications/Work Statement and special Contract requirements may be changed by written modification to this contract. The modification will be prepared by the Contracting Officer.

(2) The services to be performed by the Contractor will be performed within VA policies and procedures and the regulations of the medical staff bylaws of this VA facility.

(3) The services to be performed by the Contractor will be under the direction of the Chief of Staff, St. Cloud VAHCS or her/his designee.

b. TERM OF THE CONTRACT: The contract is effective for one year from date of award with four one-year pre-priced option year periods. The contract is subject to the availability of VA funds. No service shall be performed by the Contractor after September 30th of any year, unless authorized by the contracting Officer in writing.

c. QUALIFICATIONS: Personnel assigned by the Contractor to perform the services covered by this contract shall be licensed in a State, Territory or Commonwealth of the United States or the District of Columbia and meet the professional qualification criteria of VA. The qualifications of such personnel shall also be subject to review by VA Chief of Staff and approval by VA Facility Director. The Contracting Officer will be notified prior to any changes in personnel. VA reserves the right to approve the assignment of individual personnel furnished by the Contractor to perform these functions specified in the contract. The Pharmacy must be licensed by the State of Minnesota. All Registered Pharmacists performing work under this agreement must be licensed by the State of Minnesota. The Pharmacy License Number is to be provided after contract award.

d. PERSONNEL POLICY: The Contractor shall assume full responsibility for the protection of its personnel furnishing services under this contract, in accordance with the personnel policy of the Contractor. To carry out this responsibility, the Contractor shall provide worker’s compensation, professional liability insurance, health examinations, income tax withholding, and social security payments. The parties agree that the Contractor, its employees, agents, and subcontractors shall not be considered VA employees for any purpose.

e. DESIGNATION OF CONTRACT REPRESENTATIVE:

A VAHCS Point of Contact (POC) will be designated to represent the Contracting Officer in furnishing technical guidance and advice regarding the work being performed under this contract. The foregoing is not to be construed as authorization to interpret or furnish advice and information to the Contractor relative to the financial or legal aspects of the contract.

Enforcement of these segments is vested in and is the responsibility of the Contracting Officer.

f. MEDICAL RECORDS: Clinical or other medical records of VA beneficiaries treated by

Contractor are VA records and will remain at VA. Payment will be withheld if medical records are not complete and in compliance with VA policy.

g. PAYMENTS UNDER NONPERSONAL SERVICE CONTRACTS:

The Government shall pay the Contractor once monthly, upon submission of proper invoices or vouchers, the prices stipulated in this contract for services rendered and accepted, less any deductions provided in this contract. The Pharmacy fills prescription presented by a veteran who is enrolled in the Primary Care Program at the main facility or one of the St.

Cloud VAHCS’s CBOCs. The Pharmacy will keep track of all prescriptions filled each month. Attached to each monthly invoice will be included a complete monthly listing of all prescription filled by the Pharmacy. For each prescription, the Pharmacy must include the following information: Rx number, Patient’s name and Social Security Number, Drug & Quantity dispensed, the Provider, and the total Prescription cost.

E.8 52.212-2 EVALUATION—COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (NOV 2021)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

Lowest Price Technically Acceptable

To be Technically Acceptable, offerors shall submit the following with their quote:

• Copy of contractor Minnesota Pharmacy License and License Number

• Copy of contractor Minnesota Pharmacist license for all Pharmacists performing services under the contract.

• Provide a contractor’s facility address that reflects ten (10) miles or less from the following locations (https://www.google.com/maps/place/Minnesota/):

o St Cloud MN 4801 Veterans Drive, St Cloud MN 56303 o Alexandria MN Outpatient Clinic, 410 30th Ave East, Alexandria MN

56308 o Brainerd MN Outpatient Clinic, 722 NW 7th Street, Brainerd MN 56401 o Montevideo MN Outpatient Clinic, 1025 North 13th Street, Montevideo

MN 56265

Computation of the Overall Evaluation Score:

Example figures o AWP Discount %: 10 (Brand) o AWP Discount %: 20 (Generic) o Dispensing Fee: $ 5.00 per prescription.

1. Add the two AWP numbers together.

o Total of AWP Discount: 30

2. Identify the dispensing fee.

o Total of Dispensing Fee: 5

3. Subtract the Dispensing Fee from the totaled AWP number.

4. The Lowest Price computation is reflected as 25.

5. Add the totals for the base and all option periods for a total score.

6. The highest total offer score as computed above, is identified as the lowest priced offer.

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

Evaluation of Option to Extend Services under 52.217-8. For the purposes of the award of the resulting contract, the Government intends to evaluate the option to extend services, provided under FAR 52.217-8, as follows: The evaluation will consider the possibility that the option can be exercised at any time, and can be exercised in increments of one to six months, but for no more than a total of six months during the life of the contract. The evaluation will assume that the prices for any option exercised under FAR 52.217-8 will be at the same rates as those in effect under the contract at time of https://www.google.com/maps/place/Minnesota/ award. The evaluation will therefore assume that the addition of the price or prices of any possible extension or extensions under FAR 52.217-8 to the total price for the basic requirement and the total price for the priced options has the same effect on the total price of all offers relative to each other, and will not affect the ranking of offers based on price, unless, after reviewing the offers, the Government determines that there is a basis for finding otherwise. This evaluation will not obligate the Government to exercise any option under FAR 52.217-8.

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of Provision)

A.1 PRICE/COST SCHEDULE

ITEM INFORMATION

ITEM

NUMBER

DESCRIPTION OF

SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

1.00 YR $86,000.00 $86,000.00

Pharmacy Benefit Management Service to support the St Cloud MN VAHCS and Community Based Outpatient Clinics (CBOCs) located in Alexandria, Brainerd, and Montevideo MN. The contract will be funded based upon prior year cost and will be adjusted/modified with a Bilateral Modification if patient volume increases.

AWP Discount %: _____________ (Brand)

AWP Discount %: _____________ (Generic)

Dispensing Fee: $_____________ per prescription.

Contract Period: Base POP Begin: 11-06-2023 POP End: 11-05-2024 PRINCIPAL NAICS CODE: 524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1.00 YR $87,000.00 $87,000.00

VAHCS and Community Based Outpatient Clinics (CBOCs) located in Alexandria, Brainerd, and Montevideo MN. The contract will be funded based upon prior year cost and will be adjusted/modified with a Bilateral Modification if patient volume increases.

AWP Discount %: _____________ (Brand)

AWP Discount %: _____________ (Generic)

Dispensing Fee: $_____________ per prescription.

Contract Period: Option 1 POP Begin: 11-06-2024 POP End: 11-05-2025 PRINCIPAL NAICS CODE: 524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and

ITEM

NUMBER

DESCRIPTION OF

1.00 YR $88,000.00 $88,000.00

VAHCS and Community Based Outpatient Clinics (CBOCs) located in Alexandria, Brainerd, and Montevideo MN. The contract will be funded based upon prior year cost and will be adjusted/modified with a Bilateral Modification if patient volume increases.

AWP Discount %: _____________ (Brand)

AWP Discount %: _____________ (Generic)

Dispensing Fee: $_____________ per prescription.

Contract Period: Option 2 POP Begin: 11-06-2025 POP End: 11-05-2026 PRINCIPAL NAICS CODE: 524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and

1.00 YR $89,000.00 $89,000.00

VAHCS and Community Based Outpatient Clinics (CBOCs) located in Alexandria, Brainerd, and Montevideo MN. The contract will be funded based upon prior year cost and will be adjusted/modified with a Bilateral Modification if patient volume increases.

AWP Discount %: _____________ (Brand)

AWP Discount %: _____________ (Generic)

Dispensing Fee: $_____________ per prescription.

Contract Period: Option 3 POP Begin: 11-06-2026 POP End: 11-05-2027 PRINCIPAL NAICS CODE: 524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and

ITEM

NUMBER

DESCRIPTION OF

1.00 YR $90,000.00 $90,000.00

VAHCS and Community Based Outpatient Clinics (CBOCs) located in Alexandria, Brainerd, and Montevideo MN. The contract will be funded based upon prior year cost and will be adjusted/modified with a Bilateral Modification if patient volume increases.

AWP Discount %: _____________ (Brand)

AWP Discount %: _____________ (Generic)

Dispensing Fee: $_____________ per prescription.

Contract Period: Option 4 POP Begin: 11-06-2027 POP End: 11-05-2028 PRINCIPAL NAICS CODE: 524292 - Pharmacy Benefit Management and Other Third Party Administration of Insurance and

GRAND

TOTAL

$440,000.00

NOTE: Quantities: The St. Cloud VAHCS makes no guarantees as to quantities of items that will be ordered under this contract and is obligated only to the extent of authorized purchases actually made under this contract