36C77018Q0113-003.pdf

VHAPM Part 806.3 Other Than Full and Open Competition (OFOC) SOP Attachment 2: Request for Sole Source Justification Format

OFOC SOP Revision 06 Page 1 of 2 Original Date: 03/22/11 Revision 06 Date: 08/30/2017

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For

Other Than Full and Open Competition

Acquisition Plan Action ID:_______VA770-18-AP-0116 & VA770-18-AP-0117___________

1. Contracting Activity:

Department of Veterans Affairs Network 15 Contracting Office 3450 South 13th Street Leavenworth, KS 66048

The purchase request number is 766-18-1-400-0106 & 766-18-1-400-0105 Items are to be delivered to the Charleston CMOP.

2. Nature and/or Description of the Action Being Processed:

The Charleston-CMOP, 3725 Rivers Avenue, Suite 2, Charleston, NC 29405, Consolidated Mail Outpatient Pharmacy is requesting approval to purchase BRAND NAME specific NDC drug items. This is a new procurement and will be a firm fixed price contract.

3. Description of Supplies/Services Required to Meet the Agency’s Needs:

GLUCOSE SENSOR DEXCOM G4

• NDC -008627004104 (NO SUBSTITUTES)

• Quantity and Description of request: 4per box GLUCOSE SENSOR DEXCOM G4

• Supplier: DEXCOM, INC.

ONE TOUCH ULTRA (GLUCOSE) TEST STRIP 50ct – Retail or Mail order only box

• Must be the Original product from an authorized manufacturer and distributor

• Quantity and Description of request: ONE TOUCH ULTRA (GLUCOSE) TEST STRIP 50CT

• Supplier: LIFESCAN

• Note: Mail order boxes are just a different type of packaging. The test strips are the very same as in the retail box.

4. Statutory Authority Permitting Other than Full and Open Competition:

(X ) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy

Agency Requirements per FAR 6.302-1;

( ) (2) Unusual and Compelling Urgency per FAR 6.302-2;

( ) (3) Industrial Mobilization, Engineering, Developmental or Research Capability

VHAPM Part 806.3 Other Than Full and Open Competition (OFOC) SOP Attachment 2: Request for Sole Source Justification Format

OFOC SOP Revision 06 Page 2 of 2 Original Date: 03/22/11 Revision 06 Date: 08/30/2017 or Expert Services per FAR 6.302-3;

( ) (4) International Agreement per FAR 6.302-4 ( ) (5) Authorized or Required by Statute FAR 6.302-5;

( ) (6) National Security per FAR 6.302-6;

( ) (7) Public Interest per FAR 6.302-7;

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the Use of the Authority Cited Above (applicability of authority

Within the VHA brand name drugs may be prescribed by physicians when in their clinical judgment the brand name drug will provide a better therapeutic outcome for patients. Brand name drugs are requested when there is a clinical requirement for the drug. In this case, the brand specific drug name is requested on the list above.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: This will be posted on www.fbo.gov as an unrestricted solicitation, and for only for the specific brand.

http://www.fbo.gov/