PM_Part813.106_Atcht1_SingleSourceJustification_MPT-SAT_761-19-1-014-0048_redac.pdf

VHAPM Part 813.106 Simplified Acquisition Procedures: Soliciting from a Single Source Attachment 1: Single Source Justification for SAP under the SAT

VHAPM Part 813.106 Page 1 of 4 Original Date: 08/30/17 Revision 01 Eff Date: 04/23/2018

DEPARTMENT OF VETERANS AFFAIRS

Justification for Single Source Awards IAW FAR 13.106-1 For

Over Micro-Purchase Threshold but Not Exceeding the SAT ($250K)

Acquisition Plan Action ID:___ 761-19-1-014-0048___________________

1. Contracting Activity: Department of Veterans Affairs, VISN 15, Chelmsford, MA CMOP.

2. Brief Description of Supplies/ Services required and the intended use/Estimated Amount: items are needed to replenish GIP Inventory levels. $

3. Unique characteristics that limit availability to only one source, with the reason no other supplies or services can be used:

XI431 - GLUCOSE SENSOR DEXCOM G4-G5

• NDC/PART# DEXSTS-GL-041

• Quantity of request: 240

• Supplier: DEXCOM

• The Dexcom G4 Platinum Sensor (Box of 4) is the smallest Sensor available — about the size of 2 human hairs. Plus, while other brands have rigid, rectangular probes, the Dexcom G4 Platinum Sensor is a round, comfort-design, making it flexible, comfortable, and body-friendly. For use with the Dexcom G4 Platinum Receiver Kit.

• 7-day Sensor - The only Sensor FDA approved for 7 days of wear - a full week - (other brands only last up to 3 or 5 days), which may mean less cost and less fuss with the G4 Platinum

• Sleek Sensor - Smallest and lightest Sensor available = your comfort + discretion

The estimated Purchase Order value is for this request for this item is $

XH019 - LANCET,ACCU-CHEK FASTCLIX DRUM

• NDC/PART# 65702028810

• Quantity of Request: 576

• SUPPLIER – ROCHE

These special strips are designed to work with all models of Accu-Chek FastClix, the only one-click lancing system available with a drum. Accu-Chek lancets draw blood quickly and effectively https://www.acquisition.gov/?q=/browse/far/13

VHAPM Part 813.106 Page 2 of 4 Original Date: 08/30/17 Revision 01 Eff Date: 04/23/2018 for neat and easy application onto test strips. Each package comes with 102 lancets. Accu-Chek FastClix devices and test strips are sold separately.

Accu-Chek FastClix Lancets:

• For all models of Accu-Chek FastClix

• Accu-Check FastClix devices are sold separately

• The only 1-click lancing system with a drum

• Designed to reduce the pain of blood glucose testing

• Proven least painful and overall easiest to use

• Package contains 102 Roche lancets

• The estimated Purchase Order value is for this request for this item is $

XT868 - SET,INFUSION MINIMED #MMT-387

• NDC/PART# 70524406515/MMT-387

• Quantity of request: 240

• SUPPLIER : MEDTRONIC

The Medtronic Minimed Quick-set® infusion conveniently disconnects at the infusion site and offers a pre-attached adhesive for a discreet, low profile design. The Medtronic Minimed Quick-set® Infusion Set (MMT397) offers a 9mm soft cannula and 23 inch tubing for mostly everyone. The Safe Needle Disposal System of the Medtronic Minimed Quick-set helps prevent accidental sticking when disposing of the introducer needle in your sharps container. This Medtronic Minimed set works with the Quick-serter to provide optimal insertion every time.

The estimated Purchase Order value is for this request for this item is $

XZ173 - ONE TOUCH ULTRA (GLUCOSE) TEST STRIPS

• NDC/PART# 53885024510

• Quantity of request: 192

• SUPPLIER: LIFESCAN

The One Touch Ultra Diabetic Test Strip is the #1 Test Strip in the United States Fast Accurate Results, Results in just 5 seconds, Small Sample Size ,Requires just a small amount of blood, Alternate Site Testing ,Test from your fingertip, palm, forearm, upper arm, thigh, or calf.

VHAPM Part 813.106 Page 3 of 4 Original Date: 08/30/17 Revision 01 Eff Date: 04/23/2018

Compatible: One Touch Ultra Blue Blood Glucose Test Strips are compatible with

• OneTouch Ultra2 Blood Glucose Meter

• OneTouch UltraSmart Blood Glucose Meter

• OneTouch UltraMini Blood Glucose Meter

• OneTouch Ultra Blood Glucose Meter

The estimated Purchase Order value is for this request for this item is $

XZ835 - RESERVOIR,MINIMED #MMT-332A

• NDC/PART# 43169786554/ MMT-332A

• Quantity of request: 720

• SUPPLIER: MEDRONIC

Medtronic MiniMed Paradigm Reservoir is intended for use with the MiniMed Paradigm™ 71x insulin pumps and infusion sets only. It is custom made for Medtronic MiniMed Paradigm™ 7 Series insulin pumps and can be used with all Medtronic MiniMed Paradigm™ infusion sets.

User-filled reservoir holds up to 3ml of insulin Reservoir Size: 3.0 ml – MMT332A About MiniMed Paradigm 71x insulin Pumps: Can be hidden and worn under clothing for daily use. It is small and water resistant. Ref #: MMT-332A

The estimated Purchase Order value is for this request for this item is $

4. Description of market research conducted and results or statement why it was not conducted:

Products were searched in the NAC and GSA catalog and none of the items were found to be on contract except XI431. Item too expensive to manage on credit card due to high volume usage and contract cost.

Inventory Management Specialist

Frank Tarara Title: Contract Specialist

VHAPM Part 813.106 Page 4 of 4 Original Date: 08/30/17 Revision 01 Eff Date: 04/23/2018

5. Contracting Officer's Certification: Purchase is approved in accordance with FAR13.106-1(b). I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief.

Name Date Title: Contracting Officer https://acquisition.gov/far/current/html/Subpart%2013_1.html#wp1125466