36C77019Q0335-002.xlsx
XLSX spreadsheet 20 KB Posted
- Solicitation number
- 36C77019Q0335
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36C77019Q0335 Solicitation Attachment 1 - Quote Spreadsheet Q0335.xlsx
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| File | Type | Posted |
|---|---|---|
| 36C77019Q0335-001.docx | DOCX document | |
| 36C77019Q0335-000.docx | DOCX document |
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Quote Spreadsheet
| CHELMSFORD MA CMOP | **All "Yellow" highlighted fields must be completed. |
| 36C77019Q0335 | Delivery ARO 10 Days |
| Solicitation Attachment 1 - Quote Spreadsheet |
| Vendor Name: | |||||||||||||||
| DUNS #: | |||||||||||||||
| POC Name: | Signed SF1449 Form and Copy of State-Issued Wholesale Drug Distributor License Required | ||||||||||||||
| POC E-Mail: | Email spreadsheet, SF1449, State License, and any inquirie prior to closing to : Karen.Griffin4@va.gov | ||||||||||||||
| Phone: | |||||||||||||||
| Tax ID Number: | PRODUCTS PROPOSED SHALL BE FDA COMPLIANT. | ||||||||||||||
| Vendor Complete | Vendor Complete | Total Price | Vendor Comments/ Alternate Proposed Delivery Date | ||||||||||||
| Line Item | CMOP Item Number | Description | NDC | Proposed Alternate NDCs | Alternative Bottle/PKG size | Mfr | Country of Origin | QTY | Unit | Unit Price | |||||
| Vendor Comments | Total | ||||||||||||||
| 1 | A1069 | ALENDRONATE 35MG | |||||||||||||
| TAB 4CT | 16252-0599-44, 69097022316 | 288 | BX | $ - 0 | $0.00 | ||||||||||
| 2 | A0447 | ATENOLOL | |||||||||||||
| 100/CHLORTHALIDONE 25MG TAB 100 CT | 00591-5783-01 | 36 | BT | $ - 0 | $0.00 | ||||||||||
| 3 | A0450 | ATENOLOL | |||||||||||||
| 50/CHLORTHALIDONE 25MG TAB 100CT | 00591-5782-01 | 144 | BT | $ - 0 | $0.00 | ||||||||||
| 4 | A0478 | AZATHIOPRINE 50MG | |||||||||||||
| TAB 100CT | 60219-1076-01) | 48 | BT | $ - 0 | $0.00 | ||||||||||
| 5 | A0765 | ALENDRONATE 5MG | |||||||||||||
| TAB, 100 PER BT | 00115-1676-01) | 12 | BT | $ - 0 | $0.00 | ||||||||||
| 6 | A1070 | ALENDRONATE 70MG | |||||||||||||
| 4CT | 69097-0224-16 | 1152 | BX | $ - 0 | $0.00 | ||||||||||
| 7 | A1324 | AMLODIPINE | |||||||||||||
| 5/BENAZEPRIL 40MG CAP | 65862-0585-01 | 432 | BT | $ - 0 | $0.00 | ||||||||||
| 8 | B0180 | BROMOCRIPTINE | |||||||||||||
| MESYLATE 2.5MG TAB 100CT | 00574-0106-01, 63304096201 | 96 | BT | $ - 0 | $0.00 | ||||||||||
| 9 | B0544 | BUPROPION (SMK-C) | |||||||||||||
| 150MG 12HR SA TAB, 100CT | 00591-3543-76, | 24 | BT | $ - 0 | $0.00 | ||||||||||
| 10 | C0245 | CHLORZOXAZONE | |||||||||||||
| 500MG TAB | 00591-2520-01 | 36 | BT | $ - 0 | $0.00 | ||||||||||
| 11 | C0268 | CLINDAMYCIN HCL | |||||||||||||
| 150MG CAP 100CT | 63304-0692-01 | 72 | BT | $ - 0 | $0.00 | ||||||||||
| 12 | 4188 | CLINDAMYCIN HCL | |||||||||||||
| 300MG CAP 100CT | 63304-0693-01 | 12 | BT | $ - 0 | $0.00 | ||||||||||
| 13 | D0061 | DICLOFENAC | |||||||||||||
| NA 25MG EC TAB - 100 COUNT | 16571-0203-10 | 96 | BT | $ - 0 | $0.00 | ||||||||||
| 14 | D1033 | DILTIAZEM HCL 90MG | |||||||||||||
| 12HR CAP,SA 100CT | 00378-6090-01 | 336 | BT | $ - 0 | $0.00 | ||||||||||
| 15 | D1034 | DILTIAZEM HCL | |||||||||||||
| 120MG 12HR SA CAP | 00378-6120-01 | 240 | BT | $ - 0 | $0.00 | ||||||||||
| 16 | D1079 | DOXYCYCLINE | |||||||||||||
| HYCLATE 50MG CAP/TAB 50CT | 67405-0650-55 | 240 | EA | $ - 0 | $0.00 | ||||||||||
| 17 | F0080 | FUROSEMIDE 80MG | |||||||||||||
| TAB, 500CT | 69315-0118-05 | 72 | BT | $ - 0 | $0.00 | ||||||||||
| 18 | H0062 | HYDROCORTISONE | |||||||||||||
| 2.5% OINT 20GM PER TU | 45802-0014-02 | 600 | TU | $ - 0 | $0.00 | ||||||||||
| 19 | H0469 | HYDROCORTISONE | |||||||||||||
| 1%/PRAMOXINE 1% TOP OINT 30GM PER TU | 54766-0763-04 | 96 | TU | $ - 0 | $0.00 | ||||||||||
| 20 | I0019 | INDOMETHACIN 25MG | |||||||||||||
| CAP 1000CT | 68462-0406-10 | 48 | BT | $ - 0 | $0.00 | ||||||||||
| 21 | L0181 | LEVOFLOXACIN 500MG | |||||||||||||
| TAB, 50CT | 31722-0722-50 | 36 | BT | $ - 0 | $0.00 | ||||||||||
| 22 | M0084 | METOLAZONE 2.5MG | |||||||||||||
| TAB 100CT | 00527-2215-37, 00185505001 | 288 | BT | $ - 0 | $0.00 | ||||||||||
| 23 | N0245 | NEFAZODONE 200MG | |||||||||||||
| TAB 60CT | 00093-1025-06 | 12 | BT | $ - 0 | $0.00 | ||||||||||
| 24 | O0156 | OLANZAPINE 10MG | |||||||||||||
| RAPID DISINTEGRATING TAB, 30 PER BX | 60505-3276-03 | 144 | BX | $ - 0 | $0.00 | ||||||||||
| 25 | O0180 | OLANZAPINE 5MG | |||||||||||||
| RAPID DISINTEGRATING TAB, 30 PER BX | 60505-3275-03 | 240 | BX | $ - 0 | $0.00 | ||||||||||
| 26 | P0060 | PILOCARPINE HCL 1% | |||||||||||||
| OPH SOLN 15ML PER BT | 61314-0203-15 | 72 | BT | $ - 0 | $0.00 | ||||||||||
| 27 | P0062 | PILOCARPINE HCL 2% | |||||||||||||
| OPH SOLN 15ML, PER BT | 61314-0204-15 | 108 | BT | $ - 0 | $0.00 | ||||||||||
| 28 | P0356 | PREDNISOLON AC | |||||||||||||
| 0.2/SULFACET 10% OPH OINT, 1 PER EA | 00023031304 | 36 | EA | ||||||||||||
| 29 | R0004 | RAMIPRIL | |||||||||||||
| 5MG CAP 100CT | 65862-0476-01, 57237022401 | 96 | BT | ||||||||||||
| 30 | S0044 | SPIRONOLACTONE | |||||||||||||
| 50MG TAB 100CT | 59746-0217-01, 00378024301 | 48 | BT | ||||||||||||
| 31 | 2922 | SULFACETAMIDE NA | |||||||||||||
| 10/SULFUR 5% LOT, 25 PER EA | 44523-0602-01 | 864 | EA | ||||||||||||
| 32 | T0112 | TRIHEXYPHENIDYL | |||||||||||||
| HCL 2MG TAB, 100CT | 00591-5335-01 | 12 | BT | ||||||||||||
| 33 | intentially left blank cancelled item #33 | N/A | N/A | N/A | |||||||||||
| 34 | Z0031 | ZOLMITRIPTAN 5MG | |||||||||||||
| TAB PKG 3 | 65862-0915-64, 68462049833 | 384 | PG | $ - 0 | $0.00 | ||||||||||
| GRAND TOTAL PRICE: | $0.00 | ERROR:#REF! |
| If you are proposing NDC with count other than CMOP listed, the quantity shall be adjusted | ALL QUOTES ARE CONFIDENTIAL |
| for the count you can provide. Fill sections in spreadsheet, and noted in vendor comments. |
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