Attachment D.11 - Three Sample Packs-Bills of Materials Amended.xlsx
XLSX spreadsheet 25 MB Posted
- Solicitation number
- 36C77625R0017
About this file
This is a bill of materials document detailing the components and packaging requirements for three custom sterile procedure packs: Basic Pack, General Surgery Pack, and Urology Pack. The document provides detailed specifications for each pack's contents, interior/exterior labeling requirements, and configuration instructions with accompanying photos.
The Basic Pack contains items like surgical gowns, towels, gauze, syringes, and various medical instruments. The General Surgery Pack includes additional specialized items such as cautery tools, mastisol vials, and needle counters. The Urology Pack features specialized components like leggings, cystoscopy drapes, and irrigation sets. All packs require specific labeling that must include pack name, contents, country of origin, hospital name, catalog number, lot number, use-by date, and contract number. The document is part of VA solicitation 36C77625R0017 for custom sterile procedure packs to be supplied to VA Medical Centers and CBOCs across VISNs 5, 9, 10, 12, 15, 16, and 23.
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#1 BASIC PACK
| Solicitation 36C77625R0017 - Custom Sterile Procedure Packs | ||||
| Pack Name | ||||
| BASIC PACK (sample #1): If providing an alternate/substitution, it shall be equal to the item requested (complete columns G - J). | ||||
| Customer Fill In (1 of 3) Pack Components | ||||
| Component Names | Manufacturer Name | Manufacturer Part No. | Country of Origin | Unit of Issue |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
| See Unit of Issue Codes Tab | Qty per pack | Substitution Reason | Alternate Manufacturer | Alternate Manufacturer Part No. | Alternate's Country of Origin | ||
| BAG BEDSIDE UTILITY LARGE 6 X 12 | Tidi Products | 950251 | EA | 1 | |||
| TRAY RECTANGULAR 11X9.5X2 | Spt Plastics | 614OR | EA | 1 | |||
| YANKAUER SUCTION INSTRUMENT W/BULB TIP | Robert Busse Hospital Disposable | 2986 | EA | 1 | |||
| GAUZE 4 X 4 16-PLY SPONGE X-RAY NS | AMD Ritmed | 6006 | EA | 10 | |||
| SYRINGE 10-12ML LUER-LOK | Transfers | SYR110010 | EA | 3 | |||
| BLADE NO.15 CS RIB NEW | OR Necessities | MDS15015LBN | EA | 1 | |||
| NDL CNTR 20CT FM MAG | OR Necessities | NS9102 | EA | 1 | |||
| SUCTION TUBING, 1/4" X 12', NON- STERILE | Cardinal Health Medical Products | 428779 | EA | 1 | |||
| MAYO STAND COVER 23 X 54 E SMS REINFORCE | O&M Halyard Inc | 78656 | EA | 1 | |||
| TOWEL OR BLUE | Primary Care | 14937 | EA | 4 | |||
| TOWEL, 18 X 21, ABSORBENT, WH, FOLDED | EVS Plus | 75289 | EA | 4 | |||
| GOWN SURG XL PREV PLUS | Proxima | SPT-2307PTM | EA | 3 | |||
| TOWEL OR BLUE | Proxima | 14937 | EA | 1 | |||
| TABLE COVER, 50" X 90", BULK FOLD | OR Specialities | PE61024 | EA | 1 | |||
| DNQ pouch BR 17.25x22.75 3ML | SPT Packaging | 49803 | EA | 1 | |||
| CTN 24 1/4X14 1/4X26 1/2 UNPTD | Anesthesia | 335673 | EA | 1 | |||
| Customer Fill In (2 of 3 ) Interior Labels/Exterior Labels/Packaging/Cartons | |||||||
| Label/Package/Carton Name | Brief Description from BOM | Pack Level or Case Level |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
Is the label for a case or an individual pack
| INTERIOR LABEL | Label is located inside the dust cover on top of the contents, front side. | Pack |
| Label shall contain PACK NAME AND CONTENTS (OR) COMPONENT DETAILS | ||
| Label to include country of origin for each item in parethesis after item description | ||
| Label shall state "DISPOSABLE - SINGLE USE ONLY" | ||
| Label shall state HOSPITAL NAME, CATALOG NUMBER, LOT NUMBER, USE BY DATE, CONTRACT NUMBER, STATION NUMBER, DATE OF MFG | ||
| At the bottom of the label it shall state "NOTE. **ONLY THE COMPONENTS MARKED WITH THE SYMBOL IN THE LIST ABOVE CONTAIN LATEX." | ||
| **See Image 1 for example** | ||
| IMAGE 1 | ||
| This is label tear here blank. | ||
| EXTERIOR LABEL | This is label to be placed on exterior shipping carton. Label shall state Product Number, Pack Description, Expiration Date, Case Quantity, Sample Pack Number, Vendor Name, Facility Name and Address. (If Applicatable) Contains Latex Material | Pack |
| **See Image 1 for example** | ||
| Customer Fill In (3 of 3) Special Packaging Requirements | ||
| Special Packaging Requirement Name (i.e.. Sterilization, configuration etc.) | Brief Description from BOM | Component OR Entire Pack |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
If for a component, enter manufacturer part number. If for the entire pack enter "entire pack"
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
Is the label for a case or an individual pack Configuration See images below. Entire pack
Photo Examples
Figure 1 Figure 2 Figure 3
Figure 2
Basic Pack contents label inside dust cover on top of outer wrap, shall be visible.
Figure 2 = top of pack Figure 9 = bottom of pack
| Components wrapped in 1 each blue wrap, 50 x 90 bulk fold | 1 each OR blue towel, | ||||
| 3 each XL gowns | 4 each towels, 18 x 21, white, absorbent, folded | ||||
| Figure 4 | Figure 5 | Figure 6 |
4 each OR towels Blue, Lint Free 1 each mayo stand cover, 23 x 54 E SMS reinforce 1 each #15 blade, 3 each syringe 10 CC, 1 each 10-pack gauze, 4x4 ply, sponge, x-ray detectable, non-sterile, 1 each suction tubing, 1/4"x12' non-sterile, Figure 7 Figure 8 Figure 9
1 each needle counter 20 count open just to show which is in Figure 6 1 each tray rectangular 11.9.5 x 2, 1 NDL CNTR (needle holder) 20 count FM MAG.
All items in Figures 2 - 7 shall be placed inside the tray.
Items listed in Figure 9 shall be placed under the tray 1 each bedside bag
#2 GENERAL SURGERY PACK
| Pack Name | ||||
| General Surgery Pack (sample #2): If providing an alternate/substitution, it shall be equal to the item requested (complete columns G - J). | ||||
| Customer Fill In (1 of 3) Pack Components | ||||
| Component Names | Manufacturer Name | Manufacturer Part No. | Country of Origin | Unit of Issue |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
| See Unit of Issue Codes Tab | Qty per pack | Substitution Reason | Alternate Manufacturer | Alternate Manufacturer Part No. | Alternate's Country of Origin | |
| SYR 50CC BULB | C. R. BARD INC.(UROLOGICAL) | 0935280 | EACH | 1 | ||
| SYR 10CC L/L | BECTON DICKINSON AND CO | 301029 | EACH | 2 | ||
| BLADE #15 CARB | ASPEN SURGICAL PRODUCTS INC | 371115 | EACH | 2 | ||
| BAG 7WX10L POLY 2ML | CANTWELL-CLEARY CO. | 20F-0710 | EACH | 1 | ||
| MASTISOL 2/3CC VIAL | FERNDALE LABORATORIES INC | 052348 | EACH | 1 | ||
| TRAY FOAM 18 X 14 X 5/8 | VERITIV OPERATING COMPANY | 10265242 | EACH | 1 | ||
| COUNTER NDL DBL MAG XLG 60CT | CARDINAL HEALTHCARE | 31155297 | EACH | 1 | ||
| GAUZE SPONGE 4X8 12PLY XR 10'S | CARDINAL HEALTHCARE | 7462 | EACH | 10 | ||
| PAD TELFA 8 X 3 2 SIDE MYLAR | CARDINAL HEALTHCARE | 12388 | EACH | 1 | ||
| STRIP STERI 1/4 X 4 5'S | 3M COMPANY | R1546NS | EACH | 1 | ||
| LABEL CUST. PRE-PRINT. SURVEY | R R DONNELLEY & SONS CO | SURVEY FORM | EACH | 1 | ||
| TAPE CLOSURE LABEL LOGO | MASA CORPORATION | 10702386/10702387 | EACH | 2 | ||
| LABEL 3 1/2 X10 | R R DONNELLEY & SONS CO | 3510 | EACH | 1 | ||
| TEGADERM 4 X 4.75 | 3M COMPANY | 1626WNS | EACH | 2 | ||
| BAG HEADER 21 X 30 | BEMIS HEALTHCARE PACKAGING | 100000098258 | EACH | 1 | ||
| BAG SUTURE CLEAR 20X18 W/TAPE | CLARK CONTAINER INC | 2018 | EACH | 1 | ||
| NDL 25G X 1.5' SAFETY | BECTON DICKINSON AND CO | 305767 | EACH | 2 | ||
| CORRECT MED LABEL SYSTEM | ANSELL SANDEL MEDICAL | 3300PNS | EACH | 1 | ||
| CARTON23X15X23 SW | WESTROCK CP LLC | 519720 | EACH | 1 | ||
| GOWN XLG FAB REIN ULTRA | HALYARD SALES LLC | 79512 | EACH | 1 | ||
| GOWN LG FAB REIN ULTRA | O&M HALYARD INC | 79511 | EACH | 1 | ||
| CAUTERY ROCKER W/EDGE BLADE | US SURGICAL CORPORATION | E2350H-GNSB | EACH | 1 | ||
| TOWEL ABSORB. WHITE 17 X 20 | LITTLE RAPIDS CORP - OEM | 50585 | EACH | 1 | ||
| TOWEL ABSORB. WHITE 17 X 20 | LITTLE RAPIDS CORP - OEM | 50585 | EACH | 1 | ||
| POUCH TYVEK 8' X 12' | AMCOR FLEXIBLES HEALTHCARE INC | 027710E | EACH | 1 | ||
| TOWEL OR BLUE XR W/GOLD STITCH | US MEDCO INC | TOWELXRNSB BLUE 400 | EACH | 10 | ||
| LAP SPONGE 18X18 XR 5S NO RING | US MEDCO INC | 1818 W1900 | PACK | 5 | ||
| COVER TABLE 60 X 90 HD | O&M HALYARD INC | 42307NS | EACH | 1 | ||
| LINER POLY 43X48 16 MIC | ATLANTIC CORPORATION | 17-50500 | EACH | 1 | ||
| LABELS- DOT BLANK LIMITED | ULINE SHIPPING SUPPLIES | S-17372 | EACH | 1 | ||
| DRAPE XLG 76' X 96' HANDIBIN | O&M HALYARD INC | 47632 | EACH | 1 |
Label/Package/Carton Name Brief Description from BOM Pack Level or Case Level Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
Is the label for a case or an individual pack
| INTERIOR LABEL | Label is located inside the dust cover on top of the contents, front side. | Pack |
| Label shall contain PACK NAME AND CONTENTS (OR) COMPONENT DETAILS | ||
| Label to include country of origin for each item in parethesis after item description | ||
| Label shall state "DISPOSABLE - SINGLE USE ONLY" | ||
| Label shall state HOSPITAL NAME, CATALOG NUMBER, LOT NUMBER, USE BY DATE, CONTRACT NUMBER, STATION NUMBER, DATE OF MFG | ||
| At the bottom of the label it shall state "NOTE. **ONLY THE COMPONENTS MARKED WITH THE SYMBOL IN THE LIST ABOVE CONTAIN LATEX." | ||
| **See Image 1 for example** | ||
| IMAGE 1 | ||
| This is label tear here blank. | ||
| EXTERIOR LABEL | This is label to be placed on exterior shipping carton. Label shall state Product Number, Pack Description, Expiration Date, Case Quantity, Sample Pack Number, Vendor Name, Facility Name and Address. (If Applicatable) Contains Latex Material | Pack |
| **See Image 1 for example** | ||
| Customer Fill In (3 of 3) Special Packaging Requirements | ||
| Special Packaging Requirement Name (i.e.. Sterilization, configuration etc.) | Brief Description from BOM | Component OR Entire Pack |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
If for a component, enter manufacturer part number. If for the entire pack enter "entire pack"
Is the label for a case or an individual pack Configuration See images below. Entire pack
Photo Examples
Figure 1 Figure 2 Figure 3
Figure 2
| General Surgery Pack contents label inside dust cover on top of Cover, Table 60X90 HD. | 1 each Drape XLG 76"X96" Handibin, | |||
| 1 each Towel, Absorb. White 17X20 | 1 each Towel, Absorb. White 17 x 20, white, 1 each Gown, LG Fab Rein Ultra | |||
| Figure 4 | Figure 5 | Figure 6 |
1 each Gown, XLG Fab Rein Ultra, 1 each Gauze Sponge 4X8 12 Ply XR 10's Pouch, Tyvek 8"X12" with contents listed in Figure 6 1 each Strip, Steri 1/4X4, 5's 2 each Tegaderm, 4X4.75 1 each Mastisol, 2/3 cc, Vial 1 each Pad, Telfa 8X3, 2 side Mylar Figure 7 Figure 8 Figure 9
10 each Towel OR Blue XR W/Gold Stitch, 1 each Cautery, Rocker W/Edge Blade, 1 each Syr, 50CC Bulb, 1 each Lap Sponge 18X18 XR 5S No Ring, 1 each Bag, 7WX10L Poly 2ML with contents shown in Figure 8. 1 each Counter, Ndl Dbl Mag XLG 60Ct, 1 each Correct Med Label System, 2 each Blade, #15 Carb, 2 each Ndl, 25GX1.5" Safety, 2 each Syr, 10cc L/L 1 each Bag, Suture Clear 20X18 W/Tape on top of 1 each Tray, Foam 18X14X5/8
#3 UROLOGY PACK
| Pack Name | |||
| Urology Pack (sample #3): If providing an alternate/substitution, it shall be equal to the item requested (complete columns G - J). | |||
| Customer Fill In (1 of 3) Pack Components | |||
| Component Names | Manufacturer Name | Manufacturer Part No. | Country of Origin |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
See Unit of Issue Codes Tab Unit of Issue Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
| See Unit of Issue Codes Tab | Qty per pack | Substitution Reason | Alternate Manufacturer | Alternate Manufacturer Part No. | Alternate's Country of Origin | ||
| SYR 30CC L/L | BECTON DICKINSON AND CO | 301033 | EA | 1 | |||
| LEGGING 31 X 48 | O&M HALYARD INC | 79027 | EA | 2 | |||
| DRAPE CYSTO T | O&M HALYARD INC | 79540 | EA | 1 | |||
| SET IRRIG Y TYPE DRIP CHMBR | BAXTER - IV SYSTEMS | 2C4041 | EA | 1 | |||
| LABEL CUST. PRE-PRINT. SURVEY | R R DONNELLEY & SONS CO | SURVEY FORM | EA | 1 | |||
| TAPE CLOSURE LABEL AVID LOGO | MASA CORPORATION | 10702386/10702387 | EA | 1 | |||
| TAPE CLOSURE LABEL AVID LOGO | MASA CORPORATION | 10702386/10702387 | EA | 1 | |||
| LABEL 3 1/2 X10 | R R DONNELLEY & SONS CO | 3510 | EA | 1 | |||
| BAG HEADER 19 X 30 | BEMIS HEALTHCARE PACKAGING | 100000098082 | EA | 1 | |||
| CARTON23X15X23 SW | WESTROCK CP LLC | 519720 | EA | 1 | |||
| GOWN XLG FAB REIN ULTRA | HALYARD SALES LLC | 79512 | EA | 1 | |||
| TOWEL ABSORB. WHITE 17 X 20 | LITTLE RAPIDS CORP - OEM | 50585 | EA | 2 | |||
| SYR 60CC CATH TIP | CARDINAL HEALTHCARE | 8881160256 | EA | 1 | |||
| COVER TABLE 60 X 90 HD | O&M HALYARD INC | 42307NS | EA | 1 | |||
| LINER POLY 43X48 16 MIC | ATLANTIC CORPORATION | 17-50500 | EA | 1 | |||
| DRAPE XLG 76' X 96' HANDIBIN | O&M HALYARD INC | 47632 | EA | 1 | |||
| Customer Fill In (2 of 3 ) Interior Labels/Exterior Labels/Packaging/Cartons | |||||||
| Label/Package/Carton Name | Brief Description from BOM | Pack Level or Case Level |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
Is the label for a case or an individual pack
| INTERIOR LABEL | Label is located inside the dust cover on top of the contents, front side. | Pack |
| Label shall contain PACK NAME AND CONTENTS (OR) COMPONENT DETAILS | ||
| Label to include country of origin for each item in parethesis after item description | ||
| Label shall state "DISPOSABLE - SINGLE USE ONLY" | ||
| Label shall state HOSPITAL NAME, CATALOG NUMBER, LOT NUMBER, USE BY DATE, CONTRACT NUMBER, STATION NUMBER, DATE OF MFG | ||
| At the bottom of the label it shall state "NOTE. **ONLY THE COMPONENTS MARKED WITH THE SYMBOL IN THE LIST ABOVE CONTAIN LATEX." | ||
| **See Image 1 for example** |
| This is label tear here blank. | ||
| EXTERIOR LABEL | This is label to be placed on exterior shipping carton. Label shall state Product Number, Pack Description, Expiration Date, Case Quantity, Sample Pack Number, Vendor Name, Facility Name and Address. (If Applicatable) Contains Latex Material | Pack |
| **See Image 1 for example** | ||
| Customer Fill In (3 of 3) Special Packaging Requirements | ||
| Special Packaging Requirement Name (i.e.. Sterilization, configuration etc.) | Brief Description from BOM | Component OR Entire Pack |
Mason, Brian C CIV DLA TROOP SUPPORT (USA): Mason, Brian C CIV DLA TROOP SUPPORT (USA):
If for a component, enter manufacturer part number. If for the entire pack enter "entire pack"
Is the label for a case or an individual pack Configuration See images below. Entire pack
Photo Examples
Figure 1 Figure 2 Figure 3
Figure 2
| Urology Pack contents label inside dust cover on top of Cover, table 60 X 90 HD, shall be visible. | 1 Drape XLG 76" X 96" Handibin | 2 each towels, asorb. White 17 x 20, white, absorbent, 1 each Gown,XLG Fab Rein Ultra |
| Figure 4 | Figure 5 | Figure 6 |
2 each Legging 31 X 48 1 set, Irrig Y Type Drip Chmbr, 1 each Syr, 30CC L/L, 1 each Syr, 60CC Cath Tip 1 each Drape, Cysto T image1.png image10.png image11.png image2.png image3.png image4.png image5.png image6.png image7.png image8.png image9.png image12.png image21.png image22.png image13.png image14.png image15.png image16.png image17.png image18.png image19.png image20.png image23.jpeg image24.png image25.png image26.png image27.png image28.png image29.png
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