36C79118R0022-0004001.xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- FY19 Dialysis National Contract - Trinity Dialysis Clinic Inc. Federal contract opportunity
- Solicitation number
- 36C79118R0022
About this file
This document contains a spreadsheet template for tracking dialysis facilities and services under a national dialysis contract. The spreadsheet requires offerors to list facility details including addresses, points of contact, tax IDs, certification numbers, modalities offered, and chair capacities. Offerors must also specify whether authorizations and payments will be centralized or handled at each facility. Separate fields are included for authorization contact information and remittance addresses if different than the facilities. The related opportunity notice indicates the Department of Veterans Affairs intends to issue a solicitation on October 18, 2018 for nationwide dialysis services to veterans. Services are expected to include center hemodialysis, home hemodialysis, peritoneal dialysis, and training for home modalities. Interested contractors must possess CMS ESRD certification.
36C79118R0022 0004 Attachment 2 - Facility List - v2.xlsx
View the file
Other files for this federal contract opportunity
Show all 47
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
INSTRUCTIONS
| Purpose: This spreadsheet will be used by the VA Medical Centers to place authorizations and make payments as well as display the number of facilities under the contract, treatment modalities, and available chairs. |
| Instructions: Offerors must indicate on this spreadsheet whether the process for placing authorizations and making payments will be centralized or sent directly to the facility providing services and fill out the information in this spreadsheet accordingly. If the contact information for placing an authorization differs from the facility information, then offerors must fill out the authorization contact information. If the remittance address is different from the facility address then offerors must fill out the remittance information. The Government reserves the right to verify the number of chairs proposed by any offeror. |
| Column N- CMS Certification Column is formatted to save as "text", please ensure this is entered as text and not another number format. |
Column P- Modality Treatments Offered- Please list any and all Modalities offered (For example- Center HD, Home HD, Center PD, Home PD, Home Training)
Column I-L Point of Contact (Business Hours), Email Address, Point of Contact (After Hours), After Hours Phone #
FACILITY LISTING
| Authorization Point of Contact/Information | Remittance Information | |||||||||||||||||||||||||||
| Facility Name | Address1 | Address2 | City | State | Zip Code (+4) | Phone Number | Fax Number | Point of Contact (Business Hours) | Email Address | Point of Contact (After Hours) | After Hours Phone # | Provider Tax ID | CMS Certification Number | Facility NPI | Modality Treatments Offered | Number of Chairs | Shifts | Authorization Address | Authorization City | Authorization State | Authorization Zip Code (+4) | Authorization Phone Number | Authorization Fax Number | Remittance Address | Remittance City | Remittance State | Remittance Zip Code (+4) | Remittance Phone Number |
FACILITY LISTING
File details come from the government source that posted it. Updated .