ATTACHMENT 1 -- Price Schedule.xlsx

XLSX spreadsheet 21 KB Posted Sep 2, 2021

Attached to: 6505--NON PET Radiopharmaceuticals
Solicitation number: 36C26121Q0971
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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36C26121Q0971 0001.docx	DOCX document	Sep 8, 2021
36C26121Q0971.docx	DOCX document	Sep 2, 2021

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Price-Cost Schedule

	ATTACHMENT 2 - PRICE-COST SCHEDULE ESTIMATE		100% LEU-Tc99m
	uCi = Microcuries
	UD = UNIT DOSE
	UOM = UNIT OF MEASURE
NO.	PoP	10/01/2021 - 09/30/2022					BASE YEAR
	RADIOPHARMACEUTICAL OR RADIONUCLIDE NAME/DESCRIPTION			100% LEU	UOM	QTY PER UOM	EST QTY	UNIT	PRICE (FY22)	COST
1	Tl-201 Chloride UD			N/A	mCi	3 mCi	5	EA		$0.00
2	Ga-67 (Gallium Citrate) UD (~6 mCi per UD or $34 per mCi)			N/A	mCi	6 mCi	1	EA		$0.00
3	I-123 (Sodium Iodide I-123 Capsule) per 200 uCi			N/A	uCi	200 uCi	93	EA		$0.00
4	I-123 Iobenguane Sulfate; I-123 MIBG (Adreview) UD			N/A	dose	1-10 mCi	1	EA		$0.00
5	I-131 (Sodium Iodide Compounded Capsules) first 1 mCi			N/A	mCi	each mCi	15	EA		$0.00
6	I-131 (Sodium Iodide Compounded Capsules) per 1 mCi after first mCi			N/A	mCi	each mCi	294	EA		$0.00
7	In-111 Oxine per 1.0 mCi vial			N/A	vial	each 1 mCi vial	1	EA		$0.00
8	In-111 Pentetreotide (Octreoscan®) UD			N/A	dose	each dose	2	EA		$0.00
9	In-111 DTPA (Pentetate) per 1.5 mCi vial			N/A	vial	each vial	1	EA		$0.00
10	Tc99m DTPA ~50 mCi Pulmonary [for aerosol] UD*			yes	dose	each 50 mCi dose	50	EA		$0.00
11	Tc99m MAA (Macroaggregated Albumin) UD*			yes	dose	each 5 mCi dose	50	EA		$0.00
12	Tc99m MDP (Medronate) UD*			yes	dose	each 25 mCi dose	300	EA		$0.00
13	Tc99m Mebrofenin (Choletec) UD*			yes	dose	each 0-10 mCi dose	11	EA		$0.00
14	Tc99m Mertiatide (MAG3) UD*			yes	dose	each 0-10 mCi dose	254	EA		$0.00
15	Tc99m NaTc04 QC-Activity, 3 mCi syringe*			yes	dose	each 3 mCi dose	55	EA		$0.00
16	Tc99m NaTc04 UD; syringe (20 mCi per UD)*			yes	dose	each 20 mCi dose	5	EA		$0.00
17	Tc99m NaTc04 QC-Activity as needed, per 3 mCi VIAL*			yes	dose	each 3 mCi vial	21	EA		$0.00
18	Tc99m NaTc04 QC-Activity as needed, per 30 mCi VIAL*			yes	dose	each 30 mCi vial	6	EA		$0.00
19	Tc99m Pyrophosphate (PYP)			yes	dose	each 20 mCi dose	3	EA		$0.00
20	Tc99m NaTc04 QC-Activity as needed, per 300 mCi VIAL 4*			yes	dose	each 300 mCi vial	4	EA		$0.00
21	Tc99m Sestamibi-Generic UD*			yes	dose	each 1 to 30 mCi dose	29	EA		$0.00
22	Tc99m Tetrofosmin (Myoview) UD*			yes	dose	each 1 to 30 mCi dose	2660	EA		$0.00
23	Tc99m Sulfur Colloid Filtered UD (~0.5-1 mCi per UD)*			yes	dose	up to 1 mCi dose	30	EA		$0.00
24	Tc99m Sulfur Colloid UD (~1 mCi per UD)*			yes	dose	each 1 to 8 mCi dose	50	EA		$0.00
25	Tc99m Sulfur Colloid UD (~6-10 mCi per UD)*			yes	dose	each 1 to 8 mCi dose	2	EA		$0.00
26	Sn-PYP (Pyrophosphate) VIAL for Red Blood Cells			N/A	vial	per vial	1	EA		$0.00
27	Labeled WBC (autologous leukocytes) In-111 Oxine UD			N/A	dose	per procedure	3	EA		$0.00
28	Labeled WBC (autologous leukocytes) Tc99m Ceretec (Exametazime aka HMPAO) UD*			yes	dose	per procedure	6	EA		$0.00
									Base Year Total	$ - 0

	PoP	10/01/2022 - 09/30/2023				YEAR 1
NO
	RADIOPHARMACEUTICAL OR RADIONUCLIDE NAME/DESCRIPTION		100% LEU	UOM	QTY PER UOM	QTY	UNIT	PRICE (FY23)	COST
1	Tl-201 Chloride UD		N/A	mCi	3 mCi	5	EA		$0.00
2	Ga-67 (Gallium Citrate) UD (~6 mCi per UD or $34 per mCi)		N/A	mCi	6 mCi	1	EA		$0.00
3	I-123 (Sodium Iodide I-123 Capsule) per 200 uCi		N/A	uCi	200 uCi	93	EA		$0.00
4	I-123 Iobenguane Sulfate; I-123 MIBG (Adreview) UD		N/A	dose	1-10 mCi	1	EA		$0.00
5	I-131 (Sodium Iodide Compounded Capsules) first 1 mCi		N/A	mCi	each mCi	15	EA		$0.00
6	I-131 (Sodium Iodide Compounded Capsules) per 1 mCi after first mCi		N/A	mCi	each mCi	294	EA		$0.00
7	In-111 Oxine per 1.0 mCi vial		N/A	vial	each 1 mCi vial	1	EA		$0.00
8	In-111 Pentetreotide (Octreoscan®) UD		N/A	dose	each dose	2	EA		$0.00
9	In-111 DTPA (Pentetate) per 1.5 mCi vial		N/A	vial	each vial	1	EA		$0.00
10	Tc99m DTPA ~50 mCi Pulmonary [for aerosol] UD*		yes	dose	each 50 mCi dose	50	EA		$0.00
11	Tc99m MAA (Macroaggregated Albumin) UD*		yes	dose	each 5 mCi dose	50	EA		$0.00
12	Tc99m MDP (Medronate) UD*		yes	dose	each 25 mCi dose	300	EA		$0.00
13	Tc99m Mebrofenin (Choletec) UD*		yes	dose	each 0-10 mCi dose	11	EA		$0.00
14	Tc99m Mertiatide (MAG3) UD*		yes	dose	each 0-10 mCi dose	254	EA		$0.00
15	Tc99m NaTc04 QC-Activity, 3 mCi syringe*		yes	dose	each 3 mCi dose	55	EA		$0.00
16	Tc99m NaTc04 UD; syringe (20 mCi per UD)*		yes	dose	each 20 mCi dose	5	EA		$0.00
17	Tc99m NaTc04 QC-Activity as needed, per 3 mCi VIAL*		yes	dose	each 3 mCi vial	21	EA		$0.00
18	Tc99m NaTc04 QC-Activity as needed, per 30 mCi VIAL*		yes	dose	each 30 mCi vial	6	EA		$0.00
19	Tc99m Pyrophosphate (PYP)		yes	dose	each 20 mCi dose	3	EA		$0.00
20	Tc99m NaTc04 QC-Activity as needed, per 300 mCi VIAL 4*		yes	dose	each 300 mCi vial	4	EA		$0.00
21	Tc99m Sestamibi-Generic UD*		yes	dose	each 1 to 30 mCi dose	29	EA		$0.00
22	Tc99m Tetrofosmin (Myoview) UD*		yes	dose	each 1 to 30 mCi dose	2660	EA		$0.00
23	Tc99m Sulfur Colloid Filtered UD (~0.5-1 mCi per UD)*		yes	dose	up to 1 mCi dose	30	EA		$0.00
24	Tc99m Sulfur Colloid UD (~1 mCi per UD)*		yes	dose	each 1 to 8 mCi dose	50	EA		$0.00
25	Tc99m Sulfur Colloid UD (~6-10 mCi per UD)*		yes	dose	each 1 to 8 mCi dose	2	EA		$0.00
26	Sn-PYP (Pyrophosphate) VIAL for Red Blood Cells		N/A	vial	per vial	1	EA		$0.00
27	Labeled WBC (autologous leukocytes) In-111 Oxine UD		N/A	dose	per procedure	3	EA		$0.00
28	Labeled WBC (autologous leukocytes) Tc99m Ceretec (Exametazime aka HMPAO) UD*		yes	dose	per procedure	6	EA		$0.00
								Option year 1 total	$ - 0

	PoP	10/01/2023 - 09/30/2024				YEAR 2
NO	RADIOPHARMACEUTICAL OR RADIONUCLIDE NAME/DESCRIPTION		100% LEU	UOM	QTY PER UOM	QTY	UNIT	PRICE (FY24)	COST
1	Tl-201 Chloride UD		N/A	mCi	3 mCi	5	EA		$0.00
2	Ga-67 (Gallium Citrate) UD (~6 mCi per UD or $34 per mCi)		N/A	mCi	6 mCi	1	EA		$0.00
3	I-123 (Sodium Iodide I-123 Capsule) per 200 uCi		N/A	uCi	200 uCi	93	EA		$0.00
4	I-123 Iobenguane Sulfate; I-123 MIBG (Adreview) UD		N/A	dose	1-10 mCi	1	EA		$0.00
5	I-131 (Sodium Iodide Compounded Capsules) first 1 mCi		N/A	mCi	each mCi	15	EA		$0.00
6	I-131 (Sodium Iodide Compounded Capsules) per 1 mCi after first mCi		N/A	mCi	each mCi	294	EA		$0.00
7	In-111 Oxine per 1.0 mCi vial		N/A	vial	each 1 mCi vial	1	EA		$0.00
8	In-111 Pentetreotide (Octreoscan®) UD		N/A	dose	each dose	2	EA		$0.00
9	In-111 DTPA (Pentetate) per 1.5 mCi vial		N/A	vial	each vial	1	EA		$0.00
10	Tc99m DTPA ~50 mCi Pulmonary [for aerosol] UD*		yes	dose	each 50 mCi dose	50	EA		$0.00
11	Tc99m MAA (Macroaggregated Albumin) UD*		yes	dose	each 5 mCi dose	50	EA		$0.00
12	Tc99m MDP (Medronate) UD*		yes	dose	each 25 mCi dose	300	EA		$0.00
13	Tc99m Mebrofenin (Choletec) UD*		yes	dose	each 0-10 mCi dose	11	EA		$0.00
14	Tc99m Mertiatide (MAG3) UD*		yes	dose	each 0-10 mCi dose	254	EA		$0.00
15	Tc99m NaTc04 QC-Activity, 3 mCi syringe*		yes	dose	each 3 mCi dose	55	EA		$0.00
16	Tc99m NaTc04 UD; syringe (20 mCi per UD)*		yes	dose	each 20 mCi dose	5	EA		$0.00
17	Tc99m NaTc04 QC-Activity as needed, per 3 mCi VIAL*		yes	dose	each 3 mCi vial	21	EA		$0.00
18	Tc99m NaTc04 QC-Activity as needed, per 30 mCi VIAL*		yes	dose	each 30 mCi vial	6	EA		$0.00
19	Tc99m Pyrophosphate (PYP)		yes	dose	each 20 mCi dose	3	EA		$0.00
20	Tc99m NaTc04 QC-Activity as needed, per 300 mCi VIAL 4*		yes	dose	each 300 mCi vial	4	EA		$0.00
21	Tc99m Sestamibi-Generic UD*		yes	dose	each 1 to 30 mCi dose	29	EA		$0.00
22	Tc99m Tetrofosmin (Myoview) UD*		yes	dose	each 1 to 30 mCi dose	2660	EA		$0.00
23	Tc99m Sulfur Colloid Filtered UD (~0.5-1 mCi per UD)*		yes	dose	up to 1 mCi dose	30	EA		$0.00
24	Tc99m Sulfur Colloid UD (~1 mCi per UD)*		yes	dose	each 1 to 8 mCi dose	50	EA		$0.00
25	Tc99m Sulfur Colloid UD (~6-10 mCi per UD)*		yes	dose	each 1 to 8 mCi dose	2	EA		$0.00
26	Sn-PYP (Pyrophosphate) VIAL for Red Blood Cells		N/A	vial	per vial	1	EA		$0.00
27	Labeled WBC (autologous leukocytes) In-111 Oxine UD		N/A	dose	per procedure	3	EA		$0.00
28	Labeled WBC (autologous leukocytes) Tc99m Ceretec (Exametazime aka HMPAO) UD*		yes	dose	per procedure	6	EA		$0.00
								Option year 2 total

Grand Total

File details come from the government source that posted it. Updated Sep 2, 2021.