Attachment 3 - QSR Reporting Tool.xlsx
XLSX spreadsheet 40 KB Posted
- Attached to
- IN HOME HOSPITAL BEDS
- Solicitation number
- 36C10G25R0011
About this file
This is a Quarterly Sales Report (QSR) Excel template used for reporting sales data to the Department of Veterans Affairs across their medical facilities. The spreadsheet contains three sheets with detailed facility listings organized by Veterans Integrated Service Networks (VISNs 1-23) and includes facility numbers, names, and locations for over 150 VA medical centers and facilities nationwide. The template allows contractors to report quarterly sales quantities and amounts by line item/CLIN, calculate total quarterly sales inclusive of Service Level Agreement (SLA) fees, and determine SLA amounts. The template includes formulas to automatically calculate totals and fees, with fields for contract number, reporting quarter/fiscal year, and product details including descriptions and contract/part numbers.
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Other files
| File | Type | Posted |
|---|---|---|
| Final RFP 36C10G25R0011 Amendment 0002.docx | DOCX document | |
| 36C10G25R0011 0002.docx | DOCX document | |
| 36C10G25R0011 0001.docx | DOCX document | |
| Final RFP 36C10G25R0011 Amendment 0001.docx | DOCX document | |
| Solicitation Questions and Answers Hospital Beds Amend 0001.docx | DOCX document | |
| Attachment 9 - Pricing Schedule Amendment 0001.xlsx | XLSX spreadsheet | |
| Attachment 4 - Pay.gov Vendor Submittal Instructions.pdf | ||
| 36C10G25R0011.docx | DOCX document | |
| Attachment 9 - Pricing Schedule.xlsx | XLSX spreadsheet | |
| Attachment 8 - Past Performance Questionnaire.docx | DOCX document | |
| Attachment 1 - Invoice Inquiry Tracker.xlsx | XLSX spreadsheet | |
| Attachment 7 - RFP Questions.xlsx | XLSX spreadsheet | |
| Attachment 2 - Contract Discrepancy Report.pdf | ||
| Attachment 6 - Cross Reference Index.xlsx | XLSX spreadsheet | |
| Attachment 5 - HIPAA-Business Associate Agreement.docx | DOCX document |
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Text version
Sheet2
| 11 | 7 | 9 | 32 | 6 | 6 | 9 | 20 | 30 | 10 | 10 | 25 | 25 | 14 | 26 | 13 | 21 | 11 | 15 | 7 | 5 | 5 | 7 | 10 | 5 | 10 | 18 | 26 | 7 | 31 | 15 | 21 | 33 | 5 | 16 | 7 | 12 | 11 | 21 | 14 | 14 | 18 | 16 | 14 | ||||||
| 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 2 | 2 | 2 | 2 | 2 | 3 | 3 | 3 | 3 | 3 | 3 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 4 | 5 | 5 | 5 | 5 | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 6 | 7 | 7 | 7 | ||||||
| 402 | 405 | 518 | 523 | 608 | 631 | 650 | 689 | 528 | 528A5 | 528 A6 | 528A7 | 528 A8 | 526 | 561 | 620 | 630 | 630A4 | 632 | 460 | 503 | 529 | 540 | 542 | 562 | 595 | 642 | 646 | 693 | 512 | 512A5 | 613 | 688 | 517 | 558 | 565 | 590 | 637 | 652 | 658 | 659 | 508 | 509 | 521 | ||||||
| Togus | White River Jct | Bedford | Boston (Roxbury and Brockton) | Manchester | Northhampton | Providence | VA Connecticut (Newington) | 1 | Buffalo (Batavia) | Canadaigua | Bath | Syracuse | Albany | 2 | Bronx | VA New Jersey (Lyons and East Orange) | VA Hudson Valley (CastlePoint and Montrose) | New York | Brooklyn | Northport | 3 | Wilmington | Altoona | Butler | Clarksburg | Coatesville | Erie | Lebanon | Philadelphia | VA Pittsburgh (Pittsburgh HD) | VAMC Wilkes-Barre | 4 | VA Maryland | Perry Point | Martinsburg | Washington | 5 | Beckley | Durham | Fayetteville | Hampton | Asheville | Richmond | Salem | Salisbury | 6 | Atlanta | Augusta | Birmingham (posted stock purchased and reported by Tuscaloosa) |
Sheet3
| Contractor |
| Contract Number: |
| Reporting Quarter: __ Qtr FY2018 | Line Item(s) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | |
| CLIN Number: | ||||||||||||||||||||||||
| Description/Salient Characteristics | ||||||||||||||||||||||||
| Contract/Part Number: | ||||||||||||||||||||||||
| Price Inclusive of SLA Fee: | ||||||||||||||||||||||||
| VISN | FACILITY | VA New England Healthcare System | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item | Quantity Sold of Item |
| 1 | 402 | Togus | ||||||||||||||||||||||
| 1 | 405 | White River Jct | ||||||||||||||||||||||
| 1 | 518 | Bedford | ||||||||||||||||||||||
| 1 | 523 | Boston (Roxbury and Brockton) | ||||||||||||||||||||||
| 1 | 608 | Manchester | ||||||||||||||||||||||
| 1 | 631 | Northhampton | ||||||||||||||||||||||
| 1 | 650 | Providence | ||||||||||||||||||||||
| 1 | 523 | Jamaica Plain | ||||||||||||||||||||||
| 1 | 689 | VA Connecticut (Newington & West Haven) | ||||||||||||||||||||||
| New York/New Jersey VA Health Care Network | ||||||||||||||||||||||||
| 2 | 528 | Buffalo (Batavia) | ||||||||||||||||||||||
| 2 | 528A5 | Canadaigua | ||||||||||||||||||||||
| 2 | 528 A6 | Bath | ||||||||||||||||||||||
| 2 | 528A7 | Syracuse | ||||||||||||||||||||||
| 2 | 528 A8 | Albany | ||||||||||||||||||||||
| 2 | 526 | Bronx | ||||||||||||||||||||||
| 2 | 561 | VA New Jersey (Lyons and East Orange) | ||||||||||||||||||||||
| 2 | 620 | VA Hudson Valley (CastlePoint and Montrose) | ||||||||||||||||||||||
| 2 | 630 | New York | ||||||||||||||||||||||
| 2 | 630A4 | Brooklyn | ||||||||||||||||||||||
| 2 | 632 | Northport | ||||||||||||||||||||||
| VA Pittsburgh Healthcare System | ||||||||||||||||||||||||
| 4 | 460 | Wilmington | ||||||||||||||||||||||
| 4 | 503 | Altoona | ||||||||||||||||||||||
| 4 | 529 | Butler | ||||||||||||||||||||||
| 4 | 542 | Coatesville | ||||||||||||||||||||||
| 4 | 562 | Erie | ||||||||||||||||||||||
| 4 | 595 | Lebanon | ||||||||||||||||||||||
| 4 | 642 | Philadelphia | ||||||||||||||||||||||
| 4 | 646 | VA Pittsburgh (Pittsburgh HD) | ||||||||||||||||||||||
| 4 | 693 | VAMC Wilkes-Barre | ||||||||||||||||||||||
| VA Capitol Health Care Network | ||||||||||||||||||||||||
| 5 | 512 | VA Maryland | ||||||||||||||||||||||
| 6 | 517 | Beckley | ||||||||||||||||||||||
| 5 | 512A5 | Perry Point | ||||||||||||||||||||||
| 5 | 512GB | Loch Raven | ||||||||||||||||||||||
| 5 | 540 | Clarksburg | ||||||||||||||||||||||
| 5 | 581 | Hershel | ||||||||||||||||||||||
| 5 | 581 | Huntington | ||||||||||||||||||||||
| 5 | 613 | Martinsburg | ||||||||||||||||||||||
| 5 | 688 | Washington | ||||||||||||||||||||||
| VA Mid-Atlantic Health Care Network | ||||||||||||||||||||||||
| 6 | 558 | Durham | ||||||||||||||||||||||
| 6 | 565 | Fayetteville | ||||||||||||||||||||||
| 6 | 590 | Hampton | ||||||||||||||||||||||
| 6 | 637 | Asheville | ||||||||||||||||||||||
| 6 | 652 | Richmond | ||||||||||||||||||||||
| 6 | 658 | Salem | ||||||||||||||||||||||
| 6 | 659 | Salisbury | ||||||||||||||||||||||
| VA Southeast Network | ||||||||||||||||||||||||
| 7 | 508 | Atlanta | ||||||||||||||||||||||
| 7 | 509 | Augusta | ||||||||||||||||||||||
| 7 | 521 | Birmingham (posted stock purchased and reported by Tuscaloosa) | ||||||||||||||||||||||
| 7 | 534 | Charleston | ||||||||||||||||||||||
| 7 | 544 | Columbia | ||||||||||||||||||||||
| 7 | 557 | Dublin | ||||||||||||||||||||||
| 7 | 619 | CAVHCS ( Tuskegee and Montgomery) | ||||||||||||||||||||||
| 7 | 679 | Tuscaloosa | ||||||||||||||||||||||
| VA Sunshine Healthcare Network | ||||||||||||||||||||||||
| 8 | 516 | Bay Pines | ||||||||||||||||||||||
| 8 | 546 | Miami | ||||||||||||||||||||||
| 8 | 548 | West Palm Beach | ||||||||||||||||||||||
| 8 | 573 | NF/SGVHS | ||||||||||||||||||||||
| 8 | 672 | San Juan | ||||||||||||||||||||||
| 8 | 675 | Orlando | ||||||||||||||||||||||
| 8 | 673 | Tampa and Annex | ||||||||||||||||||||||
| VA MidSouth Healthcare Network |
| 9 | 596 | Lexington |
| 9 | 603 | Lousiville |
| 9 | 614 | Memphis |
| 9 | 621 | Mountain Home |
| 9 | 626 | VA Tennessee |
| VA Health Care System | ||
| 10 | 538 | Chillicothe |
| 10 | 539 | Cincinnati |
| 10 | 541 | Cleveland |
| 10 | 552 | Dayton |
| 10 | 757 | Columbus |
| 10 | 506 | Ann Arbor |
| 10 | 515 | Battle Creek |
| 10 | 553 | Detroit |
| 10 | 583 | Indianapolis |
| 10 | 610 | VA Northern Indiana |
| 10 | 655 | Saginaw |
| VA Great Lakes Health Care System | ||
| 12 | 537 | VA Chicago Healthcare |
| 12 | 556 | North Chicago |
| 12 | 578 | Hines |
| 12 | 550 | Danville |
| 12 | 585 | Iron Mountain |
| 12 | 607 | Madison |
| 12 | 676 | Tomah |
| 12 | 695 | Milwaukee |
| VA Heartland Network | ||
| 15 | 452 | Wichita |
| 15 | 543 | Columbia |
| 15 | 589 | Kansas City |
| 15 | 609 | Marion |
| 15 | 647 | Poplar Bluff |
| 15 | 657 | St. Louis |
| 15 | 677 | VA Eastern Kansas ( Leavenworth) |
| South Central VA Health Care Network | ||
| 16 | 502 | Alexandria |
| 16 | 520 | VA Gulf Coast |
| 16 | 564 | Fayetteville |
| 16 | 580 | Houston |
| 16 | 586 | Jackson |
| 16 | 598 | Central Arkansas |
| 16 | 629 | New Orleans |
| 16 | 635 | Oklahoma City |
| 16 | 667 | Shreveport |
| VA Heart of Texas Health Care Network | ||
| 17 | 549 | North Texas (Dallas and Bonham) |
| 17 | 504 | Amarillo |
| 17 | 671 | South Texas ( San Antonio and Kerrville) |
| 17 | 756 | El Paso |
| 17 | 519 | Big Spring |
| 17 | 740 | Harlingen |
| 17 | 674 | Central Texas ( Temple, Waco and Marlin) |
| Rocky Mountain Network | ||
| 19 | 442 | Cheyenne |
| 19 | 554 | Denver |
| 19 | 567 | Southern Colorado |
| 19 | 575 | Grand Junction |
| 19 | 623 | Muskogee |
| 19 | 660 | Salt Lake City |
| 19 | 666 | Sheridan |
| Northwest Network | ||
| 20 | 463 | Alaska |
| 20 | 531 | Boise |
| 20 | 648 | Portland |
| 20 | 653 | Roseburg |
| 20 | 663 | VA Puget Sound ( Seattle and American Lake) |
| 20 | 668 | Spokane |
| 20 | 687 | Walla Walla |
| 20 | 692 | White City |
| Sierra Pacific Network | ||
| 21 | 358 | Manila |
| 21 | 459 | Honolulu |
| 21 | 570 | C. California |
| 21 | 612 | N. California |
| 21 | 640 | Palo Alto (Livermore) |
| 21 | 654 | Sierra Nevada |
| 21 | 662 | San Francisco |
| Desert Pacific Healthcare Network | ||
| 22 | 593 | Southern Nevada |
| 22 | 501 | Albuquerque |
| 22 | 600 | Long Beach |
| 22 | 605 | Loma Linda |
| 22 | 664 | San Diego |
| 22 | 519 | West Texas |
| 22 | 644 | Phoenix |
| 22 | 649 | Northern Arizona (Prescott) |
| 22 | 678 | Southern Arizona (Tucson) |
| 22 | 691 | Greater Los Angeles ( Sepulveda and Los Angeles) |
| VA Midwest Health Care Network | ||
| 23 | 437 | Fargo |
| 23 | 438 | Sioux Falls |
| 23 | 568 | BHHCS (Black Hills and Hot Springs) |
| 23 | 618 | Minneapolis |
| 23 | 656 | St Cloud |
| 23 | 636 | NWIHCS (Omaha, Grand Island and Lincoln) |
| 23 | 636A4 | Grand Island |
| 23 | 636 A6 | CIHCS ( DM & Knx) |
| 23 | 636 A8 | Iowa City |
| Total Quarterly Quantity Sold | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Total Quantity Sold of All Items | 0 | |||||||||||||||||||||
| Total Quarterly Quantity Sold x Price | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Total Quarterly Sales inclusive of theSLA | $0.00 | |||||||||||||||||||||
| Anticipated SLA | $0.00 | |||||||||||||||||||||
| Total Sales amount without the SLA(Figure uploaded in Pay.gov) | $0.00 | |||||||||||||||||||||
| SLA Received (For HINES FISCAL ONLY) |
Attachment 3 36C10G23R0015
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