Attachment 4 - Sample Rebate Invoice.pdf
PDF 176 KB Posted
- Attached to
- T1057- WIC Infant Formula Rebate: DOH
- Solicitation number
- 22DPP00737
- Issued by
- New Jersey
About this file
The document is an attachment to a state and local contract opportunity for the New Jersey WIC Program eWIC Formula Rebates. This contract opportunity involves Mercer County and Trenton City jurisdictions. The document provides a sample rebate invoice for formula rebates redeemed in December 2021, showing details such as the number of cans redeemed, rebate amounts, and totals for various Enfamil formula products. This invoice is being presented as a template that will be used for the term of the contract.
The related state and local contract opportunity, T1057- WIC Infant Formula Rebate: DOH, is for the State of New Jersey and the listed jurisdictions of Mercer County and Trenton City. The contract involves the provision of infant formula rebate services for the WIC program in these areas.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment 5 - Retailer List.xlsx | XLSX spreadsheet | |
| T1057 Pre-Quote Conference Presentation~1.pptx | PPTX presentation | |
| Attachment 9- NJ WIC Minimum Stock Requirements Effective January 2023.pdf | ||
| Attachment 8- Data File for Issuance of Formula from June 2022 to November 2022.xlsx | XLSX spreadsheet | |
| T1057 REVISED Bid Solicitation.docx | DOCX document | |
| New Jersey State Standard Terms and Conditions.docx | DOCX document | |
| Attachment 6- WIC Service Policies.pdf | ||
| Attachment 2 - State Forms Packet.pdf | ||
| Bid Amendment 1 11223.docx | DOCX document | |
| Bid Amendment 2 12423.docx | DOCX document | |
| Bidder Data Sheet~11.pdf | ||
| T1057 NJ State Supplied Price Sheet.xlsx | XLSX spreadsheet | |
| REVISED Attachment 3 - WIC Program Overview.docx | DOCX document | |
| Bidder Overview Form.docx | DOCX document | |
| Attachment 7- Invoices for September 2022 through December 2022.pdf |
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Text version
New Jersey WIC Program eWIC Formula Rebates Redeemed
IN DECEMBER 2021
Run Date: 01/21/2022 14:46:58
Page:
Report: NJGEN9999
Run Time:
NOVEMBER
DECEMBER
NOVEMBER
DECEMBER
NOVEMBER
DECEMBER
NOVEMBER
DECEMBER
PARTICIPATION
MONTH
ISSUE MONTH
30 DAY MONTH
ISSUE MONTH
30 DAY MONTH
ISSUE MONTH
30 DAY MONTH
ISSUE MONTH
# OF CANS
REDEEMED
$2,538.2700
$5,269.3200
$240.9660
$164.2950
$83,156.8710
$37,870.8530
$1,615.4400
$975.2000
REBATE
AMOUNT
$7,807.5900
$405.2610
$121,027.7240
$2,590.6400
$16.0650
$3.6510
$15.2890
$4.2400
REBATE AMOUNT PER CAN:
REBATE AMOUNT PER CAN:
REBATE AMOUNT PER CAN:
T O T A L
T O T A L
T O T A L
T O T A L
STATE
DESCRIPTION
Enfamil AR PWD 12.9 oz
REBATE AMOUNT PER CAN:
30-DAY MONTH
Enfamil Gentlease Neuropro RTF 32 oz
Enfamil Gentlease Pwd 12.4 oz
Enfamil Infant Conc 13 oz
IN DECEMBER 2021
Run Date: 01/21/2022 14:46:58
Page:
Report: NJGEN9999
Run Time:
NOVEMBER
DECEMBER
NOVEMBER
DECEMBER
DECEMBER
NOVEMBER
DECEMBER
PARTICIPATION
MONTH
30-DAY MONTH
ISSUE MONTH
30-DAY MONTH
ISSUE MONTH
ISSUE MONTH
30-DAY MONTH
ISSUE MONTH
# OF CANS
REDEEMED
$60,375.6450
$127,093.4550
$208.9500
$125.3700
$54.2230
$2,621.3780
$4,097.9770
REBATE
AMOUNT
12740
$187,469.1000
$334.3200
$54.2230
$6,719.3550
$14.7150
$4.1790
$4.1710
$16.5910
REBATE AMOUNT PER CAN:
REBATE AMOUNT PER CAN:
REBATE AMOUNT PER CAN:
REBATE AMOUNT PER CAN:
T O T A L
T O T A L
T O T A L
T O T A L
DESCRIPTION
Enfamil Infant PWD 12.5 oz
Enfamil Neuropro RTF 32 oz
Enfamil Prosobee Conc 13 oz
Enfamil Prosobee PWD 12.9 oz
IN DECEMBER 2021
Run Date: 01/21/2022 14:46:58
Page:
Report: NJGEN9999
Run Time:
NOVEMBER
DECEMBER
PARTICIPATION
MONTH
30 DAY MONTH
ISSUE MONTH
10355
12007
# OF CANS
REDEEMED
$150,757.5200
$175,650.6930
REBATE
AMOUNT
$326,408.2130T O T A L
STATE TOTALS
22362
This invoice was created during NJ's eWIC pilot. It is not representative of an actual monthly invoice but is being presented solely as an invoice template that will be used by NJ for the term of the contract.
File details come from the government source that posted it. Updated .