Attachment 8 - Pricing Template_Final.xlsx

XLSX spreadsheet 35 KB Posted Sep 2, 2020

Attached to: DoD 4th Estate Occupational Health & Medical Case Review
Solicitation number: Solicitation_HQ0034-20-R-0211
Issued by: DOD Washington Headquarters Service

About this file

Written by GovTribe AI · Dec 30, 2023

This document contains a pricing template and related federal contract opportunity solicitation. The pricing template outlines a five-year Indefinite Delivery Indefinite Quantity contract with firm fixed price, time and material, and labor hour Contract Line Item Numbers. It includes schedules for occupational health services, medical examinations, reviews, and case management. Pricing is provided for clinical procedures, medical specialties, supplemental services, labor categories, and vaccines. The related solicitation is from the Washington Headquarters Service for DoD 4th Estate occupational health and medical case review services. It is a electronic-only solicitation released through the SAM beta site, with attachments providing instructions. The opportunity is for occupational medical and health support across the DoD 4th Estate.

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Other files

File	Type	Posted
DoD 4th Estate_QA_Amend 0006.pdf	PDF	Dec 15, 2020
HQ0034-20-R-0211 Amend 0005.pdf	PDF	Dec 15, 2020
HQ0034-20-R-0211 Amend 0006.pdf	PDF	Dec 15, 2020
DoD 4th Estate_QA_Amendment 0004.pdf	PDF	Dec 10, 2020
Attachment 1 - PWS_Amendment 0004 Final.pdf	PDF	Dec 10, 2020
HQ0034-20-R-0211 Amend 0004 Final.pdf	PDF	Dec 10, 2020
Attachment 8 - Pricing Template_Amend 0004.XLS	XLS spreadsheet	Dec 10, 2020
HQ0034-20-R-0211 Conformed_Amend 0004.pdf	PDF	Dec 10, 2020
Attachment 12 - Utilization Report 2_Amend 0003 Final.xlsx	XLSX spreadsheet	Dec 4, 2020
Additional QA - Government Response Amend 0003 Final.pdf	PDF	Dec 4, 2020
HQ0034-20-R-0211 Amend 0003 Final.pdf	PDF	Dec 4, 2020
Attachment 8 - Pricing Template_Amend 0003.XLS	XLS spreadsheet	Dec 4, 2020
HQ0034-20-R-0211 Conformed.pdf	PDF	Dec 4, 2020
Attachment 1 - PWS_Amendment 0002.pdf	PDF	Oct 16, 2020
Solicitation HQ0034-20-R-0211- Questions and Answers_Amendment 0002.pdf	PDF	Oct 16, 2020
Attachment 12 - Utilization Report_Amendment 0002.pdf	PDF	Oct 16, 2020
Solicitation HQ0034-20-R-0211_Amendment 0002.pdf	PDF	Oct 16, 2020
Attachment 8 - Pricing Template_Amend 0002.xlsx	XLSX spreadsheet	Oct 16, 2020
HQ0034-20-R-0211 Amendment 0001.pdf	PDF	Sep 28, 2020
Attachment 5 - Conflict of Interest.pdf	PDF	Sep 2, 2020
Attachment 3 - PPQ.pdf	PDF	Sep 2, 2020
Attachment 1 - PWS Occupational Health_Final.PDF	PDF	Sep 2, 2020
Attachment 4- Personnel Matrix.xlsx	XLSX spreadsheet	Sep 2, 2020
Attachment 2 - Non-Disclosure.pdf	PDF	Sep 2, 2020
Attachment 11 - Technical Exhibit 3 - Estimated Workload_Final.PDF	PDF	Sep 2, 2020
Attachment 10 - Subcontracting Plan.PDF	PDF	Sep 2, 2020
HQ0034-20-R-0211_OHS_Final_Beta.SAM.pdf	PDF	Sep 2, 2020
Attachment 6 - QASP.pdf	PDF	Sep 2, 2020
Attachment 7 - Small Business Participation Commitment.pdf	PDF	Sep 2, 2020
Attachment 9 - Wage Determination 2015-4282.PDF	PDF	Sep 2, 2020

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Tab 1 - Price Schedule Summary

Phase-in Labor	Contract Type	CLIN #	Rate	Hours	Total Price
Labor	Time & Material	0009			$ - 0
TOTALS					$ - 0

IDIQ CEILING (Year 1 Schedule Pricing)		CLIN #	Rate	Hours	Total Price
Occupational Health Services	Time & Material	0001			$0.00
Independent Medical Examinations	Time & Material	0002			$0.00
Independent Medical Reviews	Labor Hour	0003		10,000	$0.00
Outreach Support Services	Time & Material	0004			$0.00
Medical Case Review Services	Labor Hour	0005		10,000	$0.00
National Service Center Support	Firm-Fixed-Priced	0006			$0.00
Travel	Time & Material	0007			$50,000.00
Other Direct Costs	Time & Material	0008			$100,000.00
TOTALS					$150,000.00

IDIQ CEILING (Year 2 Schedule Pricing)		CLIN #	Rate	Hours	Total Price
Occupational Health Services	Time & Material	1001			$ - 0
Independent Medical Examinations	Time & Material	1002			$ - 0
Independent Medical Reviews	Labor Hour	1003		10,000	$ - 0
Outreach Support Services	Time & Material	1004			$ - 0
Medical Case Review Services	Labor Hour	1005		10,000	$ - 0
National Service Center Support	Firm-Fixed-Priced	1006			$ - 0
Travel	Time & Material	1007			$50,000.00
Other Direct Costs	Time & Material	1008			$100,000.00
TOTALS					$ 150,000.00

IDIQ CEILING (Year 3 Schedule Pricing)		CLIN #	Rate	Hours	Total Price
Occupational Health Services	Time & Material	2001			$ - 0
Independent Medical Examinations	Time & Material	2002			$ - 0
Independent Medical Reviews	Labor Hour	2003		10,000	$ - 0
Outreach Support Services	Time & Material	2004			$ - 0
Medical Case Review Services	Labor Hour	2005		10,000	$ - 0
National Service Center Support	Firm-Fixed-Priced	2006			$ - 0
Travel	Time & Material	2007			$50,000.00
Other Direct Costs	Time & Material	2008			$100,000.00
TOTALS					$ 150,000.00

IDIQ CEILING (Year 4 Schedule Pricing)		CLIN #	Rate	Hours	Total Price
Occupational Health Services	Time & Material	3001			$ - 0
Independent Medical Examinations	Time & Material	3002			$ - 0
Independent Medical Reviews	Labor Hour	3003		10,000	$ - 0
Outreach Support Services	Time & Material	3004			$ - 0
Medical Case Review Services	Labor Hour	3005		10,000	$ - 0
National Service Center Support	Firm-Fixed-Priced	3006			$ - 0
Travel	Time & Material	3007			$50,000.00
Other Direct Costs	Time & Material	3008			$100,000.00
TOTALS					$ 150,000.00

IDIQ CEILING (Year 5 Schedule Pricing)		CLIN #	Rate	Hours	Total Price
Occupational Health Services	Time & Material	4001			$ - 0
Independent Medical Examinations	Time & Material	4002			$ - 0
Independent Medical Reviews	Labor Hour	4003		10,000	$ - 0
Outreach Support Services	Time & Material	4004			$ - 0
Medical Case Review Services	Labor Hour	4005		10,000	$ - 0
National Service Center Support	Firm-Fixed-Priced	4006			$ - 0
Travel	Time & Material	4007			$50,000.00
Other Direct Costs	Time & Material	4008			$100,000.00
TOTALS					$ 150,000.00

IDIQ Phase-in Ceiling Price	IDIQ Year 1 Ceiling Price	IDIQ Year 2 Ceiling Price	IDIQ Year 3 Ceiling Price	IDIQ Year 4 Ceiling Price	TOTAL PRICE	FAR 52.217-8 (6 MONTH EXTENSION) TOTAL PRICE	TOTAL PRICE (EACH YEAR CEILING PRICE + DASH 8 EXT.)
$ - 0	$150,000.00	$ 150,000.00	$ 150,000.00	$ 150,000.00	$ 600,000.00	$ 75,000.00	$ 675,000.00

Tab 2 - Time & Material Service

CLIN X001: Service Type	Price Per Service - Year 1 Schedule Pricing	Price Per Service - Year 2 Schedule Pricing	Price Per Service - Year 3 Schedule Pricing	Price Per Service - Year 4 Schedule Pricing	Price Per Service - Year 5 Schedule Pricing
Acoustic Reflex (Stand Alone)
Acoustic Reflex (w/Exam)
Audiometry (Stand Alone)
Audiometry (w/Exam)
Audiometry with CAOHC-Certified Technician (Add-on)
Best Vision Screening (Stand Alone)
Best Vision Screening (w/Exam)
Bone Density Screening
B-Reading
Bronchodilation Responsiveness
Bronchospasm Provocation Evaluation
Color Doppler
Colorectal Cancer Screening - EZ Detect
Colorectal Cancer Screening - EZ Detect (Stand Alone)
Colorectal Cancer Screening - Hemoccult
Colorectal Cancer Screening - Hemoccult (Stand Alone)
Commercial Driver's License (CDL) Examination (Stand Alone)
Commercial Driver's License (CDL) Examination (w/Exam)
Comprehensive Audiometry
Comprehensive Eye Exam
Comprehensive Vision Screening (Stand Alone)
Comprehensive Vision Screening (w/Exam)
CT Chest (w/Contrast)
CT Chest (w/out Contrast)
CT Maxillo-Facial Area (w/Contrast)
CT Maxillo-Facial Area (w/out Contrast)
Dermatology Screening
Diffusing Capacity
Doppler
Echocardiography
EKG Overread
EKG Overread - Same Day
Electrocardiogram (EKG)
Examination - Brief
Examination - Intermediate
Examination - Comprehensive (Moderate Complexity)
Examination - Comprehensive (High Complexity)
Exercise Stress Test (EST)
Exercise Stress Test (EST) - Thallium/Cardiolyte
Federal Aviation Administration (FAA) Examination
Flexible Sigmoidoscopy
Functional Capacity Evaluation
Fundus (Retina) Photography
Hearing Aid, Binaural
Hearing Aid, Monaural
Immunization Administration (Injection) - Government Provided Vaccine
Immunization Administration (Intranasal/Oral) - Government Provided Vaccine
Independent Medical Review (up to 1/2 inch or 125 pages)
Ishihara Color Vision - 14 Plate
Ishihara Color Vision - 24 Plate
Mammography (Stand Alone)
Mammography (w/Exam)
Medical Record Review
Myocardial Perfusion
NMP22 Bladdercheck Test
Venipuncture / Specimen Collection / Lab Handling
Pulmonary Compliance Study
Pulmonary Stress Testing
Puretone Audiometry
Respirator Fit Test
Respirator Medical Clearance (Stand Alone)
Respirator Medical Clearance (w/Exam)
Reviewing Medical Officer
Speech Audiometry
Spirometry (Stand Alone)
Spirometry (w/Exam)
Stress Echocardiogram
Tonometry
Tuberculosis Skin Test and Reading (Stand Alone)
Tuberculosis Skin Test and Reading (w/Exam)
Vital Signs/Body Height and Weight (Stand Alone)
Wellness Screening
Wellness Screening - Prostate Cancer
Wellness Screening - Prostate Cancer with PSA
Wellness Vision Screening
X-Ray - Chest (PA & LAT Views)
X-Ray - Chest (PA View)
X-Ray - Hip (Bilateral, 3-4 View)
X-Ray - Hip (Unilateral, 2 View)
X-Ray - Knee (Unilateral, 1-2 View)
X-Ray - Knee (Unilateral, Femur 2 View)
X-Ray - Knee (Unilateral, Femur 3 View)
X-Ray - Knee (Unilateral, Tib/Fib 2 View)
X-Ray - Shoulder (Unilateral, 2 View)
X-Ray - Sinus
Oral Examination - Comprehensive
Oral Examination - Periodic
X-Ray - Dental Bitewing (Single Film)
X-Ray - Dental Bitewing (Two Films)
X-Ray - Dental Bitewing (Three Films)
X-Ray - Dental Bitewing (Four Films)
X-Ray - Complete Series
X-Ray - Intraoral
X-Ray - Panographic
Acetonylacetone (2,5 Hexanedione) (U)
Acrylamide, Quant (B)
Alcohol, Ethyl (B)
ANA choice Screen with Reflex to Titer, IFA
Aromatic Solvent Screen, Qual; (U) Free And Conjugated Phenol,
Arsenic (B)
Arsenic, 24 hour Urine
Arsenic, Fractionated Urine 24 Hour
Arsenic, Random Urine
Aspergillus AB by ID QL
AST
Benzene [B]
Beryllium (U)
Beta 2 Microglobin (B)
Beta 2 Microglobin (U)
Blood Type & Rh (ABO Group & RH Type)
Bromide (B)- Methyl Bromide as Metabolite
Brucella Titer by EIA: IgG, IgM and IgA
Cadmium Exposure Panel/OSHA (B)
Cadmium Exposure Panel/OSHA (U)
Cadmium, [B] Quant
Cadmium, Urine
Carbamate Pesticides (U) quant
Carboxyhemoglobin
Cardio C-Reactive Protein (Cardio CRP)
CBC (includes Diff/Plt)
Chlamydia Psittaci AB Panel reflexes to Chlamydia Species AB Panel, IGM, IGG, IGA
Chlamydia Psittaci AB Panel, Micro-IFA
Chlorinated Hydrocarbons, Quant (B); Dichloromethane, 1-1-1-Trichloroethane, Trichloroethylene, Tetrachloroethylene, Dichlorobenzene, Chloroform
Chloroform (B)
Cholesterol, Total (B)
Cholinesterase, Plasma only - Blood [quantitative]
Cholinesterase, RBC & Plasma - Blood [quantitative]
Chromium (B)
Chromium, Urine
Cobalt, Blood
Cocci/ C-F test, blood
Coccidioides immites AB
Comprehensive Metabolic Profile - NA, K, CL, GLU, BUN, Creat, CA, TP, ALB, Tbili, AP, AST, CO2
Copper (B)
Copper (U)
Coxsackie A Virus AB (MEM Panel) Type 2,4,7,9,10,16
Coxsackie B Virus AB (Coxsackie B1, B2, B3, B4, B5, B6)
Creatinine (Random (U)
Creatinine with Glomerular Filtration Rate, Estimated (eGFR) (S)
Culture, Stool Enteric Pathogens (Salmonela/Shigilosis/ Campylobacter)
Cytology, Thin Prep, Liquid Pap
Cytology, Urine
Cytopath, Gyn Smear (1 slide)
Dichloromethane (B) (Methylene Chloride)
Direct Patient Pay Blood Type (ABO & Rh)
Direct Patient Pay CMP w/o Alt (Chem Panel)
Direct Patient Pay Lipid Panel
Direct Patient Pay Prostate Specific Antigen
Draw Fee - Quest Diagnostics Patient Service Center
Ehrlichie Chaffeenis - IFA
Electrolyte Panel (Na, K, Cl, CO2)
Eosinophil Count (B)
Ferritin
Formic Acid (B)
Francisella Tularensis AB
Fungus Antibody Panel (Fungal ID, MOLDS)
GGT
Glucose (B)
Glucose 6 Phosphate Dehydrogenase
Glucose, Postprandial/2 Hour
Guinea Pig Epithelia (E6) IGE
Hamster Epithelia (E84) IGE
Hanta Virus AB
HDL / Cholesterol
Heavy Metals (U): (Arsenic, Mercury Lead, Creatinine)
Heavy Metals (U): (Arsenic, Mercury, Bismuth, Antimony)
Heavy Metals Panel (U): (Arsenic, Mercury, Lead, Cadmium, Creatinine)
Heavy Metals Panel, 24hr (U) (Arsenic, Cadmium, Lead, Mercury)
Heavy Metals Screen (U): (Arsenic, Mercury, Selenium, Bismuth, Tellurium)
Hematocrit
Hemoglobin
HemoglobinA1C
Hep A AB
Hep A IGM
Hep B Core
Hep B Core IGM
Hepatic Function panel (Alb, Tbili, Dbili, AP, AST, ALT)
Hepatitis B Surface Antibody (QL)
Hepatitis B Surface Antibody, Quant.
Hepatitis B surface Antigen
Hepatitis C Virus Antibody
Hexa-carbon Exposure Panel (U) (Creatinine, Phenol, 2-Hexanol, 2/5-Hexanedione, Cyclohexanol)
HGE -m IFA (Human Granulocylic Ehrlichiosis)
Hippuric Acid Quantitation, Urine
Histoplasma AB by CF
Histoplasma AB by ID QL
HIV testing (HIV-1 Ab Screen)
Human Chorionic Gonadotropin HCG (U)
Inhalants Panel, (Blood) Qual: (Benzene, Toluene, Xylene, Gasoline, Lighter Fluid, Acetone, Ketone, Alkyl Nitrates, Ethylacetate, Methylethyl, Ketones Cyclopropane, Ether)
Inhalants Panel, (Urine) Qual; Benzene, Toluene, Xylene, Gasoline, Lighter Fluid, Acetone, Ketone, Alkyl Nitrates, Ethylacetate, Methylethyl, Ketones, Cyclopropane, Ether)
Iron, Serum
Iron, Total Iron Binding Capacity
LDH
Lead (B) Industrial
Lipid Panel
Liver Function Profile PANEL (AP, ALT, AST, Tbili, Dbili, GGT, LDH, A/G, Ratio)
Lyme Disease AB Total with Reflex to IgG and IGM, Western Blot
Lyme Disease IGG ABS, Western Blot
Manganese (B)
Measles
Measles, Mumps & Rubella IgG Antibody, Immune Status
Mercury, blood
Mercury, Urine
Metabolic Profile, Basic (Na, K, Cl, CO2, GLU, BUN, Creat)
Metals/Metalloids Acute Poisoning Panel (antimony, barium, beryllium, bismuth, cadmium, chromium, copper, lead, mercury, nickel, selenium, strontium, tellurium, thallium, and zinc)
Methanol Quantitation, Urine
Methemoglobin (B)
Methl Hippuric Acid, Urine Quant.
Methyl Ethyl Ketone
Methyl Isobutyl Ketone, Urine
Mouse Epithelia (E71) IGE
Mouse Urine Proteins (E72) IGE
Mumps
Nickel (B)
Organochlorine Pesticides (B)- Includes DDE, Lindane, Alpha-Chlordane, Gamma-Chlordane, Oxychlordane, Trans-Nonachlor, Heptachlor, Heptachlorepoxide, DDT, Hexachlorobenzene, Dieldrin, Methoxychlor and DDD

Ova & Parasites, Feces

Paraquat (U)

Pentachlorophenol (B)

Phenol Exposure Uptake Marker - Urine [qualitative]

Phosphorus, Inorganic (B)

Platelet Sodium Citrate

Poliovirus Types 1,2,3 AB By Neutralization, Serum

Polychlorinated Biphenyls (PCBs)

Prostate Specific Antigen (PSA)

Prostatic Acid Phosphatase Screening (PAP)

Q Fever AB (IgG,IgM), with Relex to Titers

Quantiferon Gold

Quantiferon Gold, INCUBATE

Rabbit Epithelia (E82) IGE

Rabies Immunity Panel (Antibody test RFFIT)

Rapid Plasma Reagin (RPR)

Rat Epithelia (E73) IGE

Rat Urine Proteins (E74) IGE

Reticulocyte Count

Rickettsial IGG Antibody

Rocky Mountain Spotted Fever IGG,IGM w/reflex titer AB by IFA

Rubella Virus IGG AB By EIA

Selenium (B)

Selenium, Urine

Serum Amylase

Serum Lipase

Sickle Cell Reflex

Sickle Cell Screen

Strontium (B) URINE ONLY

T-3 Uptake

T-4 (Thyroxine), Free

Thyroid Profile (TSH & Free T-4)

Toluene Exposure (U)

Total T-4 (Thyroxin)

Toxoplasma IGG Antibody By EIA

Toxoplasma IGM Antibody By EIA

Trichloroethylene (U)

Triglycerides

TSH

Uranium - kinetic phosphorescence (U)

Uric Acid (serum)

Uric Acid (urine)

Urinalysis, Reflex

Varicella Zoster Virus IGG

Vinyl Chloride Metabolite

Vitamin B-12

West Nile Virus AB (IGG, IGM)

Xylene Exposure Panel Quant, Urine

ZIKA VIRUS ANTIBODY (IgM), MAC-ELISA

ZIKA VIRUS RNA QL REAL - TIME RT PCR

ZIKA VIRUS RNA, QL REALTIME RT PCR PANEL, S/U

Zinc (B)

ZPP, Blood Protoporphyrins, zinc

CLIN X002: Service Type	Price Per Service - Year 1 Schedule Pricing	Price Per Service - Year 2 Schedule Pricing	Price Per Service - Year 3 Schedule Pricing	Price Per Service - Year 4 Schedule Pricing	Price Per Service - Year 5 Schedule Pricing
Allergist
Audiologist
Cardiologist
Clarification
Dermatologist
Endocrinologist
Family Practice
Gastroenterologist
Hematologist
Infectious Disease
Internist
Nephrologist
Neurologist
Neuropsychiatrist
Neurosurgery
Oncologist
Ophthalmologist
Orthopedist
Otolaryngologist (E.N.T.)
Physical Medicine & Rehabilitation
Psychiatrist
Psychologist
Pulmonologist
Rheumatologist
Supplemental Request IME
Urologist

CLIN X003: Service Type	Price Per Service - Year 1 Schedule Pricing	Price Per Service - Year 2 Schedule Pricing	Price Per Service - Year 3 Schedule Pricing	Price Per Service - Year 4 Schedule Pricing	Price Per Service - Year 5 Schedule Pricing
Expedited Service Fee
Forms Completion Fee
Missed Appointment (No-Show) / Late Cancellation Fee
Mobile Outreach Fee
Mobile Outreach Late Cancellation Fee
OCONUS Fee
Out of Network Fee
Preferred Provider Fee

Tab 3 - Labor Hour Services

YEAR 1 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Burden Hourly Rate	Unburden Labor Rate	Total Labor Hours	Total Price
0003
0003
TOTALS CLIN 0003			0			0	0

0005
0005
TOTALS CLIN 0005	0	0	0

YEAR 2 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Burden Hourly Rate	Unburden Labor Rate	Total Labor Hours	Total Price
1003
1003
TOTALS CLIN 1003			0			0	0

1005
1005
TOTALS CLIN 1005	0	0	0

YEAR 3 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Burden Hourly Rate	Unburden Labor Rate	Total Labor Hours	Total Price
2003
2003
TOTALS CLIN 2003			0			0	0

2005
2005
TOTALS CLIN 2005	0	0	0

YEAR 4 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Burden Hourly Rate	Unburden Labor Rate	Total Labor Hours	Total Price
3003
3003
TOTALS CLIN 3003			0			0	0

3005
3005
TOTALS CLIN 3005	0	0	0

YEAR 5 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Burden Hourly Rate	Unburden Labor Rate	Total Labor Hours	Total Price
4003
4003
TOTALS CLIN 4003			0			0	0

4005
4005
TOTALS CLIN 4005	0	0	0
*The Total Labor Hours for each CLIN Shall Not Exceed 10,000 Hours for All LCATs Per Year*

Tab 4 - Firm Fixed Services

YEAR 1 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Loaded Hourly Rate	Proposed Labor Hours	Total Price
0006
0006
TOTALS CLIN 0006			0		0	0

YEAR 2 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Loaded Hourly Rate	Proposed Labor Hours	Total Price
1006
1006
TOTALS CLIN 1006			0		0	0

YEAR 3 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Loaded Hourly Rate	Proposed Labor Hours	Total Price
2006
2006
TOTALS CLIN 2006			0		0	0

YEAR 4 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Loaded Hourly Rate	Proposed Labor Hours	Total Price
3006
3006
TOTALS CLIN 3006			0		0	0

YEAR 5 PRICING - LABOR CATEGORIES
CLIN #	PWS Task Section	Labor Category	# of FTEs	Fully Loaded Hourly Rate	Proposed Labor Hours	Total Price
4006
4006
TOTALS CLIN 4006			0		0	0

Tab 5 - Other Direct Costs

Vaccines & Medications	Year 1 Schedule Pricing	Year 2 Schedule Pricing	Year 3 Schedule Pricing	Year 4 Schedule Pricing	Year 5 Schedule Pricing
Anthrax Vaccine
Antiviral - Relenza
Antiviral - Tamiflu
Bay Gam (Immune Serum Globulin) (Gamma Globulin) - 2 ml vial
Bay Gam (Immune Serum Globulin) (Gamma Globulin) - 10 ml vial
Hepatitis A / Hepatitis B Combination Vaccine
Hepatitis A Vaccine
Hepatitis B Vaccine
Influenza Virus Vaccine - Trivalent
Influenza Virus Vaccine - Quadrivalent
Influenza Virus Vaccination - Voucher Program
Japanese Encephalitis Vaccine
Measles, Mumps, and Rubella (MMR) Vaccine
Meningococcal Vaccine
Pneumococcal Vaccine - 13-Valent
Pneumococcal Vaccine - 23-Valent
Polio Vaccine
Rabies Vaccine - Booster
Rabies Vaccine (Intramuscular)
Stamaril Vaccine
Tetanus , Diphtheria, and Acellular Pertussis (Tdap) Vaccine
Tetanus and Diphtheria (Td) Vaccine
Travel Medication - Acetazolamide
Travel Medication - Chloroquine
Travel Medication - Ciprofloxacin
Travel Medication - Doxycycline
Travel Medication - Loperamide
Travel Medication - Malarone
Travel Medication - Mefloquine
Typhoid Vaccine (Injection)
Typhoid Vaccine (Oral)
Varicella Vaccine
Written Prescription - Ciprofloxacin
Written Prescription - Doxycycline
Yellow Fever Vaccine

File details come from the government source that posted it. Updated Sep 3, 2020.