Attachment A-Schedule CLIN.xlsx
XLSX spreadsheet 481 KB Posted
- Attached to
- Home Oxygen West, VISN 4 Federal contract opportunity
- Solicitation number
- 36C24421R0068
About this file
This document contains an attachment schedule for a solicitation seeking home oxygen supplies and services. The schedule lists clinical line items for oxygen concentrators, oxygen tanks, refills, and related accessories to be provided to Veterans in western Pennsylvania over a ten-year period. Services include delivery, installation, maintenance, and respiratory therapy visits. The solicitation will be set aside for a service-disabled veteran-owned small business and utilize a performance price tradeoff evaluation. The Department of Veterans Affairs Veterans Health Administration VISN 4 is the contracting agency.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| PWS May 4 2021.pdf | ||
| Attachment C - App A-VISN4-Western PA Home Oxygen_FINAL.pdf |
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Text version
Action Line Item Information
| Action Type Name | Primary ID | Secondary ID | Mod Number | Title | Order Discount Type Name | Order Discount Type | Order Discount |
| RFP | 36C24421R0068 | 36C244-21-AP-3049 | Western PA Home Oxygen | Percent | 0 |
KB Version: FY21.06A
Items
| Item Number | SLIN | Description | Ref CLIN | Comment | Include Comments in Document | Contract Period | Pop Begin | Pop End | Quantity | Unit of Measure | Packaging Multiple | Receipt Type | Line Item Is | Unit Price | Item Discount Type Name | Item Discount | Date Updated | Address1 | Address2 | Address3 | City | State | Zip | Zip4 | Country | Mark For | Contact Name | Contact Phone | Contact Email | Delivery Date | FOB | Special Instructions | Include Instructions/Comments in Document | PRINCIPAL NAICS CODE | PRODUCT/SERVICE CODE | UNSPSC | SIC CODE | MANUFACTURER PART NUMBER (MPN) | NATIONAL STOCK NUMBER | LOCAL STOCK NUMBER | DM DOC ID | DELIVERY REF. COUNTER | UNIT TEXT/DESCRIPTION | DELIVERY REFERENCE | ITEM MASTER FILE NUMBER | EXPENDABLE/NON-EXPENDABLE | QUANTITY REQUESTED | UNIT OF PURCHASE CODE | UNIT OF PURCHASE TEXT/DESC. |
| 0001 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre-filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 5LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0001 | AA | ALTOONA - see CLIN 0001 | No | Base | 08/30/21 | 08/29/22 | 7200 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0001 | AB | BUTLER - see CLIN 0001 | No | Base | 08/30/21 | 08/29/22 | 2400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0001 | AC | ERIE - see CLIN 0001 | No | Base | 08/30/21 | 08/29/22 | 8640 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0001 | AD | PITTSBURGH - see CLIN 0001 | No | Base | 08/30/21 | 08/29/22 | 11700 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0002 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices, handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 10LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0002 | AA | ALTOONA - see CLIN 0002 | No | Base | 08/30/21 | 08/29/22 | 320 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0002 | AB | BUTLER - see CLIN 0002 | No | Base | 08/30/21 | 08/29/22 | 420 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0002 | AC | ERIE - see CLIN 0002 | No | Base | 08/30/21 | 08/29/22 | 468 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0002 | AD | PITTSBURGH - see CLIN 0002 | No | Base | 08/30/21 | 08/29/22 | 1800 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0003 | Cylinder Refill and Delivery, size "E" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0003 | AA | ALTOONA - see CLIN 0003 | No | Base | 08/30/21 | 08/29/22 | 6000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0003 | AB | BUTLER - see CLIN 0003 | No | Base | 08/30/21 | 08/29/22 | 2100 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0003 | AC | ERIE - see CLIN 0003 | No | Base | 08/30/21 | 08/29/22 | 9108 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0003 | AD | PITTSBURGH - see CLIN 0003 | No | Base | 08/30/21 | 08/29/22 | 1800 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0004 | Cylinder Refill and Delivery, size "D" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0004 | AA | ALTOONA - see CLIN 0004 | No | Base | 08/30/21 | 08/29/22 | 5400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0004 | AB | BUTLER - see CLIN 0004 | No | Base | 08/30/21 | 08/29/22 | 3000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0004 | AC | ERIE - see CLIN 0004 | No | Base | 08/30/21 | 08/29/22 | 4176 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0004 | AD | PITTSBURGH - see CLIN 0004 | No | Base | 08/30/21 | 08/29/22 | 10000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0005 | Cylinder Refill and Delivery, size "B" (M6) for CLINS 0001 and 0002. Aluminum (or metal or equivalent weight) tanks required. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0005 | AA | ALTOONA - see CLIN 0005 | No | Base | 08/30/21 | 08/29/22 | 11280 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0005 | AB | BUTLER - see CLIN 0005 | No | Base | 08/30/21 | 08/29/22 | 3000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0005 | AC | ERIE - see CLIN 0005 | No | Base | 08/30/21 | 08/29/22 | 27600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0005 | AD | PITTSBURGH - see CLIN 0005 | No | Base | 08/30/21 | 08/29/22 | 25000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0006 | Cylinder Refill and Delivery, size "M60" for CLINS 0001 and 0002. Aluminum (or metal or equivalent weight) tanks required as backup system. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0006 | AA | ALTOONA - see CLIN 0006 | No | Base | 08/30/21 | 08/29/22 | 636 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0006 | AB | BUTLER - see CLIN 0006 | No | Base | 08/30/21 | 08/29/22 | 600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0006 | AC | ERIE - see CLIN 0006 | No | Base | 08/30/21 | 08/29/22 | 600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0006 | AD | PITTSBURGH - see CLIN 0006 | No | Base | 08/30/21 | 08/29/22 | 60 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0007 | Delivery and Monthly Rental of Liquid Oxygen System (90-150 lbs.) with stationary unit, portable unit, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing) on both stationary and portable, backup system consisting of tank set up (M60 Cylinders Only), appropriate continuous flow regulator, stand, and the following when specified by the VA: mask (with tubing) and disposable pre-filled humidifier, if indicated on the prescription. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0007 | AA | ALTOONA - see CLIN 0007 | No | Base | 08/30/21 | 08/29/22 | 120 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0007 | AB | BUTLER - see CLIN 0007 | No | Base | 08/30/21 | 08/29/22 | 840 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0007 | AC | ERIE - see CLIN 0007 | No | Base | 08/30/21 | 08/29/22 | 54 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0007 | AD | PITTSBURGH - see CLIN 0007 | No | Base | 08/30/21 | 08/29/22 | 9180 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0008 | 0010 Liquid Oxygen Per Pound For CLIN 0007 | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0008 | AA | ALTOONA - see CLIN 0008 | No | Base | 08/30/21 | 08/29/22 | 43200 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0008 | AB | BUTLER - see CLIN 0008 | No | Base | 08/30/21 | 08/29/22 | 72000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0008 | AC | ERIE - see CLIN 0008 | No | Base | 08/30/21 | 08/29/22 | 11040 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0008 | AD | PITTSBURGH - see CLIN 0008 | No | Base | 08/30/21 | 08/29/22 | 840000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0009 | Delivery and Weekly or Monthly Rental of portable oxygen concentrator (Inogen G2, Eclipse, Simply Go, Simply Go mini or equivalent of either as designated by the VA, to include new and emerging technology) and all accessories including but not limited to nasal cannula (with tubing), two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), 2 sets of back-up batteries, handcart, and concentrator pouch/bag. This set up is intended for the patient who is traveling, or has other situations which require a portable concentrator. All Patients would need evaluated by RT on rental system at the time of set up for proper saturation at the prescribed liter flow. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0009 | AA | ALTOONA - see CLIN 0009 | No | Base | 08/30/21 | 08/29/22 | 180 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0009 | AB | BUTLER - see CLIN 0009 | No | Base | 08/30/21 | 08/29/22 | 480 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0009 | AC | ERIE - see CLIN 0009 | No | Base | 08/30/21 | 08/29/22 | 162 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0009 | AD | PITTSBURGH - see CLIN 0009 | No | Base | 08/30/21 | 08/29/22 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0010 | Electric Air Compressor capable of continuous use of up to 10 liters per minute to include a large volume nebulizer, a large volume aerosol tubing and disposable trach mask. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0010 | AA | ALTOONA - see CLIN 0010 | No | Base | 08/30/21 | 08/29/22 | 36 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0010 | AB | BUTLER - see CLIN 0010 | No | Base | 08/30/21 | 08/29/22 | 12 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0010 | AC | ERIE - see CLIN 0010 | No | Base | 08/30/21 | 08/29/22 | 24 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0010 | AD | PITTSBURGH - see CLIN 0010 | No | Base | 08/30/21 | 08/29/22 | 250 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0011 | Respiratory Therapy Visit for the delivery or recovery of VA owned equipment including but not limited to the set up and troubleshooting for CPAP/Bi-Level Positive Airway Pressure (PAP)/Portable Oxygen Concentrator (POC), suction machines, air compressors, VA owned ventilators, prescription change and/or additional components such as but not limited to Mask sizing/fitting, Heated Humidifiers, CPAP-A/BiPAP settings. Respiratory Therapy Visit for education to be completed upon initial set up and every 6 months to include card download and compliance reports for all active Home Oxygen and PAP patients. PLEASE NOTE: If patient is ordered more than one item (i.e. oxygen and PAP), this will be covered by ONE (1) Respiratory Therapy visit only. | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0011 | AA | ALTOONA - see CLIN 0011 | No | Base | 08/30/21 | 08/29/22 | 2880 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0011 | AB | BUTLER - see CLIN 0011 | No | Base | 08/30/21 | 08/29/22 | 1080 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0011 | AC | ERIE - see CLIN 0011 | No | Base | 08/30/21 | 08/29/22 | 396 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0011 | AD | PITTSBURGH - see CLIN 0011 | No | Base | 08/30/21 | 08/29/22 | 1020 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0012 | Nocturnal pulse oximetry study as ordered by the VA including all reports. Est. Quantity 0 Unit Price $________ Amount price for 12mo | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||||
| 0012 | AA | ALTOONA - see CLIN 0012 | No | Base | 08/30/21 | 08/29/22 | 180 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0012 | AB | BUTLER - see CLIN 0012 | No | Base | 08/30/21 | 08/29/22 | 24 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0012 | AC | ERIE - see CLIN 0012 | No | Base | 08/30/21 | 08/29/22 | 48 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0012 | AD | PITTSBURGH - see CLIN 0012 | No | Base | 08/30/21 | 08/29/22 | 150 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||||||||||||||||||||||
| 0013 | Rental Ventilator: Service includes maintenance and replacement supplies (as specified) and all of the following will be performed on a monthly Basis: (a) Routine inspection per manufactures specifications. (b) Ventilator settings flow sheet must include: 1. Check respiratory rate (set and actual;)(peep if applicable). 2. Check tidal volume (delivered and exhaled) 3. FI02 4. Pressure limit/peak pressure. |
5. Alarm settings (high/low).
6. Mode. (c) Check ventilator filters.
(d) Check humidification system.
(e) Check internal and external batteries & emergency backups.
(f) Check circuit
(g) Check hour meter (report when due for preventive maintenance).
(h) Comments/observations.
(i) Replacements items: 1. Filters (disposables).
2. Circuit.
3. Peep Valve.
4. Humidifier.
| 5. Resuscitation bag (as needed). | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||||
| 0013 | AA | ALTOONA - see CLIN 0013 | No | Base | 08/30/21 | 08/29/22 | 60 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0013 | AB | BUTLER - see CLIN 0013 | No | Base | 08/30/21 | 08/29/22 | 60 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0013 | AC | ERIE - see CLIN 0013 | No | Base | 08/30/21 | 08/29/22 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0013 | AD | PITTSBURGH - see CLIN 0013 | No | Base | 08/30/21 | 08/29/22 | 144 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0014 | Delivery and monthly rental of home fill concentrator with 2 portable self-fill tanks appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices , and cylinder pouch/bag and Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Home fill tanks to include appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices and cylinder pouch/bag | No | Base | 08/30/21 | 08/29/22 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 0014 | AA | ALTOONA - see CLIN 0014 | No | Base | 08/30/21 | 08/29/22 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0014 | AB | BUTLER - see CLIN 0014 | No | Base | 08/30/21 | 08/29/22 | 32 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0014 | AC | ERIE - see CLIN 0014 | No | Base | 08/30/21 | 08/29/22 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 0014 | AD | PITTSBURGH - see CLIN 0014 | No | Base | 08/30/21 | 08/29/22 | 96 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1001 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre-filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 5LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/22 | 08/29/23 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 1001 | AA | ALTOONA - see CLIN 0001 | No | Base | 08/30/22 | 08/29/23 | 7200 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1001 | AB | BUTLER - see CLIN 0001 | No | Base | 08/30/22 | 08/29/23 | 2400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1001 | AC | ERIE - see CLIN 0001 | No | Base | 08/30/22 | 08/29/23 | 8640 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1001 | AD | PITTSBURGH - see CLIN 0001 | No | Base | 08/30/22 | 08/29/23 | 11700 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1002 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices, handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 10LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1002 | AA | ALTOONA - see CLIN 0002 | No | Base | 08/30/22 | 08/29/23 | 320 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1002 | AB | BUTLER - see CLIN 0002 | No | Base | 08/30/22 | 08/29/23 | 420 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1002 | AC | ERIE - see CLIN 0002 | No | Base | 08/30/22 | 08/29/23 | 468 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1002 | AD | PITTSBURGH - see CLIN 0002 | No | Base | 08/30/22 | 08/29/23 | 1800 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1003 | Cylinder Refill and Delivery, size "E" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1003 | AA | ALTOONA - see CLIN 0003 | No | Base | 08/30/22 | 08/29/23 | 6000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1003 | AB | BUTLER - see CLIN 0003 | No | Base | 08/30/22 | 08/29/23 | 2100 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1003 | AC | ERIE - see CLIN 0003 | No | Base | 08/30/22 | 08/29/23 | 9108 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1003 | AD | PITTSBURGH - see CLIN 0003 | No | Base | 08/30/22 | 08/29/23 | 1800 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1004 | Cylinder Refill and Delivery, size "D" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1004 | AA | ALTOONA - see CLIN 0004 | No | Base | 08/30/22 | 08/29/23 | 5400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1004 | AB | BUTLER - see CLIN 0004 | No | Base | 08/30/22 | 08/29/23 | 3000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1004 | AC | ERIE - see CLIN 0004 | No | Base | 08/30/22 | 08/29/23 | 4176 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1004 | AD | PITTSBURGH - see CLIN 0004 | No | Base | 08/30/22 | 08/29/23 | 10000 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1005 | Cylinder Refill and Delivery, size "B" (M6) for CLINS 0001 and 0002. Aluminum (or metal or equivalent weight) tanks required. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1005 | AA | ALTOONA - see CLIN 0005 | No | Base | 08/30/22 | 08/29/23 | 11280 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1005 | AB | BUTLER - see CLIN 0005 | No | Base | 08/30/22 | 08/29/23 | 3000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1005 | AC | ERIE - see CLIN 0005 | No | Base | 08/30/22 | 08/29/23 | 27600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1005 | AD | PITTSBURGH - see CLIN 0005 | No | Base | 08/30/22 | 08/29/23 | 25000 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1006 | Cylinder Refill and Delivery, size "M60" for CLINS 0001 and 0002. Aluminum (or metal or equivalent weight) tanks required as backup system. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1006 | AA | ALTOONA - see CLIN 0006 | No | Base | 08/30/22 | 08/29/23 | 636 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1006 | AB | BUTLER - see CLIN 0006 | No | Base | 08/30/22 | 08/29/23 | 600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1006 | AC | ERIE - see CLIN 0006 | No | Base | 08/30/22 | 08/29/23 | 600 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1006 | AD | PITTSBURGH - see CLIN 0006 | No | Base | 08/30/22 | 08/29/23 | 60 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1007 | Delivery and Monthly Rental of Liquid Oxygen System (90-150 lbs.) with stationary unit, portable unit, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing) on both stationary and portable, backup system consisting of tank set up (M60 Cylinders Only), appropriate continuous flow regulator, stand, and the following when specified by the VA: mask (with tubing) and disposable pre-filled humidifier, if indicated on the prescription. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1007 | AA | ALTOONA - see CLIN 0007 | No | Base | 08/30/22 | 08/29/23 | 120 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1007 | AB | BUTLER - see CLIN 0007 | No | Base | 08/30/22 | 08/29/23 | 840 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1007 | AC | ERIE - see CLIN 0007 | No | Base | 08/30/22 | 08/29/23 | 54 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1007 | AD | PITTSBURGH - see CLIN 0007 | No | Base | 08/30/22 | 08/29/23 | 9180 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1008 | 0010 Liquid Oxygen Per Pound For CLIN 0007 | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1008 | AA | ALTOONA - see CLIN 0008 | No | Base | 08/30/22 | 08/29/23 | 43200 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1008 | AB | BUTLER - see CLIN 0008 | No | Base | 08/30/22 | 08/29/23 | 72000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1008 | AC | ERIE - see CLIN 0008 | No | Base | 08/30/22 | 08/29/23 | 11040 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1008 | AD | PITTSBURGH - see CLIN 0008 | No | Base | 08/30/22 | 08/29/23 | 840000 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1009 | Delivery and Weekly or Monthly Rental of portable oxygen concentrator (Inogen G2, Eclipse, Simply Go, Simply Go mini or equivalent of either as designated by the VA, to include new and emerging technology) and all accessories including but not limited to nasal cannula (with tubing), two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), 2 sets of back-up batteries, handcart, and concentrator pouch/bag. This set up is intended for the patient who is traveling, or has other situations which require a portable concentrator. All Patients would need evaluated by RT on rental system at the time of set up for proper saturation at the prescribed liter flow. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1009 | AA | ALTOONA - see CLIN 0009 | No | Base | 08/30/22 | 08/29/23 | 180 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1009 | AB | BUTLER - see CLIN 0009 | No | Base | 08/30/22 | 08/29/23 | 480 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1009 | AC | ERIE - see CLIN 0009 | No | Base | 08/30/22 | 08/29/23 | 162 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1009 | AD | PITTSBURGH - see CLIN 0009 | No | Base | 08/30/22 | 08/29/23 | 0 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1010 | Electric Air Compressor capable of continuous use of up to 10 liters per minute to include a large volume nebulizer, a large volume aerosol tubing and disposable trach mask. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1010 | AA | ALTOONA - see CLIN 0010 | No | Base | 08/30/22 | 08/29/23 | 36 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1010 | AB | BUTLER - see CLIN 0010 | No | Base | 08/30/22 | 08/29/23 | 12 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1010 | AC | ERIE - see CLIN 0010 | No | Base | 08/30/22 | 08/29/23 | 24 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1010 | AD | PITTSBURGH - see CLIN 0010 | No | Base | 08/30/22 | 08/29/23 | 250 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1011 | Respiratory Therapy Visit for the delivery or recovery of VA owned equipment including but not limited to the set up and troubleshooting for CPAP/Bi-Level Positive Airway Pressure (PAP)/Portable Oxygen Concentrator (POC), suction machines, air compressors, VA owned ventilators, prescription change and/or additional components such as but not limited to Mask sizing/fitting, Heated Humidifiers, CPAP-A/BiPAP settings. Respiratory Therapy Visit for education to be completed upon initial set up and every 6 months to include card download and compliance reports for all active Home Oxygen and PAP patients. PLEASE NOTE: If patient is ordered more than one item (i.e. oxygen and PAP), this will be covered by ONE (1) Respiratory Therapy visit only. | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1011 | AA | ALTOONA - see CLIN 0011 | No | Base | 08/30/22 | 08/29/23 | 2880 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1011 | AB | BUTLER - see CLIN 0011 | No | Base | 08/30/22 | 08/29/23 | 1080 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1011 | AC | ERIE - see CLIN 0011 | No | Base | 08/30/22 | 08/29/23 | 396 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1011 | AD | PITTSBURGH - see CLIN 0011 | No | Base | 08/30/22 | 08/29/23 | 1020 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1012 | Nocturnal pulse oximetry study as ordered by the VA including all reports. Est. Quantity 0 Unit Price $________ Amount price for 12mo | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1012 | AA | ALTOONA - see CLIN 0012 | No | Base | 08/30/22 | 08/29/23 | 180 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1012 | AB | BUTLER - see CLIN 0012 | No | Base | 08/30/22 | 08/29/23 | 24 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1012 | AC | ERIE - see CLIN 0012 | No | Base | 08/30/22 | 08/29/23 | 48 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1012 | AD | PITTSBURGH - see CLIN 0012 | No | Base | 08/30/22 | 08/29/23 | 150 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1013 | Rental Ventilator: Service includes maintenance and replacement supplies (as specified) and all of the following will be performed on a monthly Basis: (a) Routine inspection per manufactures specifications. (b) Ventilator settings flow sheet must include: 1. Check respiratory rate (set and actual;)(peep if applicable). 2. Check tidal volume (delivered and exhaled) 3. FI02 4. Pressure limit/peak pressure. |
5. Alarm settings (high/low).
6. Mode. (c) Check ventilator filters.
(d) Check humidification system.
(e) Check internal and external batteries & emergency backups.
(f) Check circuit
(g) Check hour meter (report when due for preventive maintenance).
(h) Comments/observations.
(i) Replacements items: 1. Filters (disposables).
2. Circuit.
3. Peep Valve.
4. Humidifier.
| 5. Resuscitation bag (as needed). | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 1013 | AA | ALTOONA - see CLIN 0013 | No | Base | 08/30/22 | 08/29/23 | 60 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1013 | AB | BUTLER - see CLIN 0013 | No | Base | 08/30/22 | 08/29/23 | 60 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1013 | AC | ERIE - see CLIN 0013 | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1013 | AD | PITTSBURGH - see CLIN 0013 | No | Base | 08/30/22 | 08/29/23 | 144 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1014 | Delivery and monthly rental of home fill concentrator with 2 portable self-fill tanks appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices , and cylinder pouch/bag and Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and humidifier. Home fill tanks to include appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices and cylinder pouch/bag | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 1014 | AA | ALTOONA - see CLIN 0014 | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1014 | AB | BUTLER - see CLIN 0014 | No | Base | 08/30/22 | 08/29/23 | 32 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1014 | AC | ERIE - see CLIN 0014 | No | Base | 08/30/22 | 08/29/23 | 0 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 1014 | AD | PITTSBURGH - see CLIN 0014 | No | Base | 08/30/22 | 08/29/23 | 96 | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | |||||||
| 2001 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre-filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 5LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/23 | 08/29/24 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 2001 | AA | ALTOONA - see CLIN 0001 | No | Base | 08/30/23 | 08/29/24 | 7200 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2001 | AB | BUTLER - see CLIN 0001 | No | Base | 08/30/23 | 08/29/24 | 2400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2001 | AC | ERIE - see CLIN 0001 | No | Base | 08/30/23 | 08/29/24 | 8640 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2001 | AD | PITTSBURGH - see CLIN 0001 | No | Base | 08/30/23 | 08/29/24 | 11700 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2002 | Delivery and Monthly Rental of concentrator with backup system and portability items. Backup system consists of compressed gas source (M60 Cylinders Only), appropriate continuous flow regulator, stand, nasal cannula (with tubing), two (2) 25-foot tubing or one (1) 50-foot tubing, two (2) Oxysafe (or equivalent) fire safe devices (with appropriate fire safe tubing), and the following when specified by the VA: cannula (with tubing) and pre filled humidifier, if indicated on the prescription. Portability items consist of appropriate cylinders (Cylinder sizes B [M6], D, & E), appropriate conserving device, (2) Oxysafe (or equivalent) fire safe devices, handcart and cylinder pouch/bag. Concentrator will have flow rate capacity up to 10LPM. This set up is intended for the patient who is prescribed for use during the day and at night. NOTE: Pre-filled humidifiers are required for Altoona VA patients only. | No | Base | 08/30/23 | 08/29/24 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 2002 | AA | ALTOONA - see CLIN 0002 | No | Base | 08/30/23 | 08/29/24 | 320 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2002 | AB | BUTLER - see CLIN 0002 | No | Base | 08/30/23 | 08/29/24 | 420 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2002 | AC | ERIE - see CLIN 0002 | No | Base | 08/30/23 | 08/29/24 | 468 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2002 | AD | PITTSBURGH - see CLIN 0002 | No | Base | 08/30/23 | 08/29/24 | 1800 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2003 | Cylinder Refill and Delivery, size "E" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/23 | 08/29/24 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 2003 | AA | ALTOONA - see CLIN 0003 | No | Base | 08/30/23 | 08/29/24 | 6000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2003 | AB | BUTLER - see CLIN 0003 | No | Base | 08/30/23 | 08/29/24 | 2100 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2003 | AC | ERIE - see CLIN 0003 | No | Base | 08/30/23 | 08/29/24 | 9108 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2003 | AD | PITTSBURGH - see CLIN 0003 | No | Base | 08/30/23 | 08/29/24 | 1800 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2004 | Cylinder Refill and Delivery, size "D" for CLINS 0001 and 0002. Aluminum (or metal of equivalent weight) tanks required. | No | Base | 08/30/23 | 08/29/24 | 0 | 0 | Quantity | NSP | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||||
| 2004 | AA | ALTOONA - see CLIN 0004 | No | Base | 08/30/23 | 08/29/24 | 5400 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2004 | AB | BUTLER - see CLIN 0004 | No | Base | 08/30/23 | 08/29/24 | 3000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2004 | AC | ERIE - see CLIN 0004 | No | Base | 08/30/23 | 08/29/24 | 4176 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 | ||||||
| 2004 | AD | PITTSBURGH - see CLIN 0004 | No | Base | 08/30/23 | 08/29/24 | 10000 | Ea | 0 | Quantity | Priced | 0 | Percent | 0 | Per Individual Delivery Order | DESTINATION | Destination Date and Delivery Address is per Order | No | 532283 | W065 | 7352 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .