ATTACHMENT E - REPORTING TOOL - NX EQ Pulse Oximeters.xlsx

XLSX spreadsheet 41 KB Posted Nov 5, 2023

Attached to: 6515--NX EQ Pulse Oximeters (VA-22-00058008)
Solicitation number: 36C10G23Q0029
Issued by: Department of Veterans Affairs Headquarters

About this file

Written by GovTribe AI · Dec 21, 2023

This document contains a reporting template for a federal contractor to report sales data and payment information on pulse oximeter medical devices sold to various VA medical centers and healthcare networks. The template includes lines to report sales quantities and totals on 22 different stock keeping units or part numbers sold each quarter to over 100 individual VA facilities, broken out by their Visn or regional network. The contractor would populate the template with sales data for a given quarter and fiscal year to receive payment under contract number 36C10G23Q0029 issued by the Department of Veterans Affairs for pulse oximeters. Key information to report includes sales quantities and totals by line item and facility, anticipated service level agreement fees, and sales amounts with and without the SLA included. The purpose of the template is to capture sales performance data in order to process contractor payments for medical equipment provided to the VA.

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Other files

File	Type	Posted
36C10G23Q0029_1.docx	DOCX document	Nov 15, 2023
ATTACHMENT D - SOLICITATION PROVISIONS - NX EQ PULSE OXIMETERS.pdf	PDF	Nov 5, 2023
ATTACHMENT C- CONTRACT CLAUSES - NX EQ PULSE OXIMETERS.pdf	PDF	Nov 5, 2023
36C10G23Q0029.docx	DOCX document	Nov 5, 2023
ATTACHMENT A - NX EQ PULSE OXIMETERS - PRICE COST SCHEDULE.xlsx	XLSX spreadsheet	Nov 5, 2023
ATTACHMENT B- CONTRACT ADMINISTRATION - NX EQ PULSE OXIMETERS -.pdf	PDF	Nov 5, 2023

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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:

FY 2024

Reporting Quarter: ___ Qtr		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/Saliant Characteristics ( SCs)
			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
	5	517	Beckley
	5	512A5	Perry Point
	5	512GB	Loch Raven
	5	540	Clarksburg
	5	581	Hershel
	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	581	Huntington
	9	596	Lexington
	9	603	Louisville
	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	550	Danville
	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	623	Muskogee
	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	436	Fort Harrison
19	442	Cheyenne
19	554	Denver
19	567	Southern Colorado
19	575	Grand Junction
19	623	Muskogee
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	504	Amarillo
22	519	West Texas
22	644	Phoenix
22	649	Northern Arizona (Prescott)
22	678	Southern Arizona (Tucson)
22	756	El Paso
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)

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File details come from the government source that posted it. Updated Nov 5, 2023.