Final_ASSD_0512_WSH2600000001_1_WV_ASSD_FORM.PDF
PDF 751 KB Posted
- Attached to
- ELECTRONIC HEALTHCARE INCIDENT REPORTING SYSTEM
- Solicitation number
- ASSD 0512 WSH2600000001 1
- Issued by
- Lewis County, West Virginia
About this file
This is an Agency Sole Source Determination form issued by the West Virginia Department of Administration Purchasing Division for the State of West Virginia Health and Human Resources, specifically for William R. Sharpe Jr. Hospital. The solicitation is for an Electronic Healthcare Incident Reporting System and is identified as ASSD 0512 WSH2600000001. The procurement includes user licenses and support/maintenance services across four state facilities: William R. Sharpe Jr. Hospital (800 user licenses annually), Mildred Mitchell-Bateman Hospital (500 user licenses annually), and Welch Community Hospital (325 user licenses annually), along with corresponding annual support and updates for each facility. The solicitation was issued on September 16, 2025, with a closing date of September 30, 2025 at 1:30 PM. The contract term spans four years (Years 1-4) with line items structured to provide annual user licenses and yearly support and updates for each facility throughout the contract period.
The procurement officer is Roberta A. Wagner, contact number (304) 558-0437, email roberta.a.wagner@wv.gov. All invoicing and shipping is directed to William R. Sharpe Jr. Hospital, 936 Sharpe Hospital Road, Weston, WV 26452. The form indicates specific commodity codes for user licenses (43230000) and support/updates services (81161501), though unit prices and total pricing amounts are not populated in the document. As this is an Agency Sole Source Determination, the procurement indicates that only one vendor is capable of providing this specific electronic healthcare incident reporting system, eliminating competitive bidding requirements. No information regarding funding sources, budget amounts, or pricing terms is specified in this form.
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Text version
Date Printed: Sep 16, 2025 Page: 1 FORM ID: WV-PRC-ASSD-002 2020/05
Department of Administration Purchasing Division 2019 Washington Street East Post Office Box 50130 Charleston, WV 25305-0130
State of West Virginia Agency Sole Source Determination
Service - Misc
Proc Folder: 1791163 Reason for Modification:
Doc Description: ELECTRONIC HEALTHCARE INCIDENT REPORTING SYSTEM
Proc Type: Agency Sole Source
Date Issued Solicitation Closes Solicitation No Version
2025-09-16 2025-09-30 13:30 ASSD 0512 WSH2600000001 1
BID RECEIVING LOCATION
PROCUREMENT OFFICER - 304-269-1210
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
VENDOR
Vendor Customer Code:
Vendor Name :
Address :
Street :
City :
State : Country : Zip :
Principal Contact :
Vendor Contact Phone: Extension:
FOR INFORMATION CONTACT THE BUYER
Roberta A Wagner
(304) 558-0437 roberta.a.wagner@wv.gov
Vendor Signature X FEIN# DATE
Date Printed: Sep 16, 2025 Page: 2 FORM ID: WV-PRC-ASSD-002 2020/05
All offers subject to all terms and conditions contained in this solicitation
ADDITIONAL INFORMATION
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
1 USER LICENSES - WILLIAM R. SHARPE, JR
HOSPITAL - YEAR 1
800.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - WILLIAM R. SHARPE, JR HOSPITAL - YEAR 1
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
2 USER LICENSES - WILLIAM R. SHARPE, JR
HOSPITAL - YEAR 2
800.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - WILLIAM R. SHARPE, JR HOSPITAL - YEAR 2
Date Printed: Sep 16, 2025 Page: 3 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
3 USER LICENSES - WILLIAM R. SHARPE, JR
HOSPITAL - YEAR 3
800.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - WILLIAM R. SHARPE, JR HOSPITAL - YEAR 3
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
4 USER LICENSES - WILLIAM R. SHARPE, JR
HOSPITAL - YEAR 4
800.00000 EA
Comm Code Manufacturer Specification Model # 43230000
USER LICENSES - WILLIAM R. SHARPE, JR HOSPITAL - YEAR 4
Date Printed: Sep 16, 2025 Page: 4 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
5 SUPPORT AND UPDATES - YEAR 1 -
WILLIAM R. SHARPE, JR. HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 1 -WILLIAM R. SHARPE, JR. HOSP.
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
6 SUPPORT AND UPDATES - YEAR 2 -
WILLIAM R. SHARPE, JR. HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
SUPPORT AND UPDATES - YEAR 2 -WILLIAM R. SHARPE, JR. HOSP.
Date Printed: Sep 16, 2025 Page: 5 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
7 SUPPORT AND UPDATES - YEAR 3 -
WILLIAM R. SHARPE, JR. HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 3 -WILLIAM R. SHARPE, JR. HOSP.
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
8 SUPPORT AND UPDATES - YEAR 4 -
WILLIAM R. SHARPE, JR. HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
SUPPORT AND UPDATES - YEAR 4 -WILLIAM R. SHARPE, JR. HOSP.
Date Printed: Sep 16, 2025 Page: 6 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
9 USER LICENSES - MILDRED MITCHELL-
BATEMAN HOSPITAL - YEAR 1
500.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - MILDRED MITCHELL-BATEMAN HOSPITAL - YEAR 1
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
10 USER LICENSES - MILDRED MITCHELL-
BATEMAN HOSPITAL - YEAR 2
500.00000 EA
Comm Code Manufacturer Specification Model # 43230000
USER LICENSES - MILDRED MITCHELL-BATEMAN HOSPITAL - YEAR 2
Date Printed: Sep 16, 2025 Page: 7 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
11 USER LICENSES - MILDRED MITCHELL-
BATEMAN HOSPITAL - YEAR 3
500.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - MILDRED MITCHELL-BATEMAN HOSPITAL - YEAR 3
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
12 USER LICENSES - MILDRED MITCHELL-
BATEMAN HOSPITAL - YEAR 4
500.00000 EA
Comm Code Manufacturer Specification Model # 43230000
USER LICENSES - MILDRED MITCHELL-BATEMAN HOSPITAL - YEAR 4
Date Printed: Sep 16, 2025 Page: 8 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
13 SUPPORT AND UPDATES - YEAR 1 -
MILDRED MITCHELL-BATEMAN HOSP
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 1 - MILDRED MITCHELL-BATEMAN HOSP
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
14 SUPPORT AND UPDATES - YEAR 2 -
MILDRED MITCHELL-BATEMAN HOSP
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
SUPPORT AND UPDATES - YEAR 2 - MILDRED MITCHELL-BATEMAN HOSP
Date Printed: Sep 16, 2025 Page: 9 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
15 SUPPORT AND UPDATES - YEAR 3 -
MILDRED MITCHELL-BATEMAN HOSP
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 3 - MILDRED MITCHELL-BATEMAN HOSP
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
16 SUPPORT AND UPDATES - YEAR 4 -
MILDRED MITCHELL-BATEMAN HOSP
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
SUPPORT AND UPDATES - YEAR 4 - MILDRED MITCHELL-BATEMAN HOSP
Date Printed: Sep 16, 2025 Page: 10 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
17 USER LICENSES - WELCH COMMUNITY
HOSPITAL - YEAR 1
325.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - WELCH COMMUNITY HOSPITAL - YEAR 1
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
18 USER LICENSES - WELCH COMMUNITY
HOSPITAL - YEAR 2
325.00000 EA
Comm Code Manufacturer Specification Model # 43230000
USER LICENSES - WELCH COMMUNITY HOSPITAL - YEAR 2
Date Printed: Sep 16, 2025 Page: 11 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
19 USER LICENSES - WELCH COMMUNITY
HOSPITAL - YEAR 3
325.00000 EA
Comm Code Manufacturer Specification Model # 43230000
Extended Description:
USER LICENSES - WELCH COMMUNITY HOSPITAL - YEAR 3
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
20 USER LICENSES - WELCH COMMUNITY
HOSPITAL - YEAR 4
325.00000 EA
Comm Code Manufacturer Specification Model # 43230000
USER LICENSES - WELCH COMMUNITY HOSPITAL - YEAR 4
Date Printed: Sep 16, 2025 Page: 12 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
21 SUPPORT AND UPDATES - YEAR 1 -
WELCH COMMUNITY HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 1 - WELCH COMMUNITY HOSP.
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
22 SUPPORT AND UPDATES - YEAR 2 -
WELCH COMMUNITY HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
SUPPORT AND UPDATES - YEAR 2 - WELCH COMMUNITY HOSP.
Date Printed: Sep 16, 2025 Page: 13 FORM ID: WV-PRC-ASSD-002 2020/05
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
23 SUPPORT AND UPDATES - YEAR 3 -
WELCH COMMUNITY HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 3 - WELCH COMMUNITY HOSP.
INVOICE TO SHIP TO
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
HEALTH AND HUMAN RESOURCES
WILLIAM R SHARPE JR HOSPITAL
936 SHARPE HOSPITAL RD
WESTON WV 26452
US
Line Comm Ln Desc Qty Unit Issue Unit Price Total Price
24 SUPPORT AND UPDATES - YEAR 4 -
WELCH COMMUNITY HOSP.
1.00000 YR
Comm Code Manufacturer Specification Model # 81161501
Extended Description:
SUPPORT AND UPDATES - YEAR 4 - WELCH COMMUNITY HOSP.
SCHEDULE OF EVENTS
Line Event Event Date
Document Phase Document Description Page
WSH2600000001 Final ELECTRONIC HEALTHCARE
INCIDENT REPORTING SYSTEM
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File details come from the government source that posted it. Updated .