Home Oxygen Item Schedule v2 SAM.xlsx

XLSX spreadsheet 29 KB Posted May 8, 2023

Attached to: VA Home Oxygen for Palo Alto
Solicitation number: 36C26123Q0582
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

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Other files

File	Type	Posted
Item Schedule- PALO ALTO.xlsx	XLSX spreadsheet	May 19, 2023
36C26123Q0582 VAPAHCS.pdf	PDF	May 19, 2023
WAGE DETERMINATIONS - Palo Alto.pdf	PDF	May 8, 2023
RFQ 36C26123Q0582.pdf	PDF	May 8, 2023
QASP - Home Oxygen.pdf	PDF	May 8, 2023

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Order Min and Max

The guaranteed minimum award amount for this contract is $2,500.00.

The maximum aggregate value of orders that can be placed under this contract is $3,000,000.00.

The Government does not guarantee it will place any orders under this contract in excess of the guaranteed minimum award amount

Palo Alto

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD		ESTIMATED	UNIT	UNIT	TOTAL
		CODE				QUANTITIES	PRICE	(Where just number,	ESTIMATED COST
								unit is "Month.")
1	Rental of Contractor	E1392	Concentrator, Colored Tubing, Adapter	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1		12	$0.00
	Owned Portable		Humidifier (when required), Cannulas or
	System		Masks and other required supplies and
			equipment, including back up systems.
	Priced Per Month		Perform Equipment Maintenance in
			accordance with manufacturer standards.
			At a minimum of once every 90 calendar
			days, visit and assess patient to assure
			equipment complinace, change filters and						1.07
			provide disposable supplies.

1a	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	535	12	$0.00
	Owned Low Decibel		maintenance and 90 calendar day visit as
	Concentrator System		described in Item 1

Priced Per Month

1b	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	12	$0.00
	Owned Home Fill		maintenance and 90 calendar day visit as
	Oxygen System		described in Item 1

Priced Per Month

1c	Rental of Contractor	E1390	To include all supplies, equipment	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	12	$0.00
	Owned Hi Flow		maintenance and 90 calendar day visit as
	Concentrator System		described in Item 1

Priced Per Month

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD		ESTIMATED	UNIT	UNIT	TOTAL
		CODE				QUANTITIES	PRICE	(Where just number,	ESTIMATED COST
								unit is "Month.")
2	Rental of Contractor	E0431	Portable System, Regulator,	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	570		12	$0.00
	Owned Portable O2		Flowmeter, Humidifier, Cannulas,
	Gaseous System for		or Masks, Tubing,
	use with or without		Conserving Device and O2 Tank
	Stationary System		Cylinder Stands capable of holding
	Priced Per Month		12 cylinders, sizes E, D, C & M-6

3	Rental of Contractor	E0439	Resevoir, Regulator, Flowmeter,	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	2	12	$0.00
	Owned Stationary		Humidifier, Cannulas or Masks, and
	Liquid O2 System		Colored Tubing (priced per month)

4	Rental of Contractor	E0434	Portable Container, Refill Adapter	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	7	12	$0.00
	Owned Portable		Flowmeter, Cannulas or Masks, and
	Liquid O2 System		Colored Tubing. Resevoir will be provided
			if another Stationary System (e.g.
	Priced Per Month		Concentrator) is rented.

5	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	4	Each	$0.00
	Airway Device		Government Owned CPAP in
	(CPAP) Set-up		Patient's Home to include mask and
			all required supplies (priced per each)

6	CPAP Maintenance	E0601	Maintenance of Government Owned	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	As Requested		CPAP, to include maintenance in
			accordance with Manufacturer
	Priced Per Each		recommendation, replacement of
			Mask, Headgear, Chinstraps, Tubing
			& Filters Disposible/Non-Disposible
			in Patients Home

6a	Pressure Support	E0463	Pressure Support Ventilator with Volume	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	Ventilator		Control Mode, may include pressure control
			mod, used with invasive interface (e.g.,
			tracheostomy tube)

6b	Pressure Support	E0464	Pressure Support Ventilator with Volume	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	Ventilator		Control Mode, may include pressure control

14a	Rental of Contractor	E0465	Home Ventilator, Invasive Interface	Base Period:	07-01-2023 through 06-30-2024	1	12	$0.00
	Owned Volume		Delivery, Set-up, Training, and
	Invasive Ventilator		Maintenance of Contractor Owned
			Stationary or Portable Ventilator, to
	Priced Per Month		include back up Ventilator and all supplies

14b	Rental of Contractor	E0466	Home Ventilator, Non-Invasive Interface	Base Period:	07-01-2023 through 06-30-2024	1	12	$0.00
	Owned Volume		Delivery, Set-up, Training, and
	Non-Invasive Ventilator		Maintenance of Contractor Owned
			Stationary or Portable Ventilator, to
	Priced Per Month		include back up Ventilator and all supplies
			mod, used w/non-invasive interface (e.g., mask)

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD		ESTIMATED	UNIT	UNIT	TOTAL
		CODE				QUANTITIES	PRICE	(Where just number,	ESTIMATED COST
								unit is "Month.")
7	Continuous Positive	E0601	Delivery, Set-up & Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1		Each	$0.00
	Airway Device		Government Owned CPAP at the
	(CPAP) Set-up		Contractors Facility to include mask
			and all supplies
	Priced Per Each

8	Bilevel Positive Airway	E0470	Delivery, Set-up & Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	Pressure Device		Government Owned BiLevel in
	Set-up		Patient's Home to include mask
			and all supplies
	Priced Per Each

9	BiLevel Maintenance	E0470	Maintenance of Government Owned	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	As Requested		BiLevel, to include maintenance in
			accordance with Manufacturer
			recommendation, replacement of
	Priced Per Each		Mask, Headgear, Chinstraps, Tubing
			& Filters Disposible/Non-Disposible
			in Patients Home

10	BiLevel Set-up	E0470	Delivery, Set-up & Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
			Government Owned BiLevel at the
			Contractors Facility to include mask
	Priced Per Each		and all supplies

11	Nebulizers	E0570	Delivery, Set-up and Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
			Government Owned Nebulizer,
			Compressor or Battery Powered as
	Priced Per Each		ordered

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD		ESTIMATED	UNIT	TOTAL
		CODE				QUANTITIES	(Where just number,	ESTIMATED COST
							unit is "Month.")
12	Suction Pump	E0600	Purchase, Delivery, Set-up and	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
			Training of Contractor Home Model
			Respiratory Suction Pump, portable
	Priced Per Each		or stationary electric to include all
			supplies

13	Suction Pump Rental	E0600	Delivery, Set-up, and Training of	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	5	Each	$0.00
			Contractor Owned Suction Pump to
			Include all supplies
	Priced Per Each

							12
14	Rental of Contractor	E0450	Delivery, Set-up, Training, and	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	2	$0.00
	Owned Volume		Maintenance of Contractor Owned
	Ventilator		Stationary or Portable Ventilator, to
			include back up Ventilator and all supplies
	Priced Per Month

15	Government Owned	E0450	Delivery, Set-up, and Training of a	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	Ventilator Set-up		Government Owned Ventilator
			to include all necessary supplies
	Priced Per Each

16	Ventilator	E0450	Maintenance of Government Owned	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	2	12	$0.00
	Maintenance		Ventilator Systems, to include all
			supplies
	Priced Per Month

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	CONTRACT PERIOD		ESTIMATED	UNIT	UNIT	TOTAL
		CODE				QUANTITIES	PRICE	(Where just number,	ESTIMATED COST
								unit is "Month.")
17	Air Compressor	E0565	Rental of Contractor Owned and	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1		12	$0.00
			Maintained continuous or intermittent
			air compressor for use with
			equipment not self contained or
	Priced Per Month		cylinder driven, to include all
			associated supplies

18	Full Face Masks	A7030	CPAP/Bilevel Full Face Masks	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
			Including Headgear

Priced Per Each

19	Nasal Interface Mask	A7034	CPAP/Bilevel Masks, Nasal	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	or Cannula Type		Interface, Nasal Pillows & Nasal
			Cushions (Mask or Cannula Type)
	Priced Per Each		Including Headgear

20	Delivery Charge	A9901	Deliveries not made under all other	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	2	Each	$0.00
			line items

Priced Per Each

21	Respiratory Therapist	VA120	Government requested Respiratory	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1	Each	$0.00
	Visit		Therapist visit not covered by other
			Line Items
	Priced Per Each

Palo Alto specific pricing instructions

Line Items 1-1c Require Quarterly Maintenance Visits

				REFILLS - ALL QUANTITIES ARE MONTHLY			ESTIMATED	UNIT
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION		CONTRACT PERIOD		MONTHLY	CYLINDER	UNIT	TOTAL ESTIMATED
		CODE					QUANTITIES	PRICE		MONTHLY COST
R1	E Cylinder	E0443	E Cylinder Refill		Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	1110		Cylinder	$0.00

R2 D Cylinder E0443 D Cylinder Refill Base Period: 10-01-2015 through 12-31-2015 07-01-2023 through 06-30-2024 60 Cylinder $0.00

R3 C Cylinder E0443 C Cylinder Refill Base Period: 10-01-2015 through 12-31-2015 07-01-2023 through 06-30-2024 1 Cylinder $0.00

R4 M-6 Cylinder E0443 M-6 Cylinder Refill Base Period: 10-01-2014 through 03-31-2015 07-01-2023 through 06-30-2024 2085 Cylinder $0.00

R5 H Tank E0443 H Tank Refill Base Period: 10-01-2015 through 12-31-2015 07-01-2023 through 06-30-2024 8 Cylinder $0.00

							UNIT PER LB
							PRICE
R6	Liquide Oxygen	E0444	Liquide Oxygen	Base Period: 10-01-2015 through 12-31-2015	07-01-2023 through 06-30-2024	833		LBS	$0.00
			Refill

PRICING TOTAL PAGE

LINE ITEMS 1 THROUGH 21
TOTAL ESTIMATED PRICE	$0.00
LINE ITEMS R1 - R6
TOTAL ESTIMATED PRICE	$0.00

Grand Total $0.00

&"Arial,Bold Italic"Palo Alto Pricing Sheet

&"Arial,Bold Italic"Palo Alto Page &P O2 Line Items Amendment #1

File details come from the government source that posted it. Updated May 8, 2023.