MED50 Bidders Price Sheet 11-6-15.doc
DOC document 51 KB Posted
- Attached to
- MED50 Flu Vaccine 2016-2017season
- Solicitation number
- BD-16-1080-OSD03-SRC3-00000005621
- Issued by
- Massachusetts
About this file
This document is a price sheet for the MED50 Influenza Vaccine Request for Response (RFR) issued by the Massachusetts Department of Public Health (MDPH) Immunization Program for the 2016-2017 flu season. The RFR is seeking bids for quadrivalent influenza vaccines in various presentations and dosages for infants, children, and adults. The estimated requirements range from 10,000 to 150,000 doses across the different line items. Bidders must submit their pricing, product details, and delivery schedules. The MDPH Immunization Program may choose not to purchase these vaccines on the state contract, but other state agencies, cities, and towns will be able to do so for their own use.
The price bid must be fixed for the life of the resulting contract. Bidders may bid on more than one product per line item, but must submit the same price for the same vaccine across multiple line items. The RFR also includes line items for live attenuated nasal spray vaccine, intradermal injectable vaccine, high-dose injectable vaccine, recombinant injectable vaccine, and cell culture injectable vaccine, though no estimated purchase quantities are provided for these. All pricing must include the Federal Excise tax.
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| consig contractor authorized signatory.doc | DOC document | |
| w_9.doc | DOC document | |
| RFR MED50 10-6-15 FINAL~1.doc | DOC document | |
| MED50 Bidders Submission Checklist.doc | DOC document | |
| EFT_FORM.pdf | ||
| eppform.doc | DOC document | |
| standard_contract_MED50.doc | DOC document | |
| ppd.doc | DOC document | |
| sdp-plan-form-1-commitment.docx | DOCX document | |
| sdp-plan-form-2-declaration.docx | DOCX document | |
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Text version
Price Sheet RFR MED50 Influenza Vaccine for the 2016 - 2017 Flu Season
Bidders must download this document before completing it on a computer, saving the file and uploading the file through COMMBUYS.
NOTE: For Line Items 1-4, bidders should submit pricing only for quadrivalent influenza vaccines.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 1 - Mercury free IM injectable vaccine 0.25 ml single dose prefilled syringes for use in infants 6 months to less than 3 years old. Estimated Requirement is 50,000 Doses Name of Company submitting bid:
Packaging Type & Description:
quadrivalent _______________________________________
Full NDC #:
quadrivalent __________________________
Brand Name: quadrivalent _________________________
Manufacturer: quadrivalent _________________________
Age Range the Vaccine is approved for: quadrivalent _______________
The number of doses we can supply: quadrivalent _______________
The delivery schedule is:
quadrivalent ______________________________________________
Price per each dose that includes the Federal Excise is:
quadrivalent $ __________________________
The price bid will be fixed throughout the life of any resulting contract.
NOTE: For Line Items 1-4, bidders should submit pricing only for quadrivalent influenza vaccines.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 2 - IM injectable vaccine in 5.0 ml multi-dose vials. 6 months and older. Estimated Requirement is 10,000 Doses Name of Company submitting bid:
Packaging Type & Description:
quadrivalent _______________________________________
Full NDC #: quadrivalent __________________________
Brand Name: quadrivalent _________________________
Manufacturer: quadrivalent _________________________
Age Range the Vaccine is approved for: quadrivalent _______________
The number of doses we can supply: quadrivalent _______________
The delivery schedule is:
quadrivalent _____________________________________________
Price per each dose that includes the Federal Excise is:
quadrivalent $ __________________________
The price bid will be fixed throughout the life of any resulting contract.
NOTE: For Line Items 1-4, bidders should submit pricing only for quadrivalent influenza vaccines.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 3 – Mercury free IM Injectable vaccine 0.5mls per dose in 0.5ml single dose vials, 3 years and older. Total estimated requirement for this age range is 30,000 doses Name of Company submitting bid:
Packaging Type & Description:
quadrivalent _______________________________________
Full NDC #: quadrivalent __________________________
Brand Name: quadrivalent _________________________
Manufacturer: quadrivalent _________________________
Age Range the Vaccine is approved for: quadrivalent _______________
The number of doses we can supply: quadrivalent _______________
The delivery schedule is:
quadrivalent ____________________________________________
The price bid will be fixed throughout the life of any resulting contract.
NOTE: For Line Items 1-4, bidders should submit pricing only for quadrivalent influenza vaccines.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 4 – Mercury free IM Injectable vaccine 0.5mls per dose in single dose 0.5ml prefilled syringes. 3 years and older Total estimated requirement for this age range is 150,000 doses. (MDPH 100,000 + Others 50,000) Name of Company submitting bid:
Packaging Type & Description:
quadrivalent _______________________________________
Full NDC #: quadrivalent __________________________
Brand Name: quadrivalent _________________________
Manufacturer: quadrivalent _________________________
Age Range the Vaccine is approved for: quadrivalent _______________
The number of doses we can supply: quadrivalent _______________
The delivery schedule is:
quadrivalent ______________________________________________
The price bid will be fixed throughout the life of any resulting contract.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 5 – Mercury Free Live attenuated nasal spray vaccine (FluMist© or equal) Estimated Requirement is 55,000 doses.
Name of Company submitting bid: ___________________________________
Packaging Type and Description: ____________________________________
Full NDC #: ____________________________________________________
Brand Name: ___________________________________________________
Manufacturer: ___________________________________________________
Age Range the Vaccine is approved for: ______________________________
The number of doses we can supply: _________________________________
The delivery schedule is: ___________________________________________
Price that includes the Federal Excise per each dose is: $ _________________ All nasal vaccine that outdates within the 2016-2017 flu season must be replaced with in-date nasal vaccine to be used within the 2016-2017 Flu Season at no cost.
The price bid will be fixed throughout the life of any resulting contract.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 6 – INTRADERMAL Injectable vaccine 0.1mls single dose microinjection system, 18 years through 64 years we are not providing an estimated purchase quantity.
Name of Company submitting bid: ___________________________________
Packaging Type and Description: ____________________________________
Full NDC #: ____________________________________________________
Brand Name: ___________________________________________________
Manufacturer: ___________________________________________________
Age Range the Vaccine is approved for: ______________________________
The number of doses we can supply: _________________________________
The delivery schedule is: ___________________________________________
Price that includes the Federal Excise per each dose is: $ _________________
The price bid will be fixed throughout the life of any resulting contract.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 7 – HIGH DOSE (180 mcg HA) IM Injectable vaccine 0.5mls single dose prefilled syringe. We are not providing an estimated purchase quantity. 65 years and older
Name of Company submitting bid: ___________________________________
Packaging Type and Description: ____________________________________
Full NDC #: ____________________________________________________
Brand Name: ___________________________________________________
Manufacturer: ___________________________________________________
Age Range the Vaccine is approved for: ______________________________
The number of doses we can supply: _________________________________
The delivery schedule is: ___________________________________________
Price that includes the Federal Excise per each dose is: $ _________________
The price bid will be fixed throughout the life of any resulting contract.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 8 – Mercury Free Recombinant IM injectable vaccine 0.5-mL single-dose vials (FluBlok© or equal). We are not providing an estimated purchase quantity.
18 years and older Name of Company submitting bid: ___________________________________
Packaging Type and Description: ____________________________________
Full NDC #: ____________________________________________________
Brand Name: ___________________________________________________
Manufacturer: ___________________________________________________
Age Range the Vaccine is approved for: ______________________________
The number of doses we can supply: _________________________________
The delivery schedule is: ___________________________________________
Price that includes the Federal Excise per each dose is: $ _________________ The price bid will be fixed throughout the life of any resulting contract.
In some cases the same exact vaccine that a bidder is offering may be bid for multiple line items on the Price Sheet but when a bidder offers the same vaccine on multiple lines on the Price Sheet the bidder must enter the same price on each line being bid for which the same vaccine is being offered. If a product NDC is not yet available - state “not available, to be supplied later”. A Bidder may bid more than one (1) product on an individual line item.
The Massachusetts Department of Public Health (MDPH) Immunization Program may choose not to purchase these doses on the state contract. However other state agencies, cities, and towns will also be able to purchase doses on this contract for their use, and these doses will not be resold.
Line Item 9 – Mercury Free Cell Culture IM injectable vaccine 0.5-mL single-dose pre-filled syringes (Flucelvax© or equal). We are not providing an estimated purchase quantity. 18 years and older.
Name of Company submitting bid: ___________________________________
Packaging Type and Description: ____________________________________
Full NDC #: ____________________________________________________
Brand Name: ___________________________________________________
Manufacturer: ___________________________________________________
Age Range the Vaccine is approved for: ______________________________
The number of doses we can supply: _________________________________
The delivery schedule is: ___________________________________________
Price that includes the Federal Excise per each dose is: $ _________________
The price bid will be fixed throughout the life of any resulting contract.
RFR MED50 Price Sheet
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