MED53 Bidders Price Sheet 9-25-18.doc

Price Sheet RFR MED53 Influenza Vaccine for the 2019-2020 Flu Season Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

Bidders must download this document before completing it on a computer, saving the file and uploading the file through COMMBUYS.

NOTE: For Line Items 1-5 , 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 single dose prefilled syringes for use in infants 6 months to less than 3 years old. Total 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 $ __________________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

The price bid will be fixed throughout the life of any resulting contract.

NOTE: For Line Items 1-5 , 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. Total 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 $ __________________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

The price bid will be fixed throughout the life of any resulting contract.

NOTE: For Line Items 1-5 , 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. Total estimated requirement 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 ____________________________________________

Price per each dose that includes the Federal Excise is: quadrivalent $ ___________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

The price bid will be fixed throughout the life of any resulting contract.

NOTE: For Line Items 1-5 , 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. Total 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 $ _____________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

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 – HIGH DOSE (180 mcg HA) IM Injectable vaccine 0.5mls single dose prefilled syringe for age 65 and older. 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 per each dose that includes the Federal Excise is: $ _________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

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 – Adjuvanted IM Injectable vaccine 0.5mls single dose prefilled syringe for age 65 and older. 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 per each dose that includes the Federal Excise is: $ _________________

Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

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 – Mercury Free Recombinant IM injectable vaccine 0.5-mL single-dose vials (FluBlok© or equal). 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 per each dose that includes the Federal Excise is: $ _________________ Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines.

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 Cell Culture IM injectable vaccine 0.5-mL single-dose pre-filled syringes (Flucelvax© or equal). 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 per each dose that includes the Federal Excise is: $ _________________ Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 20198-2020 season recommendations regarding the use of seasonal influenza vaccines.

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 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 per each dose that includes the Federal Excise is: $ _________________ Prior to sale, influenza vaccines must be recommended by the Advisory Committee on Immunization Practices (ACIP) in their 2019-2020 season recommendations regarding the use of seasonal influenza vaccines. All nasal vaccine that outdates within the 2019-2020 flu season must be replaced with in-date nasal vaccine to be used within the 2019-2020 Flu Season at no cost.

The price bid will be fixed throughout the life of any resulting contract.

RFR MED53 Price Sheet