NOR CAL HOME OXYGEN Item Schedule v2 SAM.xlsx

XLSX spreadsheet 24 KB Posted May 8, 2023

Attached to: VA Home Oxygen Services for Northern California
Solicitation number: 36C26123Q0465
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 21

View the file

Other files

File	Type	Posted
Item Schedule- NCHCS.xlsx	XLSX spreadsheet	May 19, 2023
36C26123Q0465 VANCHCS.pdf	PDF	May 19, 2023
WAGE DETERMINATIONS - North Cal.pdf	PDF	May 8, 2023
RFQ 36C26123Q0465.pdf	PDF	May 8, 2023
QASP - Home Oxygen.pdf	PDF	May 8, 2023

On GovTribe

Work with this file

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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 $5,000,000.00.

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

NorCal

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	ESTIMATED QUANTITIES	Unit Price	CONTRACT PERIOD
		CODE				1 June 2023 to 31 May 2024

1	Rental of Contractor	E1390	Concentrator, Colored Tubing, Adapter	852	0
	Owned Concentrator		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
			provide disposable supplies.

1a	Rental of Contractor	E1390		0
	Owned Low Decibel		To include all supplies, equipment
	Concentrator System		maintenance and 90 calendar day visit as
			described in Item 1
	Priced Per Month

1b	Rental of Contractor	K0738		`
	Owned Home Fill		To include all supplies, equipment
	Oxygen System		maintenance and 90 calendar day visit as
			described in Item 1
	Priced Per Month

1c	Rental of Contractor	E1390		0
	Owned Hi Flow		To include all supplies, equipment
	Concentrator System		maintenance and 90 calendar day visit as
			described in Item 1

1d	Rental of Contractor	E1392	Portable Oxygen Concentrator, Colored Tubing, Adapter	41		0
	Owned Portable Concentrator		Humidifier (when required), Cannulas or
	System		Masks and other required supplies and
			equipment, including back up systems.
			Perform Equipment Maintenance in
			accordance with manufacturer standards.
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	ESTIMATED QUANTITIES	Unit Price
		CODE

2	Rental of Contractor	E0431	Portable System, Regulator,	772	0
	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,	5	0
	Owned Stationary		Humidifier, Cannulas or Masks, and
	Liquid O2 System		Colored Tubing.

Priced Per Month

4	Rental of Contractor	E0434	Portable Container, Refill Adapter	3	0
	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	0
	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			0
	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 Mask will be provided by VA
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	ESTIMATED QUANTITIES	Unit Price
		CODE

7	Continuous Positive	E0601	Delivery, Set-up & Training of	0
	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	0
	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	0
	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. Mask will be provided by VA

10	BiLevel Set-up	E0470	Delivery, Set-up & Training of	0
			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	0
			Government Owned Nebulizer,
			Compressor or Battery Powered as
	Priced Per Each		ordered

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	ESTIMATED QUANTITIES	Unit Price
		CODE

12	Suction Pump	E0600	Purchase, Delivery, Set-up and	5	0
			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		0
			Contractor Owned Suction Pump to
			Include all supplies
	Priced Per Each
13a	Rental of Contractor	E0465	Home Ventilator, Invasive Interface		0
	Owned Volume		Delivery, Set-up, Training, and
	Invasive Ventilator		Maintenance of Contractor Owned
			Stationary or Portable Ventilator, to
			include back up Ventilator and all supplies
13b	Rental of Contractor	E0466	Home Ventilator, Non-Invasive Interface	23	0
	Owned Volume		Delivery, Set-up, Training, and
	Non-Invasive Ventilator		Maintenance of Contractor Owned
			Stationary or Portable Ventilator, to
			include back up Ventilator and all supplies

ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION	ESTIMATED QUANTITIES	Unit Price
		CODE

14	Air Compressor	E0565	Rental of Contractor Owned and	150	0
			Maintained continuous or intermittent
			air compressor for use with
			equipment not self contained or
	Priced Per Month		cylinder driven, to include all
			associated supplies

15	Delivery Charge	A9901	Deliveries not made under all other	0
			line items

Priced Per Each

16	Respiratory Therapist	VA120	Government requested Respiratory	0
	Visit		Therapist visit not covered by other
			Line Items
	Priced Per Each

17	O2 Conc Start Up Kit	R038949	O2 Conc Start Up Kit Firesafe Bi-Directional;	40	0
	FireSafe Bi-Directional		Includes two (2) Firesafe Thermal Shut-off Valves
			and one (1) Firesafe Tubing Connector
	Priced Per Each

Martinez specific pricing instructions

Line Items 1-1c Require Quarterly Maintenance Visits

Line Items 5, 7, 8, & 10 Contractor provided Mask

Line Items 6 & 9 Maintenance upon request, Mask will be provided by VA

				REFILLS - ALL QUANTITIES ARE MONTHLY		Unit Price
ITEM#	ITEM NAME	HCPCS	ITEM DESCRIPTION		ESTIMATED QUANTITIES
		CODE
R1	E Cylinder	E0443	E Cylinder Refill		1428		0

R2 D Cylinder E0443 D Cylinder Refill 12 0

R3 C Cylinder E0443 C Cylinder Refill 2 0

R4 M-6 Cylinder E0443 M-6 Cylinder Refill 1825 0

R5 H Tank E0443 H Tank Refill 5 0

R6	Liquide Oxygen	E0444	Liquide Oxygen	2	0
			Refill

Monthly Total:	$ - 0
Yearly total:	$ - 0

&"Arial,Bold Italic"Northern California (Martinez) Pricing Sheet

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

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