Price-Cost_Schedule - 26Q0292.xlsx
XLSX spreadsheet 74 KB Posted
- Solicitation number
- 36C25026Q0292
About this file
This is a Price-Cost Schedule for contingency hazardous compounding services solicitation 36C25026Q0292 issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The schedule requires offerors to complete pricing for both a Base Year (5/1/2026–4/30/2027) and four Option Years (Years 1–4 covering 5/1/2027–4/30/2031). All pricing entries must be completed in designated yellow-highlighted cells (F2, F128–F132, and G134), with incomplete responses subject to dismissal from evaluation.
The pricing structure is based on Average Wholesale Price (AWP) with offerors required to input a single discount or surcharge percentage applied across all medications and supplies. The schedule lists over 140 chemotherapy drugs and supportive pharmaceuticals with estimated monthly usage quantities across seven VA locations requiring hazardous compounding. Medication pricing is calculated as AWP multiplied by the offeror's discount/surcharge percentage and estimated contingency usage per month. The Base Year medication total is estimated at $1,261,276.27, with an additional $70,000.00 for fees and supplies, yielding a total evaluated price of $1,331,276.27 per year. Actual invoiced pricing shall reflect the current AWP at time of order plus the discount or surcharge, plus approved fees and supplies. Supplies are estimated at $70.00 per order with vendors charging actual fees not to exceed $70.00 without Contracting Officer Representative approval. All applicable fees including USP 797, USP 800, delivery, and special compounding services (chemoembolic mix, intrathecal mix, exact volume requirement, STAT orders, and per diem services) are to be priced by offerors. The five-year total contract value across all years is estimated at $6,656,381.33.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25026Q0292.pdf | ||
| Guidance Documents for Outsourcing of Compounded Sterile Products.docx | DOCX document | |
| Vendor Cover Page Template.docx | DOCX document | |
| 26Q0292 - PPQ - Vendor Name.pdf | ||
| Solicitation Concurrence Table.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
INSTRUCTIONS
INSTRUCTIONS / ADDITIONAL INFORMATION:
ALL OFFERORS ARE TO FILL OUT EACH TAB, BASE and all Option Years (1-4)
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128 - F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
BASE Year
| Generic Name | Brand/Trade Name | NDC / Product Number | Scheduled Usage Over 7 Days (Per Vial) Estimated Quantity | AWP BASE Price | |||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Base Year | 5/1/2026 - 4/30/2027 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | 0% | Total Price Medication (Less other) | $ 1,261,276.27 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 1.00 | $ 1.00 | Total Price Fees (Less Supplies) | $ 70,000.00 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 50242-0088-01 | 6 | $ 4,979.06 | $ 4,979.06 | $ 29,874.36 | Total Evaluated Price | ||
| (Less Supplies/other) | $ 1,331,276.27 | ||||||||
| Arsenic Trioxide 12mg | Trisenox | 70710-1610-06 | 10 | $ 646.65 | $ 646.65 | $ 6,466.52 | |||
| Azacitidine 100mg | Vidaza | 00781-3253-94 | 56 | $ 617.62 | $ 617.62 | $ 34,586.72 | |||
| Bendamustine 100mg | Belrapzo | 42367-0521-25 | 2 | $ 3,120.00 | $ 3,120.00 | $ 6,240.00 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128, F129. F130, F131, F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
| Bendamustine 100mg | Bendeka | 63459-0348-04 | 12 | $ 2,968.56 | $ 2,968.56 | $ 35,622.72 | |
| Bleomycin 15 units | Blenoxane | 71288-0106-10 | 2 | $ 36.82 | $ 36.82 | $ 73.64 | |
| Bleomycin 30 units | Blenoxane | 71288-0107-20 | 2 | $ 80.03 | $ 80.03 | $ 160.06 | |
| Blinatumomab 35mcg | Blincyto | 55513-0160-01 | 2 | $ 6,668.12 | $ 6,668.12 | $ 13,336.24 | |
| Bortezomib 3.5mg | 63323-0821-10 | 30 | $ 55.20 | $ 55.20 | $ 1,656.00 | ||
| Brentuximab vedotin 50mg | Adcetris | 51144-0050-01 | 10 | $ 15,804.19 | $ 15,804.19 | $ 158,041.90 | |
| Cabazitaxel 60mg | Jevtana | 00024-5824-11 | 2 | $ 17,663.82 | $ 17,663.82 | $ 35,327.64 | |
| Carboplatin 600mg | 55150-0386-01 | 30 | $ 60.22 | $ 60.22 | $ 1,806.60 | ||
| Carfilzomib 30mg | Kyprolis | 76075-0102-01 | 2 | $ 2,122.32 | $ 2,122.32 | $ 4,244.64 | |
| Carfilzomib 60mg | Kyprolis | 76075-0101-01 | 12 | $ 4,244.63 | $ 4,244.63 | $ 50,935.56 | |
| Cisplatin 100mg | Platinol | 00143-9505-01 | 30 | $ 36.83 | $ 36.83 | $ 1,104.90 | |
| Cladribine 10mg | Leustatin | 63323-0140-10 | 2 | $ 522.00 | $ 522.00 | $ 1,044.00 | |
| Cyclophosphamide 1g | Cytoxan | 10019-0956-01 | 22 | $ 563.38 | $ 563.38 | $ 12,394.36 | |
| Cyclophosphamide 500mg | Cytoxan | 75907-0191-02 | 6 | $ 351.60 | $ 351.60 | $ 2,109.60 | |
| Cytarabine 100mg | ARA-C, Cytosar | 61703-0305-38 | 6 | $ 7.88 | $ 7.88 | $ 47.28 | |
| Cytarabine 2g | ARA-C, Cytosar | 63323-0120-20 | 15 | $ 25.08 | $ 25.08 | $ 376.20 | |
| Dacarbazine 200mg | DTIC | 00143-9245-10 | 6 | $ 14.40 | $ 14.40 | $ 86.40 | |
| Dactinomycin 0.5mg | Cosmegen | 71288-0129-02 | 3 | $ 600.00 | $ 600.00 | $ 1,800.00 | |
| datopotamab deruxtecan 100mg | 65597-0801-01 | 6 | $ 5,986.49 | $ 5,986.49 | $ 35,918.94 | ||
| Daunorubicin 20mg | Cerubidine | 00143-9551-10 | 4 | $ 160.97 | $ 160.97 | $ 643.87 | |
| Decitabine 50mg | Dacogen | 00143-9385-01 | 12 | $ 120.00 | $ 120.00 | $ 1,440.00 | |
| Dexrazoxane 500mg | Zinecard, Totect | 00143-9248-01 | 2 | $ 240.00 | $ 240.00 | $ 480.00 | |
| Dextrose 5% 1000ml | 00264-7510-00 | 10 | $ 4.82 | $ 4.82 | $ 48.20 | ||
| Dextrose 5% 100ml | 00264-1510-32 | 10 | $ 2.96 | $ 2.96 | $ 29.64 | ||
| Dextrose 5% 250ml | 00264-7510-20 | 60 | $ 4.44 | $ 4.44 | $ 266.40 | ||
| Dextrose 5% 500ml | 00264-7510-10 | 30 | $ 4.84 | $ 4.84 | $ 145.20 | ||
| Dextrose 5% 50ml | 65219-456-05 | 10 | $ 2.96 | $ 2.96 | $ 29.60 | ||
| dihydroergotamine | 81284-0411-05 | 8 | $ 93.60 | $ 93.60 | $ 748.80 | ||
| Docetaxel 160mg | 43066-0010-01 | 10 | $ 327.60 | $ 327.60 | $ 3,276.00 | ||
| Docetaxel 20mg | 25021-0245-01 | 4 | $ 30.00 | $ 30.00 | $ 120.00 | ||
| Docetaxel 80mg | 25021-0245-04 | 10 | $ 102.00 | $ 102.00 | $ 1,020.00 | ||
| Doxorubicin 10mg/5mL | 00069-3030-20 | 6 | $ 12.18 | $ 12.18 | $ 73.08 | ||
| Doxorubicin 50mg | Adriamycin | 00069-0343-02 | 27 | $ 29.48 | $ 29.48 | $ 795.96 | |
| Eculizumab 300mg | Soliris | 25682-0001-01 | 2 | $ 7,827.60 | $ 7,827.60 | $ 15,655.20 | |
| Enfortumab vedotin-ejfv 20mg | Padcev | 51144-0020-01 | 20 | $ 3,370.80 | $ 3,370.80 | $ 67,416.00 | |
| Enfortumab vedotin-ejfv 30mg | Padcev | 51144-0030-01 | 40 | $ 5,056.20 | $ 5,056.20 | $ 202,248.00 | |
| Epirubicin 50mg | Ellence | 00009-5091-01 | 2 | $ 57.71 | $ 57.71 | $ 115.42 | |
| Eribulin mesylate 1mg | Halaven | 62856-0389-01 | 2 | $ 1,692.00 | $ 1,692.00 | $ 3,384.00 | |
| Etoposide 100mg | Vepesid, VP-16, Toposar | 16729-0114-31 | 70 | $ 11.37 | $ 11.37 | $ 795.90 | |
| Etoposide Phosphate 100mg | Etopophos | 61269-0410-20 | 14 | $ 204.42 | $ 204.42 | $ 2,861.88 | |
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 65597-0406-01 | 12 | $ 3,521.70 | $ 3,521.70 | $ 42,260.40 | |
| Fludarabine 50mg | Fludara | 25021-0242-02 | 2 | $ 261.00 | $ 261.00 | $ 522.00 | |
| Fluorouracil 1g | Adrucil, 5-FU | 63323-0117-20 | 15 | $ 8.21 | $ 8.21 | $ 123.12 | |
| Fluorouracil 500mg | Adrucil, 5-FU | 63323-0117-10 | 70 | $ 4.10 | $ 4.10 | $ 287.28 | |
| Fluorouracil 5g | Adrucil, 5-FU | 63323-0117-61 | 52 | $ 32.13 | $ 32.13 | $ 1,670.76 | |
| Fosphenytoin 500mg | 63323-0403-10 | 10 | $ 30.78 | $ 30.78 | $ 307.80 | ||
| Ganciclovir 500mg | Cytovene | 70436-0089-55 | 14 | $ 52.80 | $ 52.80 | $ 739.20 | |
| Gemcitabine 1g | Gemzar | 71288-0117-28 | 40 | $ 26.40 | $ 26.40 | $ 1,056.00 | |
| Gemcitabine 2000mg | Gemzar | 71288-0117-54 | 30 | $ 53.40 | $ 53.40 | $ 1,602.00 | |
| Gemtuzumab ozogamicin | Mylotarg | 00008-4510-01 | 4 | $ 12,601.86 | $ 12,601.86 | $ 50,407.44 | |
| hydrocortisone 100mg PF | 00009-0011-03 | 4 | $ 30.32 | $ 30.32 | $ 121.28 | ||
| Idarubicin 10mg | Idamycin | 00013-2586-10 | 2 | $ 129.34 | $ 129.34 | $ 258.68 | |
| Idarubicin 20mg | Idamycin | 00013-2596-20 | 2 | $ 248.34 | $ 248.34 | $ 496.68 | |
| Idarubicin 5mg | Idamycin | 00013-2576-05 | 2 | $ 64.68 | $ 64.68 | $ 129.36 | |
| Ifosfamide 1g | Ifex | 00703-3427-11 | 2 | $ 44.09 | $ 44.09 | $ 88.18 | |
| Ifosfamide 3g | Ifex | 00338-3993-01 | 40 | $ 125.56 | $ 125.56 | $ 5,022.40 | |
| Inotuzumab Ozogamicin | Besponsa | 00008-0100-01 | 2 | $ 28,699.14 | $ 28,699.14 | $ 57,398.28 | |
| Irinotecan 100mg | Camptosar | 60505-6128-01 | 100 | $ 36.07 | $ 36.07 | $ 3,607.00 | |
| Liposomal Doxorubicin 20mg | Doxil | 00338-0063-01 | 2 | $ 384.19 | $ 384.19 | $ 768.38 | |
| Liposomal Doxorubicin 50mg | Doxil | 00338-0067-01 | 2 | $ 2,020.80 | $ 2,020.80 | $ 4,041.60 | |
| Liposomal Irinotecan 43mg | Onivyde | 69171-0398-01 | 5 | $ 2,137.20 | $ 2,137.20 | $ 10,686.00 | |
| Lurbinectedin 4mg | Zepzelca | 68727-0712-01 | 4 | $ 9,732.00 | $ 9,732.00 | $ 38,928.00 | |
| Mesna 1g | Mesnex | 10019-0953-01 | 2 | $ 30.00 | $ 30.00 | $ 60.00 | |
| Methotrexate 1g | Rheumatrex, Trexall | 16729-0277-35 | 5 | $ 41.16 | $ 41.16 | $ 205.80 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 00703-3671-01 | 4 | $ 12.42 | $ 12.42 | $ 49.68 | |
| Mitomycin 20mg | Mutamycin | 00143-9279-01 | 2 | $ 758.40 | $ 758.40 | $ 1,516.80 | |
| Mitomycin 40mg | Mutamycin | 00143-9280-01 | 2 | $ 1,200.00 | $ 1,200.00 | $ 2,400.00 | |
| Mitomycin 5mg | Mutamycin | 16729-0115-05 | 5 | $ 272.46 | $ 272.46 | $ 1,362.30 | |
| Mitoxantrone 25mg | Novantrone | 00703-4680-01 | 2 | $ 324.71 | $ 324.71 | $ 649.42 | |
| Mycophenolate mofetil 500mg | Cellcept | 00004-0298-09 | 3 | $ 129.57 | $ 129.57 | $ 388.72 | |
| Nelarabine 250mg/50ml inj vial | Arranon | 00078-0683-61 | 15 | $ 969.80 | $ 969.80 | $ 14,547.00 | |
| Oxaliplatin 100mg | 71288-0172-21 | 55 | $ 24.00 | $ 24.00 | $ 1,320.00 | ||
| Paclitaxel 100mg | Taxol | 00703-3216-01 | 8 | $ 40.00 | $ 40.00 | $ 320.00 | |
| Paclitaxel 300mg | Taxol | 61703-0342-50 | 15 | $ 85.56 | $ 85.56 | $ 1,283.40 | |
| Paclitaxel 30mg | Taxol | 61703-0015-04 | 13 | $ 11.17 | $ 11.17 | $ 145.21 | |
| Paclitaxel Protein-Bound 100mg | Abraxane | 67457-0937-50 | 35 | $ 1,535.82 | $ 1,535.82 | $ 53,753.70 | |
| Pamidronate 30mg | 61703-0324-18 | 2 | $ 17.33 | $ 17.33 | $ 34.66 | ||
| Pamidronate 90mg | 61703-0326-18 | 2 | $ 44.98 | $ 44.98 | $ 89.96 | ||
| Pemetrexed 100mg | 71288-0166-10 | 30 | $ 36.00 | $ 36.00 | $ 1,080.00 | ||
| Pemetrexed 500mg | 63323-0134-10 | 48 | $ 150.00 | $ 150.00 | $ 7,200.00 | ||
| Pentostatin 10mg | Nipent | 00409-0801-01 | 1 | $ 3,541.54 | $ 3,541.54 | $ 3,541.54 | |
| Pertuzumab 420mg | Perjeta | 50242-0145-01 | 2 | $ 8,266.43 | $ 8,266.43 | $ 16,532.86 | |
| Phenytoin 250mg inj | 00641-2555-45 | 5 | $ 2.39 | $ 2.39 | $ 11.96 | ||
| Polatuzumab vedotin-piiq 140mg vial | Polivy | 50242-0105-01 | 2 | $ 23,673.71 | $ 23,673.71 | $ 47,347.42 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 50242-0103-01 | 2 | $ 5,072.95 | $ 5,072.95 | $ 10,145.90 | |
| Pralatrexate 20mg | Folotyn | 72893-0003-01 | 2 | $ 8,891.75 | $ 8,891.75 | $ 17,783.50 | |
| Pralatrexate 40mg | Folotyn | 72893-0005-01 | 2 | $ 17,783.50 | $ 17,783.50 | $ 35,567.00 | |
| Reconstitution - NaCl 0.9% 10 mL | 00409-4888-10 | 25 | $ 1.13 | $ 1.13 | $ 28.26 | ||
| Reconstitution - NaCl 0.9% 20 mL | 00409-4888-20 | 25 | $ 1.64 | $ 1.64 | $ 41.10 | ||
| Reconstitution - NaCl 0.9% 50 mL | 00409-4888-50 | 25 | $ 4.25 | $ 4.25 | $ 106.20 | ||
| Reconstitution - SW 10 mL | 00409-4887-10 | 25 | $ 1.37 | $ 1.37 | $ 34.26 | ||
| Reconstitution - SW 20 mL | 00409-4887-20 | 25 | $ 1.94 | $ 1.94 | $ 48.41 | ||
| Reconstitution - SW 50 mL | 00409-4887-50 | 25 | $ 3.53 | $ 3.53 | $ 88.16 | ||
| Reconstitution - SW 100 mL | 00409-4887-99 | 10 | $ 9.83 | $ 9.83 | $ 98.28 | ||
| Romidepsin 10mg | Istodax | 63323-0926-88 | 2 | $ 3,802.38 | $ 3,802.38 | $ 7,604.76 | |
| Sacituzumab govitecan-hziy 180mg vial | Trodelvy | 55135-0132-01 | 13 | $ 3,137.72 | $ 3,137.72 | $ 40,790.36 | |
| Sodium Chloride 0.9% 1000ml | 17271-0701-07 | 17 | $ 11.00 | $ 11.00 | $ 187.00 | ||
| Sodium Chloride 0.9% 100ml | 00264-1800-32 | 100 | $ 3.26 | $ 3.26 | $ 326.41 | ||
| Sodium Chloride 0.9% 150ml | 00990-7983-61 | 40 | $ 6.64 | $ 6.64 | $ 265.44 | ||
| Sodium Chloride 0.9% 250ml | 00264-7800-20 | 100 | $ 3.45 | $ 3.45 | $ 345.00 | ||
| Sodium Chloride 0.9% 50ml | 00264-1800-31 | 40 | $ 3.24 | $ 3.24 | $ 129.60 | ||
| Sodium Chloride 0.9% 500ml | 00264-7800-10 | 40 | $ 4.06 | $ 4.06 | $ 162.40 | ||
| Temsirolimus 25mg | Torisel | 65219-0200-05 | 2 | $ 1,416.00 | $ 1,416.00 | $ 2,832.00 | |
| Topotecan 4mg | Hycamptin | 25021-0236-04 | 2 | $ 180.00 | $ 180.00 | $ 360.00 | |
| Trabectedin 1mg | Yondelis | 59676-0610-01 | 4 | $ 4,737.11 | $ 4,737.11 | $ 18,948.44 | |
| Trastuzumab 150mg | Herceptin | 50242-0132-01 | 0 | $ 1,870.10 | $ 1,870.10 | $ - 0 | |
| Trastuzumab-anns 420mg | Kanjinti | 55513-0141-21 | 8 | $ 1,632.08 | $ 1,632.08 | $ 13,056.64 | |
| Trastuzumab-dttb 150mg vial | Ontruzant | 78206-0147-01 | 0 | $ 1,589.59 | $ 1,589.59 | $ - 0 | |
| Trastuzumab-qyyp 420mg | Trazimera | 00069-0305-01 | 0 | $ 4,069.30 | $ 4,069.30 | $ - 0 | |
| Valproate sodium 500mg | 63323-0494-05 | 10 | $ 8.04 | $ 8.04 | $ 80.40 | ||
| Vinblastine 10mg | Velban | 63323-0278-10 | 4 | $ 73.54 | $ 73.54 | $ 294.16 | |
| Vincristine 1mg | Oncovin | 61703-0309-06 | 5 | $ 21.30 | $ 21.30 | $ 106.50 | |
| Vincristine 2mg | Oncovin | 61703-0309-16 | 5 | $ 18.48 | $ 18.48 | $ 92.40 | |
| Vinorelbine 50mg | Navelbine | 25021-0204-05 | 2 | $ 108.00 | $ 108.00 | $ 216.00 | |
| Voriconazole 200mg | 70594-0067-01 | 10 | $ 48.00 | $ 48.00 | $ 480.00 | ||
| Zoledronic Acid 4mg | Zometa | 25021-0826-82 | 8 | $ 216.00 | $ 216.00 | $ 1,728.00 | |
| Empty Bag (250mL, 1000mL) | 10 | $ 12.00 | $ 12.00 | $ 120.00 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | Trade Name / Generic info will be provided | Valid NDC will be provided at time of TO | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | NDC / Product Number | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | Per Diem | 1000 | $ - 0 | $ - 0 | |||
| Chemoembolic Mixing | Chemoembolic Mix | 4 | $ - 0 | $ - 0 | |||
| Exact Volume Requirement | Exact Vol Req | 200 | $ - 0 | $ - 0 | |||
| Intrathecal Mixing | Intrathecal Mix | 50 | $ - 0 | $ - 0 | |||
| STAT Order | STAT | 10 | $ - 0 | $ - 0 | |||
| Supplies |
All supplies are priced at (AWP (+/- 0.00%) ESTIMATED AT $70.00 per order, Vendor to charge for actual fees, not to exceed $70.00 without approval from the COR
| Estimated Quantity, Not to Exceed, Bill for Actual Usage | Supply | 1000 | $ 70.00 | $ 70,000.00 | ||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | -60% |
Option Year 1
| Generic Name | Brand/Trade Name | NDC / Product Number | Scheduled Usage Over 7 Days (Per Vial) Estimated Quantity | AWP BASE Price | |||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Option Year 1 | 5/1/2027 - 4/30/2028 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | 0% | Total Price Medication (Less other) | $ 1,261,276.27 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 1.00 | $ 1.00 | Total Price Fees (Less Supplies) | $ 70,000.00 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 50242-0088-01 | 6 | $ 4,979.06 | $ 4,979.06 | $ 29,874.36 | Total Evaluated Price | ||
| (Less Supplies/other) | $ 1,331,276.27 | ||||||||
| Arsenic Trioxide 12mg | Trisenox | 70710-1610-06 | 10 | $ 646.65 | $ 646.65 | $ 6,466.52 | |||
| Azacitidine 100mg | Vidaza | 00781-3253-94 | 56 | $ 617.62 | $ 617.62 | $ 34,586.72 | |||
| Bendamustine 100mg | Belrapzo | 42367-0521-25 | 2 | $ 3,120.00 | $ 3,120.00 | $ 6,240.00 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128, F129. F130, F131, F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
| Bendamustine 100mg | Bendeka | 63459-0348-04 | 12 | $ 2,968.56 | $ 2,968.56 | $ 35,622.72 | |
| Bleomycin 15 units | Blenoxane | 71288-0106-10 | 2 | $ 36.82 | $ 36.82 | $ 73.64 | |
| Bleomycin 30 units | Blenoxane | 71288-0107-20 | 2 | $ 80.03 | $ 80.03 | $ 160.06 | |
| Blinatumomab 35mcg | Blincyto | 55513-0160-01 | 2 | $ 6,668.12 | $ 6,668.12 | $ 13,336.24 | |
| Bortezomib 3.5mg | 63323-0821-10 | 30 | $ 55.20 | $ 55.20 | $ 1,656.00 | ||
| Brentuximab vedotin 50mg | Adcetris | 51144-0050-01 | 10 | $ 15,804.19 | $ 15,804.19 | $ 158,041.90 | |
| Cabazitaxel 60mg | Jevtana | 00024-5824-11 | 2 | $ 17,663.82 | $ 17,663.82 | $ 35,327.64 | |
| Carboplatin 600mg | 55150-0386-01 | 30 | $ 60.22 | $ 60.22 | $ 1,806.60 | ||
| Carfilzomib 30mg | Kyprolis | 76075-0102-01 | 2 | $ 2,122.32 | $ 2,122.32 | $ 4,244.64 | |
| Carfilzomib 60mg | Kyprolis | 76075-0101-01 | 12 | $ 4,244.63 | $ 4,244.63 | $ 50,935.56 | |
| Cisplatin 100mg | Platinol | 00143-9505-01 | 30 | $ 36.83 | $ 36.83 | $ 1,104.90 | |
| Cladribine 10mg | Leustatin | 63323-0140-10 | 2 | $ 522.00 | $ 522.00 | $ 1,044.00 | |
| Cyclophosphamide 1g | Cytoxan | 10019-0956-01 | 22 | $ 563.38 | $ 563.38 | $ 12,394.36 | |
| Cyclophosphamide 500mg | Cytoxan | 75907-0191-02 | 6 | $ 351.60 | $ 351.60 | $ 2,109.60 | |
| Cytarabine 100mg | ARA-C, Cytosar | 61703-0305-38 | 6 | $ 7.88 | $ 7.88 | $ 47.28 | |
| Cytarabine 2g | ARA-C, Cytosar | 63323-0120-20 | 15 | $ 25.08 | $ 25.08 | $ 376.20 | |
| Dacarbazine 200mg | DTIC | 00143-9245-10 | 6 | $ 14.40 | $ 14.40 | $ 86.40 | |
| Dactinomycin 0.5mg | Cosmegen | 71288-0129-02 | 3 | $ 600.00 | $ 600.00 | $ 1,800.00 | |
| datopotamab deruxtecan 100mg | 65597-0801-01 | 6 | $ 5,986.49 | $ 5,986.49 | $ 35,918.94 | ||
| Daunorubicin 20mg | Cerubidine | 00143-9551-10 | 4 | $ 160.97 | $ 160.97 | $ 643.87 | |
| Decitabine 50mg | Dacogen | 00143-9385-01 | 12 | $ 120.00 | $ 120.00 | $ 1,440.00 | |
| Dexrazoxane 500mg | Zinecard, Totect | 00143-9248-01 | 2 | $ 240.00 | $ 240.00 | $ 480.00 | |
| Dextrose 5% 1000ml | 00264-7510-00 | 10 | $ 4.82 | $ 4.82 | $ 48.20 | ||
| Dextrose 5% 100ml | 00264-1510-32 | 10 | $ 2.96 | $ 2.96 | $ 29.64 | ||
| Dextrose 5% 250ml | 00264-7510-20 | 60 | $ 4.44 | $ 4.44 | $ 266.40 | ||
| Dextrose 5% 500ml | 00264-7510-10 | 30 | $ 4.84 | $ 4.84 | $ 145.20 | ||
| Dextrose 5% 50ml | 65219-456-05 | 10 | $ 2.96 | $ 2.96 | $ 29.60 | ||
| dihydroergotamine | 81284-0411-05 | 8 | $ 93.60 | $ 93.60 | $ 748.80 | ||
| Docetaxel 160mg | 43066-0010-01 | 10 | $ 327.60 | $ 327.60 | $ 3,276.00 | ||
| Docetaxel 20mg | 25021-0245-01 | 4 | $ 30.00 | $ 30.00 | $ 120.00 | ||
| Docetaxel 80mg | 25021-0245-04 | 10 | $ 102.00 | $ 102.00 | $ 1,020.00 | ||
| Doxorubicin 10mg/5mL | 00069-3030-20 | 6 | $ 12.18 | $ 12.18 | $ 73.08 | ||
| Doxorubicin 50mg | Adriamycin | 00069-0343-02 | 27 | $ 29.48 | $ 29.48 | $ 795.96 | |
| Eculizumab 300mg | Soliris | 25682-0001-01 | 2 | $ 7,827.60 | $ 7,827.60 | $ 15,655.20 | |
| Enfortumab vedotin-ejfv 20mg | Padcev | 51144-0020-01 | 20 | $ 3,370.80 | $ 3,370.80 | $ 67,416.00 | |
| Enfortumab vedotin-ejfv 30mg | Padcev | 51144-0030-01 | 40 | $ 5,056.20 | $ 5,056.20 | $ 202,248.00 | |
| Epirubicin 50mg | Ellence | 00009-5091-01 | 2 | $ 57.71 | $ 57.71 | $ 115.42 | |
| Eribulin mesylate 1mg | Halaven | 62856-0389-01 | 2 | $ 1,692.00 | $ 1,692.00 | $ 3,384.00 | |
| Etoposide 100mg | Vepesid, VP-16, Toposar | 16729-0114-31 | 70 | $ 11.37 | $ 11.37 | $ 795.90 | |
| Etoposide Phosphate 100mg | Etopophos | 61269-0410-20 | 14 | $ 204.42 | $ 204.42 | $ 2,861.88 | |
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 65597-0406-01 | 12 | $ 3,521.70 | $ 3,521.70 | $ 42,260.40 | |
| Fludarabine 50mg | Fludara | 25021-0242-02 | 2 | $ 261.00 | $ 261.00 | $ 522.00 | |
| Fluorouracil 1g | Adrucil, 5-FU | 63323-0117-20 | 15 | $ 8.21 | $ 8.21 | $ 123.12 | |
| Fluorouracil 500mg | Adrucil, 5-FU | 63323-0117-10 | 70 | $ 4.10 | $ 4.10 | $ 287.28 | |
| Fluorouracil 5g | Adrucil, 5-FU | 63323-0117-61 | 52 | $ 32.13 | $ 32.13 | $ 1,670.76 | |
| Fosphenytoin 500mg | 63323-0403-10 | 10 | $ 30.78 | $ 30.78 | $ 307.80 | ||
| Ganciclovir 500mg | Cytovene | 70436-0089-55 | 14 | $ 52.80 | $ 52.80 | $ 739.20 | |
| Gemcitabine 1g | Gemzar | 71288-0117-28 | 40 | $ 26.40 | $ 26.40 | $ 1,056.00 | |
| Gemcitabine 2000mg | Gemzar | 71288-0117-54 | 30 | $ 53.40 | $ 53.40 | $ 1,602.00 | |
| Gemtuzumab ozogamicin | Mylotarg | 00008-4510-01 | 4 | $ 12,601.86 | $ 12,601.86 | $ 50,407.44 | |
| hydrocortisone 100mg PF | 00009-0011-03 | 4 | $ 30.32 | $ 30.32 | $ 121.28 | ||
| Idarubicin 10mg | Idamycin | 00013-2586-10 | 2 | $ 129.34 | $ 129.34 | $ 258.68 | |
| Idarubicin 20mg | Idamycin | 00013-2596-20 | 2 | $ 248.34 | $ 248.34 | $ 496.68 | |
| Idarubicin 5mg | Idamycin | 00013-2576-05 | 2 | $ 64.68 | $ 64.68 | $ 129.36 | |
| Ifosfamide 1g | Ifex | 00703-3427-11 | 2 | $ 44.09 | $ 44.09 | $ 88.18 | |
| Ifosfamide 3g | Ifex | 00338-3993-01 | 40 | $ 125.56 | $ 125.56 | $ 5,022.40 | |
| Inotuzumab Ozogamicin | Besponsa | 00008-0100-01 | 2 | $ 28,699.14 | $ 28,699.14 | $ 57,398.28 | |
| Irinotecan 100mg | Camptosar | 60505-6128-01 | 100 | $ 36.07 | $ 36.07 | $ 3,607.00 | |
| Liposomal Doxorubicin 20mg | Doxil | 00338-0063-01 | 2 | $ 384.19 | $ 384.19 | $ 768.38 | |
| Liposomal Doxorubicin 50mg | Doxil | 00338-0067-01 | 2 | $ 2,020.80 | $ 2,020.80 | $ 4,041.60 | |
| Liposomal Irinotecan 43mg | Onivyde | 69171-0398-01 | 5 | $ 2,137.20 | $ 2,137.20 | $ 10,686.00 | |
| Lurbinectedin 4mg | Zepzelca | 68727-0712-01 | 4 | $ 9,732.00 | $ 9,732.00 | $ 38,928.00 | |
| Mesna 1g | Mesnex | 10019-0953-01 | 2 | $ 30.00 | $ 30.00 | $ 60.00 | |
| Methotrexate 1g | Rheumatrex, Trexall | 16729-0277-35 | 5 | $ 41.16 | $ 41.16 | $ 205.80 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 00703-3671-01 | 4 | $ 12.42 | $ 12.42 | $ 49.68 | |
| Mitomycin 20mg | Mutamycin | 00143-9279-01 | 2 | $ 758.40 | $ 758.40 | $ 1,516.80 | |
| Mitomycin 40mg | Mutamycin | 00143-9280-01 | 2 | $ 1,200.00 | $ 1,200.00 | $ 2,400.00 | |
| Mitomycin 5mg | Mutamycin | 16729-0115-05 | 5 | $ 272.46 | $ 272.46 | $ 1,362.30 | |
| Mitoxantrone 25mg | Novantrone | 00703-4680-01 | 2 | $ 324.71 | $ 324.71 | $ 649.42 | |
| Mycophenolate mofetil 500mg | Cellcept | 00004-0298-09 | 3 | $ 129.57 | $ 129.57 | $ 388.72 | |
| Nelarabine 250mg/50ml inj vial | Arranon | 00078-0683-61 | 15 | $ 969.80 | $ 969.80 | $ 14,547.00 | |
| Oxaliplatin 100mg | 71288-0172-21 | 55 | $ 24.00 | $ 24.00 | $ 1,320.00 | ||
| Paclitaxel 100mg | Taxol | 00703-3216-01 | 8 | $ 40.00 | $ 40.00 | $ 320.00 | |
| Paclitaxel 300mg | Taxol | 61703-0342-50 | 15 | $ 85.56 | $ 85.56 | $ 1,283.40 | |
| Paclitaxel 30mg | Taxol | 61703-0015-04 | 13 | $ 11.17 | $ 11.17 | $ 145.21 | |
| Paclitaxel Protein-Bound 100mg | Abraxane | 67457-0937-50 | 35 | $ 1,535.82 | $ 1,535.82 | $ 53,753.70 | |
| Pamidronate 30mg | 61703-0324-18 | 2 | $ 17.33 | $ 17.33 | $ 34.66 | ||
| Pamidronate 90mg | 61703-0326-18 | 2 | $ 44.98 | $ 44.98 | $ 89.96 | ||
| Pemetrexed 100mg | 71288-0166-10 | 30 | $ 36.00 | $ 36.00 | $ 1,080.00 | ||
| Pemetrexed 500mg | 63323-0134-10 | 48 | $ 150.00 | $ 150.00 | $ 7,200.00 | ||
| Pentostatin 10mg | Nipent | 00409-0801-01 | 1 | $ 3,541.54 | $ 3,541.54 | $ 3,541.54 | |
| Pertuzumab 420mg | Perjeta | 50242-0145-01 | 2 | $ 8,266.43 | $ 8,266.43 | $ 16,532.86 | |
| Phenytoin 250mg inj | 00641-2555-45 | 5 | $ 2.39 | $ 2.39 | $ 11.96 | ||
| Polatuzumab vedotin-piiq 140mg vial | Polivy | 50242-0105-01 | 2 | $ 23,673.71 | $ 23,673.71 | $ 47,347.42 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 50242-0103-01 | 2 | $ 5,072.95 | $ 5,072.95 | $ 10,145.90 | |
| Pralatrexate 20mg | Folotyn | 72893-0003-01 | 2 | $ 8,891.75 | $ 8,891.75 | $ 17,783.50 | |
| Pralatrexate 40mg | Folotyn | 72893-0005-01 | 2 | $ 17,783.50 | $ 17,783.50 | $ 35,567.00 | |
| Reconstitution - NaCl 0.9% 10 mL | 00409-4888-10 | 25 | $ 1.13 | $ 1.13 | $ 28.26 | ||
| Reconstitution - NaCl 0.9% 20 mL | 00409-4888-20 | 25 | $ 1.64 | $ 1.64 | $ 41.10 | ||
| Reconstitution - NaCl 0.9% 50 mL | 00409-4888-50 | 25 | $ 4.25 | $ 4.25 | $ 106.20 | ||
| Reconstitution - SW 10 mL | 00409-4887-10 | 25 | $ 1.37 | $ 1.37 | $ 34.26 | ||
| Reconstitution - SW 20 mL | 00409-4887-20 | 25 | $ 1.94 | $ 1.94 | $ 48.41 | ||
| Reconstitution - SW 50 mL | 00409-4887-50 | 25 | $ 3.53 | $ 3.53 | $ 88.16 | ||
| Reconstitution - SW 100 mL | 00409-4887-99 | 10 | $ 9.83 | $ 9.83 | $ 98.28 | ||
| Romidepsin 10mg | Istodax | 63323-0926-88 | 2 | $ 3,802.38 | $ 3,802.38 | $ 7,604.76 | |
| Sacituzumab govitecan-hziy 180mg vial | Trodelvy | 55135-0132-01 | 13 | $ 3,137.72 | $ 3,137.72 | $ 40,790.36 | |
| Sodium Chloride 0.9% 1000ml | 17271-0701-07 | 17 | $ 11.00 | $ 11.00 | $ 187.00 | ||
| Sodium Chloride 0.9% 100ml | 00264-1800-32 | 100 | $ 3.26 | $ 3.26 | $ 326.41 | ||
| Sodium Chloride 0.9% 150ml | 00990-7983-61 | 40 | $ 6.64 | $ 6.64 | $ 265.44 | ||
| Sodium Chloride 0.9% 250ml | 00264-7800-20 | 100 | $ 3.45 | $ 3.45 | $ 345.00 | ||
| Sodium Chloride 0.9% 50ml | 00264-1800-31 | 40 | $ 3.24 | $ 3.24 | $ 129.60 | ||
| Sodium Chloride 0.9% 500ml | 00264-7800-10 | 40 | $ 4.06 | $ 4.06 | $ 162.40 | ||
| Temsirolimus 25mg | Torisel | 65219-0200-05 | 2 | $ 1,416.00 | $ 1,416.00 | $ 2,832.00 | |
| Topotecan 4mg | Hycamptin | 25021-0236-04 | 2 | $ 180.00 | $ 180.00 | $ 360.00 | |
| Trabectedin 1mg | Yondelis | 59676-0610-01 | 4 | $ 4,737.11 | $ 4,737.11 | $ 18,948.44 | |
| Trastuzumab 150mg | Herceptin | 50242-0132-01 | 0 | $ 1,870.10 | $ 1,870.10 | $ - 0 | |
| Trastuzumab-anns 420mg | Kanjinti | 55513-0141-21 | 8 | $ 1,632.08 | $ 1,632.08 | $ 13,056.64 | |
| Trastuzumab-dttb 150mg vial | Ontruzant | 78206-0147-01 | 0 | $ 1,589.59 | $ 1,589.59 | $ - 0 | |
| Trastuzumab-qyyp 420mg | Trazimera | 00069-0305-01 | 0 | $ 4,069.30 | $ 4,069.30 | $ - 0 | |
| Valproate sodium 500mg | 63323-0494-05 | 10 | $ 8.04 | $ 8.04 | $ 80.40 | ||
| Vinblastine 10mg | Velban | 63323-0278-10 | 4 | $ 73.54 | $ 73.54 | $ 294.16 | |
| Vincristine 1mg | Oncovin | 61703-0309-06 | 5 | $ 21.30 | $ 21.30 | $ 106.50 | |
| Vincristine 2mg | Oncovin | 61703-0309-16 | 5 | $ 18.48 | $ 18.48 | $ 92.40 | |
| Vinorelbine 50mg | Navelbine | 25021-0204-05 | 2 | $ 108.00 | $ 108.00 | $ 216.00 | |
| Voriconazole 200mg | 70594-0067-01 | 10 | $ 48.00 | $ 48.00 | $ 480.00 | ||
| Zoledronic Acid 4mg | Zometa | 25021-0826-82 | 8 | $ 216.00 | $ 216.00 | $ 1,728.00 | |
| Empty Bag (250mL, 1000mL) | 10 | $ 12.00 | $ 12.00 | $ 120.00 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | Trade Name / Generic info will be provided | Valid NDC will be provided at time of TO | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | NDC / Product Number | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | Per Diem | 1000 | $ - 0 | $ - 0 | |||
| Chemoembolic Mixing | Chemoembolic Mix | 4 | $ - 0 | $ - 0 | |||
| Exact Volume Requirement | Exact Vol Req | 200 | $ - 0 | $ - 0 | |||
| Intrathecal Mixing | Intrathecal Mix | 50 | $ - 0 | $ - 0 | |||
| STAT Order | STAT | 10 | $ - 0 | $ - 0 | |||
| Supplies |
All supplies are priced at (AWP (+/- 0.00%) ESTIMATED AT $70.00 per order, Vendor to charge for actual fees, not to exceed $70.00 without approval from the COR
| Estimated Quantity, Not to Exceed, Bill for Actual Usage | Supply | 1000 | $ 70.00 | $ 70,000.00 | ||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | -60% |
Option Year 2
| Generic Name | Brand/Trade Name | NDC / Product Number | Scheduled Usage Over 7 Days (Per Vial) Estimated Quantity | AWP BASE Price | |||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Option Year 2 | 5/1/2028 - 4/30/2029 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | 0% | Total Price Medication (Less other) | $ 1,261,276.27 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 1.00 | $ 1.00 | Total Price Fees (Less Supplies) | $ 70,000.00 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 50242-0088-01 | 6 | $ 4,979.06 | $ 4,979.06 | $ 29,874.36 | Total Evaluated Price | ||
| (Less Supplies/other) | $ 1,331,276.27 | ||||||||
| Arsenic Trioxide 12mg | Trisenox | 70710-1610-06 | 10 | $ 646.65 | $ 646.65 | $ 6,466.52 | |||
| Azacitidine 100mg | Vidaza | 00781-3253-94 | 56 | $ 617.62 | $ 617.62 | $ 34,586.72 | |||
| Bendamustine 100mg | Belrapzo | 42367-0521-25 | 2 | $ 3,120.00 | $ 3,120.00 | $ 6,240.00 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128, F129. F130, F131, F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
| Bendamustine 100mg | Bendeka | 63459-0348-04 | 12 | $ 2,968.56 | $ 2,968.56 | $ 35,622.72 | |
| Bleomycin 15 units | Blenoxane | 71288-0106-10 | 2 | $ 36.82 | $ 36.82 | $ 73.64 | |
| Bleomycin 30 units | Blenoxane | 71288-0107-20 | 2 | $ 80.03 | $ 80.03 | $ 160.06 | |
| Blinatumomab 35mcg | Blincyto | 55513-0160-01 | 2 | $ 6,668.12 | $ 6,668.12 | $ 13,336.24 | |
| Bortezomib 3.5mg | 63323-0821-10 | 30 | $ 55.20 | $ 55.20 | $ 1,656.00 | ||
| Brentuximab vedotin 50mg | Adcetris | 51144-0050-01 | 10 | $ 15,804.19 | $ 15,804.19 | $ 158,041.90 | |
| Cabazitaxel 60mg | Jevtana | 00024-5824-11 | 2 | $ 17,663.82 | $ 17,663.82 | $ 35,327.64 | |
| Carboplatin 600mg | 55150-0386-01 | 30 | $ 60.22 | $ 60.22 | $ 1,806.60 | ||
| Carfilzomib 30mg | Kyprolis | 76075-0102-01 | 2 | $ 2,122.32 | $ 2,122.32 | $ 4,244.64 | |
| Carfilzomib 60mg | Kyprolis | 76075-0101-01 | 12 | $ 4,244.63 | $ 4,244.63 | $ 50,935.56 | |
| Cisplatin 100mg | Platinol | 00143-9505-01 | 30 | $ 36.83 | $ 36.83 | $ 1,104.90 | |
| Cladribine 10mg | Leustatin | 63323-0140-10 | 2 | $ 522.00 | $ 522.00 | $ 1,044.00 | |
| Cyclophosphamide 1g | Cytoxan | 10019-0956-01 | 22 | $ 563.38 | $ 563.38 | $ 12,394.36 | |
| Cyclophosphamide 500mg | Cytoxan | 75907-0191-02 | 6 | $ 351.60 | $ 351.60 | $ 2,109.60 | |
| Cytarabine 100mg | ARA-C, Cytosar | 61703-0305-38 | 6 | $ 7.88 | $ 7.88 | $ 47.28 | |
| Cytarabine 2g | ARA-C, Cytosar | 63323-0120-20 | 15 | $ 25.08 | $ 25.08 | $ 376.20 | |
| Dacarbazine 200mg | DTIC | 00143-9245-10 | 6 | $ 14.40 | $ 14.40 | $ 86.40 | |
| Dactinomycin 0.5mg | Cosmegen | 71288-0129-02 | 3 | $ 600.00 | $ 600.00 | $ 1,800.00 | |
| datopotamab deruxtecan 100mg | 65597-0801-01 | 6 | $ 5,986.49 | $ 5,986.49 | $ 35,918.94 | ||
| Daunorubicin 20mg | Cerubidine | 00143-9551-10 | 4 | $ 160.97 | $ 160.97 | $ 643.87 | |
| Decitabine 50mg | Dacogen | 00143-9385-01 | 12 | $ 120.00 | $ 120.00 | $ 1,440.00 | |
| Dexrazoxane 500mg | Zinecard, Totect | 00143-9248-01 | 2 | $ 240.00 | $ 240.00 | $ 480.00 | |
| Dextrose 5% 1000ml | 00264-7510-00 | 10 | $ 4.82 | $ 4.82 | $ 48.20 | ||
| Dextrose 5% 100ml | 00264-1510-32 | 10 | $ 2.96 | $ 2.96 | $ 29.64 | ||
| Dextrose 5% 250ml | 00264-7510-20 | 60 | $ 4.44 | $ 4.44 | $ 266.40 | ||
| Dextrose 5% 500ml | 00264-7510-10 | 30 | $ 4.84 | $ 4.84 | $ 145.20 | ||
| Dextrose 5% 50ml | 65219-456-05 | 10 | $ 2.96 | $ 2.96 | $ 29.60 | ||
| dihydroergotamine | 81284-0411-05 | 8 | $ 93.60 | $ 93.60 | $ 748.80 | ||
| Docetaxel 160mg | 43066-0010-01 | 10 | $ 327.60 | $ 327.60 | $ 3,276.00 | ||
| Docetaxel 20mg | 25021-0245-01 | 4 | $ 30.00 | $ 30.00 | $ 120.00 | ||
| Docetaxel 80mg | 25021-0245-04 | 10 | $ 102.00 | $ 102.00 | $ 1,020.00 | ||
| Doxorubicin 10mg/5mL | 00069-3030-20 | 6 | $ 12.18 | $ 12.18 | $ 73.08 | ||
| Doxorubicin 50mg | Adriamycin | 00069-0343-02 | 27 | $ 29.48 | $ 29.48 | $ 795.96 | |
| Eculizumab 300mg | Soliris | 25682-0001-01 | 2 | $ 7,827.60 | $ 7,827.60 | $ 15,655.20 | |
| Enfortumab vedotin-ejfv 20mg | Padcev | 51144-0020-01 | 20 | $ 3,370.80 | $ 3,370.80 | $ 67,416.00 | |
| Enfortumab vedotin-ejfv 30mg | Padcev | 51144-0030-01 | 40 | $ 5,056.20 | $ 5,056.20 | $ 202,248.00 | |
| Epirubicin 50mg | Ellence | 00009-5091-01 | 2 | $ 57.71 | $ 57.71 | $ 115.42 | |
| Eribulin mesylate 1mg | Halaven | 62856-0389-01 | 2 | $ 1,692.00 | $ 1,692.00 | $ 3,384.00 | |
| Etoposide 100mg | Vepesid, VP-16, Toposar | 16729-0114-31 | 70 | $ 11.37 | $ 11.37 | $ 795.90 | |
| Etoposide Phosphate 100mg | Etopophos | 61269-0410-20 | 14 | $ 204.42 | $ 204.42 | $ 2,861.88 | |
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 65597-0406-01 | 12 | $ 3,521.70 | $ 3,521.70 | $ 42,260.40 | |
| Fludarabine 50mg | Fludara | 25021-0242-02 | 2 | $ 261.00 | $ 261.00 | $ 522.00 | |
| Fluorouracil 1g | Adrucil, 5-FU | 63323-0117-20 | 15 | $ 8.21 | $ 8.21 | $ 123.12 | |
| Fluorouracil 500mg | Adrucil, 5-FU | 63323-0117-10 | 70 | $ 4.10 | $ 4.10 | $ 287.28 | |
| Fluorouracil 5g | Adrucil, 5-FU | 63323-0117-61 | 52 | $ 32.13 | $ 32.13 | $ 1,670.76 | |
| Fosphenytoin 500mg | 63323-0403-10 | 10 | $ 30.78 | $ 30.78 | $ 307.80 | ||
| Ganciclovir 500mg | Cytovene | 70436-0089-55 | 14 | $ 52.80 | $ 52.80 | $ 739.20 | |
| Gemcitabine 1g | Gemzar | 71288-0117-28 | 40 | $ 26.40 | $ 26.40 | $ 1,056.00 | |
| Gemcitabine 2000mg | Gemzar | 71288-0117-54 | 30 | $ 53.40 | $ 53.40 | $ 1,602.00 | |
| Gemtuzumab ozogamicin | Mylotarg | 00008-4510-01 | 4 | $ 12,601.86 | $ 12,601.86 | $ 50,407.44 | |
| hydrocortisone 100mg PF | 00009-0011-03 | 4 | $ 30.32 | $ 30.32 | $ 121.28 | ||
| Idarubicin 10mg | Idamycin | 00013-2586-10 | 2 | $ 129.34 | $ 129.34 | $ 258.68 | |
| Idarubicin 20mg | Idamycin | 00013-2596-20 | 2 | $ 248.34 | $ 248.34 | $ 496.68 | |
| Idarubicin 5mg | Idamycin | 00013-2576-05 | 2 | $ 64.68 | $ 64.68 | $ 129.36 | |
| Ifosfamide 1g | Ifex | 00703-3427-11 | 2 | $ 44.09 | $ 44.09 | $ 88.18 | |
| Ifosfamide 3g | Ifex | 00338-3993-01 | 40 | $ 125.56 | $ 125.56 | $ 5,022.40 | |
| Inotuzumab Ozogamicin | Besponsa | 00008-0100-01 | 2 | $ 28,699.14 | $ 28,699.14 | $ 57,398.28 | |
| Irinotecan 100mg | Camptosar | 60505-6128-01 | 100 | $ 36.07 | $ 36.07 | $ 3,607.00 | |
| Liposomal Doxorubicin 20mg | Doxil | 00338-0063-01 | 2 | $ 384.19 | $ 384.19 | $ 768.38 | |
| Liposomal Doxorubicin 50mg | Doxil | 00338-0067-01 | 2 | $ 2,020.80 | $ 2,020.80 | $ 4,041.60 | |
| Liposomal Irinotecan 43mg | Onivyde | 69171-0398-01 | 5 | $ 2,137.20 | $ 2,137.20 | $ 10,686.00 | |
| Lurbinectedin 4mg | Zepzelca | 68727-0712-01 | 4 | $ 9,732.00 | $ 9,732.00 | $ 38,928.00 | |
| Mesna 1g | Mesnex | 10019-0953-01 | 2 | $ 30.00 | $ 30.00 | $ 60.00 | |
| Methotrexate 1g | Rheumatrex, Trexall | 16729-0277-35 | 5 | $ 41.16 | $ 41.16 | $ 205.80 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 00703-3671-01 | 4 | $ 12.42 | $ 12.42 | $ 49.68 | |
| Mitomycin 20mg | Mutamycin | 00143-9279-01 | 2 | $ 758.40 | $ 758.40 | $ 1,516.80 | |
| Mitomycin 40mg | Mutamycin | 00143-9280-01 | 2 | $ 1,200.00 | $ 1,200.00 | $ 2,400.00 | |
| Mitomycin 5mg | Mutamycin | 16729-0115-05 | 5 | $ 272.46 | $ 272.46 | $ 1,362.30 | |
| Mitoxantrone 25mg | Novantrone | 00703-4680-01 | 2 | $ 324.71 | $ 324.71 | $ 649.42 | |
| Mycophenolate mofetil 500mg | Cellcept | 00004-0298-09 | 3 | $ 129.57 | $ 129.57 | $ 388.72 | |
| Nelarabine 250mg/50ml inj vial | Arranon | 00078-0683-61 | 15 | $ 969.80 | $ 969.80 | $ 14,547.00 | |
| Oxaliplatin 100mg | 71288-0172-21 | 55 | $ 24.00 | $ 24.00 | $ 1,320.00 | ||
| Paclitaxel 100mg | Taxol | 00703-3216-01 | 8 | $ 40.00 | $ 40.00 | $ 320.00 | |
| Paclitaxel 300mg | Taxol | 61703-0342-50 | 15 | $ 85.56 | $ 85.56 | $ 1,283.40 | |
| Paclitaxel 30mg | Taxol | 61703-0015-04 | 13 | $ 11.17 | $ 11.17 | $ 145.21 | |
| Paclitaxel Protein-Bound 100mg | Abraxane | 67457-0937-50 | 35 | $ 1,535.82 | $ 1,535.82 | $ 53,753.70 | |
| Pamidronate 30mg | 61703-0324-18 | 2 | $ 17.33 | $ 17.33 | $ 34.66 | ||
| Pamidronate 90mg | 61703-0326-18 | 2 | $ 44.98 | $ 44.98 | $ 89.96 | ||
| Pemetrexed 100mg | 71288-0166-10 | 30 | $ 36.00 | $ 36.00 | $ 1,080.00 | ||
| Pemetrexed 500mg | 63323-0134-10 | 48 | $ 150.00 | $ 150.00 | $ 7,200.00 | ||
| Pentostatin 10mg | Nipent | 00409-0801-01 | 1 | $ 3,541.54 | $ 3,541.54 | $ 3,541.54 | |
| Pertuzumab 420mg | Perjeta | 50242-0145-01 | 2 | $ 8,266.43 | $ 8,266.43 | $ 16,532.86 | |
| Phenytoin 250mg inj | 00641-2555-45 | 5 | $ 2.39 | $ 2.39 | $ 11.96 | ||
| Polatuzumab vedotin-piiq 140mg vial | Polivy | 50242-0105-01 | 2 | $ 23,673.71 | $ 23,673.71 | $ 47,347.42 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 50242-0103-01 | 2 | $ 5,072.95 | $ 5,072.95 | $ 10,145.90 | |
| Pralatrexate 20mg | Folotyn | 72893-0003-01 | 2 | $ 8,891.75 | $ 8,891.75 | $ 17,783.50 | |
| Pralatrexate 40mg | Folotyn | 72893-0005-01 | 2 | $ 17,783.50 | $ 17,783.50 | $ 35,567.00 | |
| Reconstitution - NaCl 0.9% 10 mL | 00409-4888-10 | 25 | $ 1.13 | $ 1.13 | $ 28.26 | ||
| Reconstitution - NaCl 0.9% 20 mL | 00409-4888-20 | 25 | $ 1.64 | $ 1.64 | $ 41.10 | ||
| Reconstitution - NaCl 0.9% 50 mL | 00409-4888-50 | 25 | $ 4.25 | $ 4.25 | $ 106.20 | ||
| Reconstitution - SW 10 mL | 00409-4887-10 | 25 | $ 1.37 | $ 1.37 | $ 34.26 | ||
| Reconstitution - SW 20 mL | 00409-4887-20 | 25 | $ 1.94 | $ 1.94 | $ 48.41 | ||
| Reconstitution - SW 50 mL | 00409-4887-50 | 25 | $ 3.53 | $ 3.53 | $ 88.16 | ||
| Reconstitution - SW 100 mL | 00409-4887-99 | 10 | $ 9.83 | $ 9.83 | $ 98.28 | ||
| Romidepsin 10mg | Istodax | 63323-0926-88 | 2 | $ 3,802.38 | $ 3,802.38 | $ 7,604.76 | |
| Sacituzumab govitecan-hziy 180mg vial | Trodelvy | 55135-0132-01 | 13 | $ 3,137.72 | $ 3,137.72 | $ 40,790.36 | |
| Sodium Chloride 0.9% 1000ml | 17271-0701-07 | 17 | $ 11.00 | $ 11.00 | $ 187.00 | ||
| Sodium Chloride 0.9% 100ml | 00264-1800-32 | 100 | $ 3.26 | $ 3.26 | $ 326.41 | ||
| Sodium Chloride 0.9% 150ml | 00990-7983-61 | 40 | $ 6.64 | $ 6.64 | $ 265.44 | ||
| Sodium Chloride 0.9% 250ml | 00264-7800-20 | 100 | $ 3.45 | $ 3.45 | $ 345.00 | ||
| Sodium Chloride 0.9% 50ml | 00264-1800-31 | 40 | $ 3.24 | $ 3.24 | $ 129.60 | ||
| Sodium Chloride 0.9% 500ml | 00264-7800-10 | 40 | $ 4.06 | $ 4.06 | $ 162.40 | ||
| Temsirolimus 25mg | Torisel | 65219-0200-05 | 2 | $ 1,416.00 | $ 1,416.00 | $ 2,832.00 | |
| Topotecan 4mg | Hycamptin | 25021-0236-04 | 2 | $ 180.00 | $ 180.00 | $ 360.00 | |
| Trabectedin 1mg | Yondelis | 59676-0610-01 | 4 | $ 4,737.11 | $ 4,737.11 | $ 18,948.44 | |
| Trastuzumab 150mg | Herceptin | 50242-0132-01 | 0 | $ 1,870.10 | $ 1,870.10 | $ - 0 | |
| Trastuzumab-anns 420mg | Kanjinti | 55513-0141-21 | 8 | $ 1,632.08 | $ 1,632.08 | $ 13,056.64 | |
| Trastuzumab-dttb 150mg vial | Ontruzant | 78206-0147-01 | 0 | $ 1,589.59 | $ 1,589.59 | $ - 0 | |
| Trastuzumab-qyyp 420mg | Trazimera | 00069-0305-01 | 0 | $ 4,069.30 | $ 4,069.30 | $ - 0 | |
| Valproate sodium 500mg | 63323-0494-05 | 10 | $ 8.04 | $ 8.04 | $ 80.40 | ||
| Vinblastine 10mg | Velban | 63323-0278-10 | 4 | $ 73.54 | $ 73.54 | $ 294.16 | |
| Vincristine 1mg | Oncovin | 61703-0309-06 | 5 | $ 21.30 | $ 21.30 | $ 106.50 | |
| Vincristine 2mg | Oncovin | 61703-0309-16 | 5 | $ 18.48 | $ 18.48 | $ 92.40 | |
| Vinorelbine 50mg | Navelbine | 25021-0204-05 | 2 | $ 108.00 | $ 108.00 | $ 216.00 | |
| Voriconazole 200mg | 70594-0067-01 | 10 | $ 48.00 | $ 48.00 | $ 480.00 | ||
| Zoledronic Acid 4mg | Zometa | 25021-0826-82 | 8 | $ 216.00 | $ 216.00 | $ 1,728.00 | |
| Empty Bag (250mL, 1000mL) | 10 | $ 12.00 | $ 12.00 | $ 120.00 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | Trade Name / Generic info will be provided | Valid NDC will be provided at time of TO | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | NDC / Product Number | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | Per Diem | 1000 | $ - 0 | $ - 0 | |||
| Chemoembolic Mixing | Chemoembolic Mix | 4 | $ - 0 | $ - 0 | |||
| Exact Volume Requirement | Exact Vol Req | 200 | $ - 0 | $ - 0 | |||
| Intrathecal Mixing | Intrathecal Mix | 50 | $ - 0 | $ - 0 | |||
| STAT Order | STAT | 10 | $ - 0 | $ - 0 | |||
| Supplies |
All supplies are priced at (AWP (+/- 0.00%) ESTIMATED AT $70.00 per order, Vendor to charge for actual fees, not to exceed $70.00 without approval from the COR
| Estimated Quantity, Not to Exceed, Bill for Actual Usage | Supply | 1000 | $ 70.00 | $ 70,000.00 | ||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | -60% |
Option Year 3
| Generic Name | Brand/Trade Name | NDC / Product Number | Scheduled Usage Over 7 Days (Per Vial) Estimated Quantity | AWP BASE Price | |||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Option Year 3 | 5/1/2029 - 4/30/2030 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | 0% | Total Price Medication (Less other) | $ 1,261,276.27 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 1.00 | $ 1.00 | Total Price Fees (Less Supplies) | $ 70,000.00 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 50242-0088-01 | 6 | $ 4,979.06 | $ 4,979.06 | $ 29,874.36 | Total Evaluated Price | ||
| (Less Supplies/other) | $ 1,331,276.27 | ||||||||
| Arsenic Trioxide 12mg | Trisenox | 70710-1610-06 | 10 | $ 646.65 | $ 646.65 | $ 6,466.52 | |||
| Azacitidine 100mg | Vidaza | 00781-3253-94 | 56 | $ 617.62 | $ 617.62 | $ 34,586.72 | |||
| Bendamustine 100mg | Belrapzo | 42367-0521-25 | 2 | $ 3,120.00 | $ 3,120.00 | $ 6,240.00 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128, F129. F130, F131, F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
| Bendamustine 100mg | Bendeka | 63459-0348-04 | 12 | $ 2,968.56 | $ 2,968.56 | $ 35,622.72 | |
| Bleomycin 15 units | Blenoxane | 71288-0106-10 | 2 | $ 36.82 | $ 36.82 | $ 73.64 | |
| Bleomycin 30 units | Blenoxane | 71288-0107-20 | 2 | $ 80.03 | $ 80.03 | $ 160.06 | |
| Blinatumomab 35mcg | Blincyto | 55513-0160-01 | 2 | $ 6,668.12 | $ 6,668.12 | $ 13,336.24 | |
| Bortezomib 3.5mg | 63323-0821-10 | 30 | $ 55.20 | $ 55.20 | $ 1,656.00 | ||
| Brentuximab vedotin 50mg | Adcetris | 51144-0050-01 | 10 | $ 15,804.19 | $ 15,804.19 | $ 158,041.90 | |
| Cabazitaxel 60mg | Jevtana | 00024-5824-11 | 2 | $ 17,663.82 | $ 17,663.82 | $ 35,327.64 | |
| Carboplatin 600mg | 55150-0386-01 | 30 | $ 60.22 | $ 60.22 | $ 1,806.60 | ||
| Carfilzomib 30mg | Kyprolis | 76075-0102-01 | 2 | $ 2,122.32 | $ 2,122.32 | $ 4,244.64 | |
| Carfilzomib 60mg | Kyprolis | 76075-0101-01 | 12 | $ 4,244.63 | $ 4,244.63 | $ 50,935.56 | |
| Cisplatin 100mg | Platinol | 00143-9505-01 | 30 | $ 36.83 | $ 36.83 | $ 1,104.90 | |
| Cladribine 10mg | Leustatin | 63323-0140-10 | 2 | $ 522.00 | $ 522.00 | $ 1,044.00 | |
| Cyclophosphamide 1g | Cytoxan | 10019-0956-01 | 22 | $ 563.38 | $ 563.38 | $ 12,394.36 | |
| Cyclophosphamide 500mg | Cytoxan | 75907-0191-02 | 6 | $ 351.60 | $ 351.60 | $ 2,109.60 | |
| Cytarabine 100mg | ARA-C, Cytosar | 61703-0305-38 | 6 | $ 7.88 | $ 7.88 | $ 47.28 | |
| Cytarabine 2g | ARA-C, Cytosar | 63323-0120-20 | 15 | $ 25.08 | $ 25.08 | $ 376.20 | |
| Dacarbazine 200mg | DTIC | 00143-9245-10 | 6 | $ 14.40 | $ 14.40 | $ 86.40 | |
| Dactinomycin 0.5mg | Cosmegen | 71288-0129-02 | 3 | $ 600.00 | $ 600.00 | $ 1,800.00 | |
| datopotamab deruxtecan 100mg | 65597-0801-01 | 6 | $ 5,986.49 | $ 5,986.49 | $ 35,918.94 | ||
| Daunorubicin 20mg | Cerubidine | 00143-9551-10 | 4 | $ 160.97 | $ 160.97 | $ 643.87 | |
| Decitabine 50mg | Dacogen | 00143-9385-01 | 12 | $ 120.00 | $ 120.00 | $ 1,440.00 | |
| Dexrazoxane 500mg | Zinecard, Totect | 00143-9248-01 | 2 | $ 240.00 | $ 240.00 | $ 480.00 | |
| Dextrose 5% 1000ml | 00264-7510-00 | 10 | $ 4.82 | $ 4.82 | $ 48.20 | ||
| Dextrose 5% 100ml | 00264-1510-32 | 10 | $ 2.96 | $ 2.96 | $ 29.64 | ||
| Dextrose 5% 250ml | 00264-7510-20 | 60 | $ 4.44 | $ 4.44 | $ 266.40 | ||
| Dextrose 5% 500ml | 00264-7510-10 | 30 | $ 4.84 | $ 4.84 | $ 145.20 | ||
| Dextrose 5% 50ml | 65219-456-05 | 10 | $ 2.96 | $ 2.96 | $ 29.60 | ||
| dihydroergotamine | 81284-0411-05 | 8 | $ 93.60 | $ 93.60 | $ 748.80 | ||
| Docetaxel 160mg | 43066-0010-01 | 10 | $ 327.60 | $ 327.60 | $ 3,276.00 | ||
| Docetaxel 20mg | 25021-0245-01 | 4 | $ 30.00 | $ 30.00 | $ 120.00 | ||
| Docetaxel 80mg | 25021-0245-04 | 10 | $ 102.00 | $ 102.00 | $ 1,020.00 | ||
| Doxorubicin 10mg/5mL | 00069-3030-20 | 6 | $ 12.18 | $ 12.18 | $ 73.08 | ||
| Doxorubicin 50mg | Adriamycin | 00069-0343-02 | 27 | $ 29.48 | $ 29.48 | $ 795.96 | |
| Eculizumab 300mg | Soliris | 25682-0001-01 | 2 | $ 7,827.60 | $ 7,827.60 | $ 15,655.20 | |
| Enfortumab vedotin-ejfv 20mg | Padcev | 51144-0020-01 | 20 | $ 3,370.80 | $ 3,370.80 | $ 67,416.00 | |
| Enfortumab vedotin-ejfv 30mg | Padcev | 51144-0030-01 | 40 | $ 5,056.20 | $ 5,056.20 | $ 202,248.00 | |
| Epirubicin 50mg | Ellence | 00009-5091-01 | 2 | $ 57.71 | $ 57.71 | $ 115.42 | |
| Eribulin mesylate 1mg | Halaven | 62856-0389-01 | 2 | $ 1,692.00 | $ 1,692.00 | $ 3,384.00 | |
| Etoposide 100mg | Vepesid, VP-16, Toposar | 16729-0114-31 | 70 | $ 11.37 | $ 11.37 | $ 795.90 | |
| Etoposide Phosphate 100mg | Etopophos | 61269-0410-20 | 14 | $ 204.42 | $ 204.42 | $ 2,861.88 | |
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 65597-0406-01 | 12 | $ 3,521.70 | $ 3,521.70 | $ 42,260.40 | |
| Fludarabine 50mg | Fludara | 25021-0242-02 | 2 | $ 261.00 | $ 261.00 | $ 522.00 | |
| Fluorouracil 1g | Adrucil, 5-FU | 63323-0117-20 | 15 | $ 8.21 | $ 8.21 | $ 123.12 | |
| Fluorouracil 500mg | Adrucil, 5-FU | 63323-0117-10 | 70 | $ 4.10 | $ 4.10 | $ 287.28 | |
| Fluorouracil 5g | Adrucil, 5-FU | 63323-0117-61 | 52 | $ 32.13 | $ 32.13 | $ 1,670.76 | |
| Fosphenytoin 500mg | 63323-0403-10 | 10 | $ 30.78 | $ 30.78 | $ 307.80 | ||
| Ganciclovir 500mg | Cytovene | 70436-0089-55 | 14 | $ 52.80 | $ 52.80 | $ 739.20 | |
| Gemcitabine 1g | Gemzar | 71288-0117-28 | 40 | $ 26.40 | $ 26.40 | $ 1,056.00 | |
| Gemcitabine 2000mg | Gemzar | 71288-0117-54 | 30 | $ 53.40 | $ 53.40 | $ 1,602.00 | |
| Gemtuzumab ozogamicin | Mylotarg | 00008-4510-01 | 4 | $ 12,601.86 | $ 12,601.86 | $ 50,407.44 | |
| hydrocortisone 100mg PF | 00009-0011-03 | 4 | $ 30.32 | $ 30.32 | $ 121.28 | ||
| Idarubicin 10mg | Idamycin | 00013-2586-10 | 2 | $ 129.34 | $ 129.34 | $ 258.68 | |
| Idarubicin 20mg | Idamycin | 00013-2596-20 | 2 | $ 248.34 | $ 248.34 | $ 496.68 | |
| Idarubicin 5mg | Idamycin | 00013-2576-05 | 2 | $ 64.68 | $ 64.68 | $ 129.36 | |
| Ifosfamide 1g | Ifex | 00703-3427-11 | 2 | $ 44.09 | $ 44.09 | $ 88.18 | |
| Ifosfamide 3g | Ifex | 00338-3993-01 | 40 | $ 125.56 | $ 125.56 | $ 5,022.40 | |
| Inotuzumab Ozogamicin | Besponsa | 00008-0100-01 | 2 | $ 28,699.14 | $ 28,699.14 | $ 57,398.28 | |
| Irinotecan 100mg | Camptosar | 60505-6128-01 | 100 | $ 36.07 | $ 36.07 | $ 3,607.00 | |
| Liposomal Doxorubicin 20mg | Doxil | 00338-0063-01 | 2 | $ 384.19 | $ 384.19 | $ 768.38 | |
| Liposomal Doxorubicin 50mg | Doxil | 00338-0067-01 | 2 | $ 2,020.80 | $ 2,020.80 | $ 4,041.60 | |
| Liposomal Irinotecan 43mg | Onivyde | 69171-0398-01 | 5 | $ 2,137.20 | $ 2,137.20 | $ 10,686.00 | |
| Lurbinectedin 4mg | Zepzelca | 68727-0712-01 | 4 | $ 9,732.00 | $ 9,732.00 | $ 38,928.00 | |
| Mesna 1g | Mesnex | 10019-0953-01 | 2 | $ 30.00 | $ 30.00 | $ 60.00 | |
| Methotrexate 1g | Rheumatrex, Trexall | 16729-0277-35 | 5 | $ 41.16 | $ 41.16 | $ 205.80 | |
| Methotrexate 50mg | Rheumatrex, Trexall | 00703-3671-01 | 4 | $ 12.42 | $ 12.42 | $ 49.68 | |
| Mitomycin 20mg | Mutamycin | 00143-9279-01 | 2 | $ 758.40 | $ 758.40 | $ 1,516.80 | |
| Mitomycin 40mg | Mutamycin | 00143-9280-01 | 2 | $ 1,200.00 | $ 1,200.00 | $ 2,400.00 | |
| Mitomycin 5mg | Mutamycin | 16729-0115-05 | 5 | $ 272.46 | $ 272.46 | $ 1,362.30 | |
| Mitoxantrone 25mg | Novantrone | 00703-4680-01 | 2 | $ 324.71 | $ 324.71 | $ 649.42 | |
| Mycophenolate mofetil 500mg | Cellcept | 00004-0298-09 | 3 | $ 129.57 | $ 129.57 | $ 388.72 | |
| Nelarabine 250mg/50ml inj vial | Arranon | 00078-0683-61 | 15 | $ 969.80 | $ 969.80 | $ 14,547.00 | |
| Oxaliplatin 100mg | 71288-0172-21 | 55 | $ 24.00 | $ 24.00 | $ 1,320.00 | ||
| Paclitaxel 100mg | Taxol | 00703-3216-01 | 8 | $ 40.00 | $ 40.00 | $ 320.00 | |
| Paclitaxel 300mg | Taxol | 61703-0342-50 | 15 | $ 85.56 | $ 85.56 | $ 1,283.40 | |
| Paclitaxel 30mg | Taxol | 61703-0015-04 | 13 | $ 11.17 | $ 11.17 | $ 145.21 | |
| Paclitaxel Protein-Bound 100mg | Abraxane | 67457-0937-50 | 35 | $ 1,535.82 | $ 1,535.82 | $ 53,753.70 | |
| Pamidronate 30mg | 61703-0324-18 | 2 | $ 17.33 | $ 17.33 | $ 34.66 | ||
| Pamidronate 90mg | 61703-0326-18 | 2 | $ 44.98 | $ 44.98 | $ 89.96 | ||
| Pemetrexed 100mg | 71288-0166-10 | 30 | $ 36.00 | $ 36.00 | $ 1,080.00 | ||
| Pemetrexed 500mg | 63323-0134-10 | 48 | $ 150.00 | $ 150.00 | $ 7,200.00 | ||
| Pentostatin 10mg | Nipent | 00409-0801-01 | 1 | $ 3,541.54 | $ 3,541.54 | $ 3,541.54 | |
| Pertuzumab 420mg | Perjeta | 50242-0145-01 | 2 | $ 8,266.43 | $ 8,266.43 | $ 16,532.86 | |
| Phenytoin 250mg inj | 00641-2555-45 | 5 | $ 2.39 | $ 2.39 | $ 11.96 | ||
| Polatuzumab vedotin-piiq 140mg vial | Polivy | 50242-0105-01 | 2 | $ 23,673.71 | $ 23,673.71 | $ 47,347.42 | |
| Polatuzumab Vedotin-piiq 30mg | Polivy | 50242-0103-01 | 2 | $ 5,072.95 | $ 5,072.95 | $ 10,145.90 | |
| Pralatrexate 20mg | Folotyn | 72893-0003-01 | 2 | $ 8,891.75 | $ 8,891.75 | $ 17,783.50 | |
| Pralatrexate 40mg | Folotyn | 72893-0005-01 | 2 | $ 17,783.50 | $ 17,783.50 | $ 35,567.00 | |
| Reconstitution - NaCl 0.9% 10 mL | 00409-4888-10 | 25 | $ 1.13 | $ 1.13 | $ 28.26 | ||
| Reconstitution - NaCl 0.9% 20 mL | 00409-4888-20 | 25 | $ 1.64 | $ 1.64 | $ 41.10 | ||
| Reconstitution - NaCl 0.9% 50 mL | 00409-4888-50 | 25 | $ 4.25 | $ 4.25 | $ 106.20 | ||
| Reconstitution - SW 10 mL | 00409-4887-10 | 25 | $ 1.37 | $ 1.37 | $ 34.26 | ||
| Reconstitution - SW 20 mL | 00409-4887-20 | 25 | $ 1.94 | $ 1.94 | $ 48.41 | ||
| Reconstitution - SW 50 mL | 00409-4887-50 | 25 | $ 3.53 | $ 3.53 | $ 88.16 | ||
| Reconstitution - SW 100 mL | 00409-4887-99 | 10 | $ 9.83 | $ 9.83 | $ 98.28 | ||
| Romidepsin 10mg | Istodax | 63323-0926-88 | 2 | $ 3,802.38 | $ 3,802.38 | $ 7,604.76 | |
| Sacituzumab govitecan-hziy 180mg vial | Trodelvy | 55135-0132-01 | 13 | $ 3,137.72 | $ 3,137.72 | $ 40,790.36 | |
| Sodium Chloride 0.9% 1000ml | 17271-0701-07 | 17 | $ 11.00 | $ 11.00 | $ 187.00 | ||
| Sodium Chloride 0.9% 100ml | 00264-1800-32 | 100 | $ 3.26 | $ 3.26 | $ 326.41 | ||
| Sodium Chloride 0.9% 150ml | 00990-7983-61 | 40 | $ 6.64 | $ 6.64 | $ 265.44 | ||
| Sodium Chloride 0.9% 250ml | 00264-7800-20 | 100 | $ 3.45 | $ 3.45 | $ 345.00 | ||
| Sodium Chloride 0.9% 50ml | 00264-1800-31 | 40 | $ 3.24 | $ 3.24 | $ 129.60 | ||
| Sodium Chloride 0.9% 500ml | 00264-7800-10 | 40 | $ 4.06 | $ 4.06 | $ 162.40 | ||
| Temsirolimus 25mg | Torisel | 65219-0200-05 | 2 | $ 1,416.00 | $ 1,416.00 | $ 2,832.00 | |
| Topotecan 4mg | Hycamptin | 25021-0236-04 | 2 | $ 180.00 | $ 180.00 | $ 360.00 | |
| Trabectedin 1mg | Yondelis | 59676-0610-01 | 4 | $ 4,737.11 | $ 4,737.11 | $ 18,948.44 | |
| Trastuzumab 150mg | Herceptin | 50242-0132-01 | 0 | $ 1,870.10 | $ 1,870.10 | $ - 0 | |
| Trastuzumab-anns 420mg | Kanjinti | 55513-0141-21 | 8 | $ 1,632.08 | $ 1,632.08 | $ 13,056.64 | |
| Trastuzumab-dttb 150mg vial | Ontruzant | 78206-0147-01 | 0 | $ 1,589.59 | $ 1,589.59 | $ - 0 | |
| Trastuzumab-qyyp 420mg | Trazimera | 00069-0305-01 | 0 | $ 4,069.30 | $ 4,069.30 | $ - 0 | |
| Valproate sodium 500mg | 63323-0494-05 | 10 | $ 8.04 | $ 8.04 | $ 80.40 | ||
| Vinblastine 10mg | Velban | 63323-0278-10 | 4 | $ 73.54 | $ 73.54 | $ 294.16 | |
| Vincristine 1mg | Oncovin | 61703-0309-06 | 5 | $ 21.30 | $ 21.30 | $ 106.50 | |
| Vincristine 2mg | Oncovin | 61703-0309-16 | 5 | $ 18.48 | $ 18.48 | $ 92.40 | |
| Vinorelbine 50mg | Navelbine | 25021-0204-05 | 2 | $ 108.00 | $ 108.00 | $ 216.00 | |
| Voriconazole 200mg | 70594-0067-01 | 10 | $ 48.00 | $ 48.00 | $ 480.00 | ||
| Zoledronic Acid 4mg | Zometa | 25021-0826-82 | 8 | $ 216.00 | $ 216.00 | $ 1,728.00 | |
| Empty Bag (250mL, 1000mL) | 10 | $ 12.00 | $ 12.00 | $ 120.00 | |||
| Other (AWP+ (?)%) | |||||||
| Drugs not listed above | Trade Name / Generic info will be provided | Valid NDC will be provided at time of TO | 50 | Pricing at AWP + Discount/Surcharge above |
| Applicable Fees | NDC / Product Number | Estimated Contingency Usage / Mo | Price | Total |
| Per Diem (Includes Shipping) |
USP 797 FEE
USP 800 FEE
| Delivery Fee | Per Diem | 1000 | $ - 0 | $ - 0 | |||
| Chemoembolic Mixing | Chemoembolic Mix | 4 | $ - 0 | $ - 0 | |||
| Exact Volume Requirement | Exact Vol Req | 200 | $ - 0 | $ - 0 | |||
| Intrathecal Mixing | Intrathecal Mix | 50 | $ - 0 | $ - 0 | |||
| STAT Order | STAT | 10 | $ - 0 | $ - 0 | |||
| Supplies |
All supplies are priced at (AWP (+/- 0.00%) ESTIMATED AT $70.00 per order, Vendor to charge for actual fees, not to exceed $70.00 without approval from the COR
| Estimated Quantity, Not to Exceed, Bill for Actual Usage | Supply | 1000 | $ 70.00 | $ 70,000.00 | ||
| Supplies | Please indicate Discount off of LIST PRICE for all supplies -> | -60% |
Option Year 4
| Generic Name | Brand/Trade Name | NDC / Product Number | Scheduled Usage Over 7 Days (Per Vial) Estimated Quantity | AWP BASE Price | |||||
| No Surcharge or Discount | AWP +/- % ? Pricing | ||||||||
| (from F2) | Total | ||||||||
| Pricing | Option Year 4 | 5/1/2030 - 4/30/2031 | |||||||
| Please indicate AWP Discount or Surcharge HERE -> | 0% | Total Price Medication (Less other) | $ 1,261,276.27 | ||||||
| Example Drug | Example | 1 | 1 | $ 1.00 | $ 1.00 | $ 1.00 | Total Price Fees (Less Supplies) | $ 70,000.00 | |
| Ado-trastuzumab emtansine 100mg | Kadcyla | 50242-0088-01 | 6 | $ 4,979.06 | $ 4,979.06 | $ 29,874.36 | Total Evaluated Price | ||
| (Less Supplies/other) | $ 1,331,276.27 | ||||||||
| Arsenic Trioxide 12mg | Trisenox | 70710-1610-06 | 10 | $ 646.65 | $ 646.65 | $ 6,466.52 | |||
| Azacitidine 100mg | Vidaza | 00781-3253-94 | 56 | $ 617.62 | $ 617.62 | $ 34,586.72 | |||
| Bendamustine 100mg | Belrapzo | 42367-0521-25 | 2 | $ 3,120.00 | $ 3,120.00 | $ 6,240.00 | INSTRUCTIONS / ADDITIONAL INFORMATION: |
Discounts or Pricing shall be entered in YELLOW Highlighted cells (F2, F128, F129. F130, F131, F132, and G134)
Responses without all areas completed will be considered incomplete and will be dismissed from evaluations.
The AWP Pricing in Column E is a previous AWP Price used here for Price Evaluation purposes only.
Contractor to input actual surcharge or discount in Cell F2. All Pricing is calculated based upon the provided AWP x Disount/Surcharge x Estimated* contingency usage/mo.
Actual Price invoiced to the Government shall be AWP (At time of order) +/- Discount or Surcharge in F2 + any fees or supplies required for the order and approved by the station POC.
*Estimates in Column (D) are based on CY25 use / 7 locations that required HAZ Compounding / 12 months.
| Bendamustine 100mg | Bendeka | 63459-0348-04 | 12 | $ 2,968.56 | $ 2,968.56 | $ 35,622.72 | |
| Bleomycin 15 units | Blenoxane | 71288-0106-10 | 2 | $ 36.82 | $ 36.82 | $ 73.64 | |
| Bleomycin 30 units | Blenoxane | 71288-0107-20 | 2 | $ 80.03 | $ 80.03 | $ 160.06 | |
| Blinatumomab 35mcg | Blincyto | 55513-0160-01 | 2 | $ 6,668.12 | $ 6,668.12 | $ 13,336.24 | |
| Bortezomib 3.5mg | 63323-0821-10 | 30 | $ 55.20 | $ 55.20 | $ 1,656.00 | ||
| Brentuximab vedotin 50mg | Adcetris | 51144-0050-01 | 10 | $ 15,804.19 | $ 15,804.19 | $ 158,041.90 | |
| Cabazitaxel 60mg | Jevtana | 00024-5824-11 | 2 | $ 17,663.82 | $ 17,663.82 | $ 35,327.64 | |
| Carboplatin 600mg | 55150-0386-01 | 30 | $ 60.22 | $ 60.22 | $ 1,806.60 | ||
| Carfilzomib 30mg | Kyprolis | 76075-0102-01 | 2 | $ 2,122.32 | $ 2,122.32 | $ 4,244.64 | |
| Carfilzomib 60mg | Kyprolis | 76075-0101-01 | 12 | $ 4,244.63 | $ 4,244.63 | $ 50,935.56 | |
| Cisplatin 100mg | Platinol | 00143-9505-01 | 30 | $ 36.83 | $ 36.83 | $ 1,104.90 | |
| Cladribine 10mg | Leustatin | 63323-0140-10 | 2 | $ 522.00 | $ 522.00 | $ 1,044.00 | |
| Cyclophosphamide 1g | Cytoxan | 10019-0956-01 | 22 | $ 563.38 | $ 563.38 | $ 12,394.36 | |
| Cyclophosphamide 500mg | Cytoxan | 75907-0191-02 | 6 | $ 351.60 | $ 351.60 | $ 2,109.60 | |
| Cytarabine 100mg | ARA-C, Cytosar | 61703-0305-38 | 6 | $ 7.88 | $ 7.88 | $ 47.28 | |
| Cytarabine 2g | ARA-C, Cytosar | 63323-0120-20 | 15 | $ 25.08 | $ 25.08 | $ 376.20 | |
| Dacarbazine 200mg | DTIC | 00143-9245-10 | 6 | $ 14.40 | $ 14.40 | $ 86.40 | |
| Dactinomycin 0.5mg | Cosmegen | 71288-0129-02 | 3 | $ 600.00 | $ 600.00 | $ 1,800.00 | |
| datopotamab deruxtecan 100mg | 65597-0801-01 | 6 | $ 5,986.49 | $ 5,986.49 | $ 35,918.94 | ||
| Daunorubicin 20mg | Cerubidine | 00143-9551-10 | 4 | $ 160.97 | $ 160.97 | $ 643.87 | |
| Decitabine 50mg | Dacogen | 00143-9385-01 | 12 | $ 120.00 | $ 120.00 | $ 1,440.00 | |
| Dexrazoxane 500mg | Zinecard, Totect | 00143-9248-01 | 2 | $ 240.00 | $ 240.00 | $ 480.00 | |
| Dextrose 5% 1000ml | 00264-7510-00 | 10 | $ 4.82 | $ 4.82 | $ 48.20 | ||
| Dextrose 5% 100ml | 00264-1510-32 | 10 | $ 2.96 | $ 2.96 | $ 29.64 | ||
| Dextrose 5% 250ml | 00264-7510-20 | 60 | $ 4.44 | $ 4.44 | $ 266.40 | ||
| Dextrose 5% 500ml | 00264-7510-10 | 30 | $ 4.84 | $ 4.84 | $ 145.20 | ||
| Dextrose 5% 50ml | 65219-456-05 | 10 | $ 2.96 | $ 2.96 | $ 29.60 | ||
| dihydroergotamine | 81284-0411-05 | 8 | $ 93.60 | $ 93.60 | $ 748.80 | ||
| Docetaxel 160mg | 43066-0010-01 | 10 | $ 327.60 | $ 327.60 | $ 3,276.00 | ||
| Docetaxel 20mg | 25021-0245-01 | 4 | $ 30.00 | $ 30.00 | $ 120.00 | ||
| Docetaxel 80mg | 25021-0245-04 | 10 | $ 102.00 | $ 102.00 | $ 1,020.00 | ||
| Doxorubicin 10mg/5mL | 00069-3030-20 | 6 | $ 12.18 | $ 12.18 | $ 73.08 | ||
| Doxorubicin 50mg | Adriamycin | 00069-0343-02 | 27 | $ 29.48 | $ 29.48 | $ 795.96 | |
| Eculizumab 300mg | Soliris | 25682-0001-01 | 2 | $ 7,827.60 | $ 7,827.60 | $ 15,655.20 | |
| Enfortumab vedotin-ejfv 20mg | Padcev | 51144-0020-01 | 20 | $ 3,370.80 | $ 3,370.80 | $ 67,416.00 | |
| Enfortumab vedotin-ejfv 30mg | Padcev | 51144-0030-01 | 40 | $ 5,056.20 | $ 5,056.20 | $ 202,248.00 | |
| Epirubicin 50mg | Ellence | 00009-5091-01 | 2 | $ 57.71 | $ 57.71 | $ 115.42 | |
| Eribulin mesylate 1mg | Halaven | 62856-0389-01 | 2 | $ 1,692.00 | $ 1,692.00 | $ 3,384.00 | |
| Etoposide 100mg | Vepesid, VP-16, Toposar | 16729-0114-31 | 70 | $ 11.37 | $ 11.37 | $ 795.90 | |
| Etoposide Phosphate 100mg | Etopophos | 61269-0410-20 | 14 | $ 204.42 | $ 204.42 | $ 2,861.88 | |
| Fam-trastuzumab deruxtecan-nxki 100mg | Enhertu | 65597-0406-01 | 12 | $ 3,521.70 | $ 3,521.70 | $ 42,260.40 | |
| Fludarabine 50mg | Fludara | 25021-0242-02 | 2 | $ 261.00 | $ 261.00 | $ 522.00 | |
| Fluorouracil 1g | Adrucil, 5-FU | 63323-0117-20 | 15 | $ 8.21 | $ 8.21 | $ 123.12 | |
| Fluorouracil 500mg | Adrucil, 5-FU | 63323-0117-10 | 70 | $ 4.10 | $ 4.10 | $ 287.28 | |
| Fluorouracil 5g | Adrucil, 5-FU | 63323-0117-61 | 52 | $ 32.13 | $ 32.13 | $ 1,670.76 | |
| Fosphenytoin 500mg | 63323-0403-10 | 10 | $ 30.78 | $ 30.78 | $ 307.80 | ||
| Ganciclovir 500mg | Cytovene | 70436-0089-55 | 14 | $ 52.80 | $ 52.80 | $ 739.20 | |
| Gemcitabine 1g | Gemzar | 71288-0117-28 | 40 | $ 26.40 | $ 26.40 | $ 1,056.00 | |
| Gemcitabine 2000mg | Gemzar | 71288-0117-54 | 30 | $ 53.40 | $ 53.40 | $ 1,602.00 | |
| Gemtuzumab ozogamicin | Mylotarg | 00008-4510-01 | 4 | $ 12,601.86 | $ 12,601.86 | $ 50,407.44 | |
| hydrocortisone 100mg PF | 00009-0011-03 | 4 | $ 30.32 | $ 30.32 | $ 121.28 | ||
| Idarubicin 10mg | Idamycin | 00013-2586-10 | 2 | $ 129.34 | $ 129.34 | $ 258.68 | |
| Idarubicin 20mg | Idamycin | 00013-2596-20 | 2 | $ 248.34 | $ 248.34 | $ 496.68 | |
| Idarubicin 5mg | Idamycin | 00013-2576-05 | 2 | $ 64.68 | $ 64.68 | $ 129.36 | |
| Ifosfamide 1g | Ifex | 00703-3427-11 | 2 | $ 44.09 | $ 44.09 | $ 88.18 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .