PRICE WORKSHEET - TEMPLATE.xlsx
XLSX spreadsheet 29 KB Posted
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- 36C24222Q0881
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YEAR 1
CONTROLLED SUBSTANCE DISPOSAL PRICE EVALUATION SHEET
YEAR 1
(ADDITIONAL TABS FOR YEARS 2-5)
| BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE |
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 4 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | |
| BATAVIA VAMC | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 4 | $0.00 | |
| CANANDAIGUA VA | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| BATH VA | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| ROCHESTER OPC | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| SYRACUSE VA | ||||
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 6 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | |
| ALBANY VA | ||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | |
| BRONX VA | ||||
| Controlled Substance Destruction Base Fee | JB | 3 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 1 | $0.00 | |
| MANHATTAN VA | ||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | |
| BROOKLYN VA | ||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | |
| St. ALBANS VA | ||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | |
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | |
| NORTHPORT VA | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| EAST ORANGE NJ VA | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| LYONS NJ VA | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | |
| BRICK, NJ VA OPC | ||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | |
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 |
YEAR 1 TOTAL (FOR EVALUATION) $0.00
FIVE YEAR TOTAL FOR EVALUATION PURPOSES $0.00
YEAR 2
| CONTROLLED SUBSTANCE DISPOSAL PRICE EVALUATION SHEET | |||||
| BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE | |
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 4 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BATAVIA VAMC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 4 | $0.00 | ||
| CANANDAIGUA VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BATH VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| ROCHESTER OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| SYRACUSE VA | |||||
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 6 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| ALBANY VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| BRONX VA | |||||
| Controlled Substance Destruction Base Fee | JB | 3 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 1 | $0.00 | ||
| MANHATTAN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BROOKLYN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| St. ALBANS VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| NORTHPORT VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| EAST ORANGE NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| LYONS NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BRICK, NJ VA OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 |
YEAR 2 TOTAL (FOR EVALUATION) $0.00
YEAR 3
| CONTROLLED SUBSTANCE DISPOSAL PRICE EVALUATION SHEET | |||||
| BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE | |
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 4 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BATAVIA VAMC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 4 | $0.00 | ||
| CANANDAIGUA VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BATH VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| ROCHESTER OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| SYRACUSE VA | |||||
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 6 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| ALBANY VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| BRONX VA | |||||
| Controlled Substance Destruction Base Fee | JB | 3 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 1 | $0.00 | ||
| MANHATTAN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BROOKLYN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| St. ALBANS VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| NORTHPORT VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| EAST ORANGE NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| LYONS NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BRICK, NJ VA OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 |
YEAR 3 TOTAL (FOR EVALUATION) $0.00
YEAR 4
| CONTROLLED SUBSTANCE DISPOSAL PRICE EVALUATION SHEET | |||||
| BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE | |
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 4 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BATAVIA VAMC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 4 | $0.00 | ||
| CANANDAIGUA VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BATH VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| ROCHESTER OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| SYRACUSE VA | |||||
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 6 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| ALBANY VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| BRONX VA | |||||
| Controlled Substance Destruction Base Fee | JB | 3 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 1 | $0.00 | ||
| MANHATTAN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BROOKLYN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| St. ALBANS VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| NORTHPORT VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| EAST ORANGE NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| LYONS NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BRICK, NJ VA OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 |
YEAR 4 TOTAL (FOR EVALUATION) $0.00
YEAR 5
| CONTROLLED SUBSTANCE DISPOSAL PRICE EVALUATION SHEET | |||||
| BUFFALO VAMC | UNITS | UNIT PRICE | ESTIMATED QUANTITY FOR EVALUATION ONLY | EXTENDED PRICE | |
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 4 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BATAVIA VAMC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 4 | $0.00 | ||
| CANANDAIGUA VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BATH VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| ROCHESTER OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| SYRACUSE VA | |||||
| Controlled Substance Destruction Base Fee | JB | 12 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 6 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| ALBANY VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| BRONX VA | |||||
| Controlled Substance Destruction Base Fee | JB | 3 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 1 | $0.00 | ||
| MANHATTAN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| BROOKLYN VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| St. ALBANS VA | |||||
| Controlled Substance Destruction Base Fee | JB | 6 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 3 | $0.00 | ||
| Medsafe (CLIN 0003) | EA | 12 | $0.00 | ||
| NORTHPORT VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| EAST ORANGE NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| LYONS NJ VA | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 | ||
| BRICK, NJ VA OPC | |||||
| Controlled Substance Destruction Base Fee | JB | 4 | $0.00 | ||
| Additional Box Fee (CLIN 0002) | EA | 2 | $0.00 |
YEAR 5 TOTAL (FOR EVALUATION) $0.00
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