Pricing Schedule.pdf

Line Item Description Quantity Unit Unit Price Extended Price

Nurse Advice/Nurse Triage Telephone Services: 24 hours x 7 days x 365 days 12 months $ $

2 Nurse Triage Call with RX Refill 12 months $ $

3 Clinical Follow Up Call 12 months $ $

4 Physician Referrral 12 months $ $

5 General Information and Messaging Calls 12 months $ $

Translation Services: Navajo to English and other languages as needed.

800 minutes $ $

7 On‐Call Schedule Maintenance 12 months $ $

TOTAL = $

Line Item Description Quantity Unit Unit Price Extended Price

Nurse Advice/Nurse Triage Telephone Services: 24 hours x 7 days x 365 days 12 months $ $

2 Nurse Triage Call with RX Refill 12 months $ $

3 Clinical Follow Up Call 12 months $ $

4 Physician Referrral 12 months $ $

5 General Information and Messaging Calls 12 months $ $

Translation Services: Navajo to English and other languages as needed.

800 minutes $ $

7 On‐Call Schedule Maintenance 12 months $ $

TOTAL = $

Line Item Description Quantity Unit Unit Price Extended Price

Nurse Advice/Nurse Triage Telephone Services: 24 hours x 7 days x 365 days 12 months $ $

2 Nurse Triage Call with RX Refill 12 months $ $

3 Clinical Follow Up Call 12 months $ $

4 Physician Referrral 12 months $ $

5 General Information and Messaging Calls 12 months $ $

Translation Services: Navajo to English and other languages as needed.

800 minutes $ $

7 On‐Call Schedule Maintenance 12 months $ $

TOTAL = $

Contractor

Representative:

Print Name

DUNS #:

Note 1:

Signature & Date

Refer to Performance Work Statement for more detail.

Nurse Advice/Nurse Triage Telephone Services

Base Year 01/01/2021 to 12/31/2021

First Year Option 01/01/2022 to 12/31/2022

Second Year Option 01/01/2023 to 12/31/2023

PRICING SCHEDULE