S02_Pricing Schedule_Q0053.xlsx
XLSX spreadsheet 16 KB Posted
- Solicitation number
- 36C77025Q0053
About this file
This document is a pricing schedule for a Request for Quote (RFQ) for the Leavenworth Community-based Outpatient Pharmacy (CMOP) of the Department of Veterans Affairs (VA). The RFQ solicits quotes for various pharmaceutical products, including bacitracin/hydrocortisone/neomycin/polymyxin ophthalmic ointment, capecitabine tablets, and several other drug products.
The RFQ provides the National Drug Code (NDC) numbers, alternate NDCs, manufacturer, country of origin, packaging, quantity, and unit price for each line item. Vendors are required to submit a signed SF1449 solicitation cover page, the completed quote spreadsheet, a valid state wholesale distributor license, and a Buy American Act (BAA) certificate. Quotes must be submitted by December 2, 2024, at 3:00 PM Central Time. The required delivery time is 10 days After Receipt of Order (ARO), and all pharmaceuticals must have an expiration date of at least one year from the date of delivery.
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| File | Type | Posted |
|---|---|---|
| 36C77025Q0053_1.docx | DOCX document |
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Quote Spreadsheet
| CMOP - Leavenworth | ||||||||||||
| RFQ: 36C77025Q0053 | Delivery 10 days After Receipt of Order (ARO) | Required documents: | ||||||||||
| Solicitation - Quote Spreadsheet | Posted Date: | 11/20/24 | 1. SF1449 - Solicitation cover page (signed) | |||||||||
| Vendor shall complete all areas in orange | Closing Date: | 12/2/24 | 2. Quote - excel spreadsheet | |||||||||
| Vendor Name: | Closing Time: | 3:00PM Central Time (CT) | 3. State Wholesale Distributor License, valid and unexpired | |||||||||
| ueiSAM: | 4. Buy American Act (BAA) Certificate | |||||||||||
| POC Name: | * Vendors shall submit no more than (1) one quote per vendor | |||||||||||
| POC E-Mail: | * If vendor is proposing NDC with count other than CMOP listed NDC, | Email quotes to: Kelley.Cunningham@va.gov | ||||||||||
| Phone: | QTY shall be adjusted for that count and this should be noted in "Vendor Comments" | Customer is requesting full case quantities for products below; please adjust quantity to change total for a full case and make note within vendor comments. | ||||||||||
| * Per the Statement of Requirements, expiration dates of all pharmaceuticals and/or medical surgical supplies | ||||||||||||
| shall be no less than one (1) year of date of delivery. Please provide expiration in "Vendor Comments" if short-dated | ||||||||||||
| Line Item | CMOP Facility | Description | NDC# | Alternate NDCs | Mfr | Country of Origin | Packaging Multiple | Unit | QTY | Unit Price | Total Price | Vendor Comments |
| 0001 | Leavenworth | BACITRACIN/HC 1%/NEO/POLYMYX OPH OINT (B0259) | 24208-0785-55 | 1 | TU | 144 | $ - 0 | $0.00 | ||||
| 0002 | Leavenworth | CAPECITABINE 150MG TAB 60CT (C0795) | 16729-0072-12 | 60 | BT | 384 | $ - 0 | $0.00 | ||||
| 0003 | Leavenworth | CITRIC 334/NA CIT 500/K CIT 550/5ML(SF) 480ML, (C1362) (Must be 480ML) | 00121-0677-16 | 480 | BT | 240 | $ - 0 | $0.00 | ||||
| 0004 | Leavenworth | DEMECLOCYCLINE HCL 150MG TAB (D0013) | 42806-0143-01 | 100 | BT | 96 | $ - 0 | $0.00 | ||||
| 0005 | Leavenworth | DESOXIMETASONE 0.05% CREAM 60GM, (D0027) (Must be 60GM) | 68180-0949-02 | 60 | TU | 120 | $ - 0 | $0.00 | ||||
| 0006 | Leavenworth | DICLOXACILLIN NA 500MG CAP 100CT-(D0065) | 00093-3125-01 | 100 | BT | 144 | $ - 0 | $0.00 | ||||
| 0007 | Leavenworth | DIPYRIDAMOLE 50MG TAB 100CT (D0097) | 68382-0188-01 | 100 | EA | 216 | $ - 0 | $0.00 | ||||
| 0008 | Leavenworth | DARIFENACIN 15MG SA TAB 30CT, (D0656) (Must be 30Ct and Btl must be 3+ inches tall) | 33342-0277-07 | 30 | BT | 720 | $ - 0 | $0.00 | ||||
| 0009 | Leavenworth | DARUNAVIR 600MG TAB 60CT, (D1351) | 72205-0184-60 | 60 | BT | 576 | $ - 0 | $0.00 | ||||
| 0010 | Leavenworth | DARUNAVIR 800MG TAB 30CT, (D1352) | 72205-0185-30 | 30 | BT | 816 | $ - 0 | $0.00 | ||||
| 0011 | Leavenworth | ENTACAPONE 200MG TAB 100CT (E0294) | 62332-0478-31 | 100 | BT | 1152 | $ - 0 | $0.00 | ||||
| 0012 | Leavenworth | EPINASTINE HCL 0.05% OPH SOLN 5ML, (E0382) (Must be 5ML) | 70069-0008-01 | 5 | BT | 144 | $ - 0 | $0.00 | ||||
| 0013 | Leavenworth | ESOMEPRAZOLE MAGNESIUM 40MG EC CAP 90CT (E0444) (Must be 90CT and Btl must be 3+ inches tall) | 43598-0510-90 | 90 | BT | 8832 | $ - 0 | $0.00 | ||||
| Grand Total Price | $0.00 |
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