SCHEDULE.xlsx

XLSX spreadsheet 19 KB Posted Dec 15, 2020

Attached to: Q517--Emergent First Fill Pharmacy Prescription Services Base plus four (4) Twelve (12) Month Option Years
Solicitation number: 36C24821Q0166
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 8

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Other files

File	Type	Posted
36C24821Q0166 0003.docx	DOCX document	Dec 31, 2020
36C24821Q0166 0002.docx	DOCX document	Dec 21, 2020
Attachement A VISN 8 CBOC _ Clinics.xlsx	XLSX spreadsheet	Dec 21, 2020
36C24821Q0166 0001.docx	DOCX document	Dec 15, 2020
COPY Attachment A - VISN 8 CBOC and Clinics_.xlsx	XLSX spreadsheet	Dec 15, 2020
Descriptive Drug List .xlsx	XLSX spreadsheet	Dec 15, 2020
VISN 8 PBM Acronym List.docx	DOCX document	Dec 15, 2020
36C24821Q0166.docx	DOCX document	Dec 15, 2020
Attachement A VISN 8 w Wage Determinations Nov. 30 2020.xlsx	XLSX spreadsheet	Dec 15, 2020
VISN 8 Emergent First Fill Formulary 8-2020.xlsx	XLSX spreadsheet	Dec 15, 2020

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Item Information

Item Number

Description

Comment

Contract Period

Pop Begin

Pop End

Quantity

Unit of Measure

Unit Price

Amount

PRINCIPAL NAICS CODE

PRODUCT/SERVICE CODE

UNSPSC

SIC CODE

MANUFACTURER PART NUMBER (MPN)

NATIONAL STOCK NUMBER

LOCAL STOCK NUMBER

0001

Dispensing Fee:

Total estimated Quantity:

Brand Name RX: 3,307 Generic RX: 39,733

	Base	1/24/21	1/23/22	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AA	Dispensing Fee:

516 - Clinical Contact Center 516-21-2-083-0012

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AB	Dispensing Fee:

516- Bay Pines 516-21-2-121-0151

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AC	Dispensing Fee:

546- Miami 546-21-2-132-0319

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AD	Dispensing Fee:

548- West Palm Beach 548-21-2-224-0209

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AE	Dispensing Fee:

573- NFSG 573-21-2-089-0007

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AF	Dispensing Fee:

672- San Juan 672-21-2-138-0014

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10,626

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AG	Dispensing Fee:

673 -Tampa 673-21-2-076-0010

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0001AH	Dispensing Fee:

675 -Orlando 675-21-2-2231-0009

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0002	Drug Cost

Includes (eight) 8 separate sites, each site funded separately. Funding is located on SLINS.

AWP - % for Brand Name Drugs

AWP - % for Generic Drugs		Base	1/24/21	1/23/22	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	0002AA	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

516-21-2-083-0012

(516 CLINICAL CONTACT CENTER)

	Base	1/24/21	1/23/22	1.00	LT
0002AB	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

516-21-2-121-0151 (516 - Bay Pines)

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0002AC	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

546-21-2-132-0319 (546 Miami)

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0002AD	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

548-21-2-224-0209 (548 West Palm Beach)

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0002AE	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

573-21-2-089-0007 (573 Northern Florida & Southern Georgia)

	Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
0002AF	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10626

672-21-2-138-0014

(672 San Juan Puerto Rico)		Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	0002AG	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

673-21-2-076-0010

(673 Tampa)		Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	0002AH	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

675-21-2-2231-0009

(675 Orlando)		Base	1/24/21	1/23/22	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1001	Dispensing Fee:

Total estimated Quantity:

Brand Name RX: 3,307 Generic RX: 39,733

	Option 1	1/24/22	1/23/23	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AA	Dispensing Fee:

516 - Clinical Contact Center

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AB	Dispensing Fee:

516- Bay Pines

ESTIMATE QUANTITY:

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AC	Dispensing Fee:

546- Miami

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AD	Dispensing Fee:

548- West Palm Beach

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AE	Dispensing Fee:

573- NFSG

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AF	Dispensing Fee:

672- San Juan

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10,626

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AG	Dispensing Fee:

673 -Tampa

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1001AH	Dispensing Fee:

675 -Orlando

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1002	Drug Cost

Includes (eight) 8 separate sites, each site funded separately. Funding is located on SLINS.

AWP - % for Brand Name Drugs

AWP - % for Generic Drugs		Option 1	1/24/22	1/23/23	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1002AA	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

(516 CLINICAL CONTACT CENTER)

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1002AB	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

(516 - Bay Pines)

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1002AC	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

(546 Miami)		Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1002AD	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

(548 West Palm Beach)

	Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
1002AE	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

(573 Northern Florida & Southern Georgia)		Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1002AF	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10626

(672 San Juan Puerto Rico)		Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1002AG	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

(673 Tampa)		Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	1002AH	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

(675 Orlando)		Option 1	1/24/22	1/23/23	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2001	Dispensing Fee:

Total estimated Quantity:

Brand Name RX: 3,307 Generic RX: 39,733

	Option 2	1/24/23	1/23/24	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AA	Dispensing Fee:

516 - Clinical Contact Center

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AB	Dispensing Fee:

516- Bay Pines

ESTIMATE QUANTITY:

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AC	Dispensing Fee:

546- Miami

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AD	Dispensing Fee:

548- West Palm Beach

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AE	Dispensing Fee:

573- NFSG

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AF	Dispensing Fee:

672- San Juan

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10,626

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AG	Dispensing Fee:

673 -Tampa

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2001AH	Dispensing Fee:

675 -Orlando

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2002	Drug Cost

Includes (eight) 8 separate sites, each site funded separately. Funding is located on SLINS.

AWP - % for Brand Name Drugs

AWP - % for Generic Drugs		Option 2	1/24/23	1/23/24	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AA	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

(516 CLINICAL CONTACT CENTER)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AB	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

(516 - Bay Pines)

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2002AC	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

(546 Miami)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AD	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

(548 West Palm Beach)

	Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
2002AE	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

(573 Northern Florida & Southern Georgia)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AF	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10626

(672 San Juan Puerto Rico)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AG	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

(673 Tampa)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	2002AH	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

(675 Orlando)		Option 2	1/24/23	1/23/24	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3001	Dispensing Fee:

Total estimated Quantity:

Brand Name RX: 3,307 Generic RX: 39,733

	Option 3	1/24/24	1/23/25	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AA	Dispensing Fee:

516 - Clinical Contact Center

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AB	Dispensing Fee:

516- Bay Pines

ESTIMATE QUANTITY:

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AC	Dispensing Fee:

546- Miami

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AD	Dispensing Fee:

548- West Palm Beach

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AE	Dispensing Fee:

573- NFSG

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AF	Dispensing Fee:

672- San Juan

ESTIMATE QUANTITY:

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AG	Dispensing Fee:

673 -Tampa

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3001AH	Dispensing Fee:

675 -Orlando

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3002	Drug Cost

Includes (eight) 8 separate sites, each site funded separately. Funding is located on SLINS.

AWP - % for Brand Name Drugs

AWP - % for Generic Drugs		Option 3	1/24/24	1/23/25	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AA	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

(516 CLINICAL CONTACT CENTER)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AB	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

(516 - Bay Pines)

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3002AC	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

(546 Miami)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AD	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

(548 West Palm Beach)

	Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
3002AE	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

(573 Northern Florida & Southern Georgia)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AF	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10626

(672 San Juan Puerto Rico)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AG	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

(673 Tampa)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	3002AH	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

(675 Orlando)		Option 3	1/24/24	1/23/25	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4001	Dispensing Fee:

Total estimated Quantity:

Brand Name RX: 3,307 Generic RX: 39,733

	Option 4	1/24/25	1/23/26	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AA	Dispensing Fee:

516 - Clinical Contact Center

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AB	Dispensing Fee:

516- Bay Pines

ESTIMATE QUANTITY:

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AC	Dispensing Fee:

546- Miami

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AD	Dispensing Fee:

548- West Palm Beach

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AE	Dispensing Fee:

573- NFSG

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AF	Dispensing Fee:

672- San Juan

ESTIMATE QUANTITY:

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AG	Dispensing Fee:

673 -Tampa

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4001AH	Dispensing Fee:

675 -Orlando

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4002	Drug Cost

Includes (eight) 8 separate sites, each site funded separately. Funding is located on SLINS.

AWP - % for Brand Name Drugs

AWP - % for Generic Drugs		Option 4	1/24/25	1/23/26	8.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AA	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 434

GENERIC = 6802

(516 CLINICAL CONTACT CENTER)		Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AB	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 760

GENERIC = 6380

(516 - Bay Pines)

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4002AC	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 150

GENERIC = 2350

(546 Miami)		Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AD	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME = 450

GENERIC = 4350

(548 West Palm Beach)

	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
4002AE	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 365

GENERIC= 4,195

(573 Northern Florida & Southern Georgia)		Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AF	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 678

GENERIC= 10626

(672 San Juan Puerto Rico)		Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AG	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 270

GENERIC= 2730

(673 Tampa)		Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
	4002AH	DRUG COST

ESTIMATE QUANTITY:

BRAND NAME= 200

GENERIC= 2300

(675 Orlando)	Option 4	1/24/25	1/23/26	1.00	LT	446110 - Pharmacies and Drug Stores	Q517 - Medical - Pharmacology
						Grand Total:

File details come from the government source that posted it. Updated Dec 15, 2020.