W81K0021Q0103 AMENDMENT 0001 7.12.2021.pdf

W40M USA HLTH CONTRACTING ACT

REGIONAL HEALTH CONTRACT OFF CENTRAL

POC: SHENECQUA SOARES

36000 DARNELL LOOP

FORT HOOD TX 76544

0011617324

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type or print)

30-105-04EXCEPTION TO SF 30

APPROVED BY OIRM 11-84

STANDARD FORM 30 (Rev. 10-83) Prescribed by GSA

FAR (48 CFR) 53.243

The purpose of this Amendment is to add four (4) items to Radiopharmaceuticals List (Attachment 1) and to extend the offer date and time to 23 July 2021 at 10:00am.

1. CONTRACT ID CODE PAGE OF PAGES

J 1 6

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

16C. DATE SIGNED

BY 12-Jul-2021

16B. UNITED STATES OF AMERICA15C. DATE SIGNED15B. CONTRACTOR/OFFEROR

(Signature of Contracting Officer)(Signature of person authorized to sign)

8. NAME AND ADDRESS OF CONTRACTOR (No., Street , County, State and Zip Code) X W81K0021Q0103

X 9B. DATED (SEE ITEM 11)

08-Jun-2021

10B. DATED (SEE ITEM 13)

9A. AMENDMENT OF SOLICITATION NO.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offer X is extended, is not extended.

Offer must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended by one of the following methods:

(a) By completing Items 8 and 15, and returning 1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN

REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS.

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE

CONTRACT ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(B).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor is not, is required to sign this document and return copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

10A. MOD. OF CONTRACT/ORDER NO.

2. AMENDMENT/MODIFICATION NO. 5. PROJECT NO.(If applicable)

6. ISSUED BY

3. EFFECTIVE DATE

12-Jul-2021

CODE

W40M USA HLTH CONTRACTING ACT

REGIONAL HEALTH CONTRACT OFF CENTRAL

2539 GARDEN AVENUE

FT SAM HOUSTON TX 78234-0000

W81K00 7. ADMINISTERED BY (If other than item 6)

4. REQUISITION/PURCHASE REQ. NO.

CODE W81K00

FACILITY CODECODE

EMAIL:TEL:

W81K0021Q0103

SECTION SF 30 BLOCK 14 CONTINUATION PAGE

SUMMARY OF CHANGES

SECTION SF 1449 - CONTINUATION SHEET

SOLICITATION/CONTRACT FORM

The required response date/time has changed from 09-Jul-2021 10:00 AM to 23-Jul-2021 10:00 AM.

The following have been modified:

ATTACHMENT 1

CARL R. DARNALL ARMY MEDICAL CENTER (CRDAMC), FORT

HOOD TEXAS

PERIOD OF PERFORMANCE: 01 OCT 2021 - 30

SEPT 2025

BASE YEAR: 01 OCT 2021 - 30

SEP 2022

PHARMACY PRODUCT

CODE

UNIT OF ISSUE QUANTITY PRICE TOTAL

PRICE

Gallium 67 1 mCi 30

Tc99m MAG 3 1-15 mCi 60

I-131 Capsule 1 mCi 2500

201 Thallium Chloride 1 mCi 600

I-123 .2 mCi 200

I-123 .1 mCi 200

Tc99m Sestamibi 1 - 30 mCi 50

Myoview 1-30 mCi 1700

Tc99m Neurolite 1-30 mCi 10

In-111 Octreotide per study 10

In-111 Oxine 1 mCi 15

Tc99m MAA 1-7 mCi 80

Tc99m MDP 1-25 mCi 1000

Tc99m Sulfur Colloid 8 mCi 120

Tc99m Tc04 1 mCi 10000

Tc99m Filtered Sulfur Colloid

1 mCi 40

Tc99m PYP 1-25 mCi 60

Tc99m Ceretec 1-30 mCi 10

Tc99m Mebrofenin 1-10 mCi 200

Tc99m ROTOP DMSA 5 mCi 20

WBC Kit-Base each 15

WBC Labeling - Base per study 15

Delivery Charge 50

Tc99m DTPA (Ventilation) 26-40 mCi 80

STAT Delivery 75

RP on call Charge 30

I-131 Diagnostic Caps 1 mCi 20

I-123 MIBG 10 mCi 5

I-123 MIBG each add'l mCi 100

In-111 DTPA Vial 1.5 mCi 10

H.Pylori Breath Test 50

1ST OPTION YEAR: 01 OCT

2022 - 30 SEP 2023

UNIT OF ISSUE QUANTITY PRICE TOTAL

PRICE

Gallium 67 1 mCi 30

Tc99m MAG 3 1-15 mCi 60

I-131 Capsule 1 mCi 2500

201 Thallium Chloride 1 mCi 600

I-123 .2 mCi 200

I-123 .1 mCi 200

Tc99m Sestamibi 1 - 30 mCi 50

Myoview 1-30 mCi 1700

Tc99m Neurolite 1-30 mCi 10

In-111 Octreotide per study 10

In-111 Oxine 1 mCi 15

Tc99m MAA 1-7 mCi 80

Tc99m MDP 1-25 mCi 1000

Tc99m Sulfur Colloid 8 mCi 120

Tc99m Tc04 1 mCi 10000

Tc99m Filtered Sulfur Colloid

1 mCi 40

Tc99m PYP 1-25 mCi 60

Tc99m Ceretec 1-30 mCi 10

Tc99m Mebrofenin 1-10 mCi 200

Tc99m ROTOP DMSA 5 mCi 20

WBC Kit-Base each 15

WBC Labeling - Base per study 15

Delivery Charge 50

Tc99m DTPA (Ventilation) 26-40 mCi 80

STAT Delivery 75

RP on call Charge 30

I-131 Diagnostic Caps 1 mCi 20

I-123 MIBG 10 mCi 5

I-123 MIBG each add'l mCi 100

2nd OPTION YEAR: 01 OCT

2023 - 30 SEP 2024

UNIT OF ISSUE QUANTITY PRICE TOTAL

PRICE

Gallium 67 1 mCi 30

Tc99m MAG 3 1-15 mCi 60

I-131 Capsule 1 mCi 2500

201 Thallium Chloride 1 mCi 600

I-123 .2 mCi 200

I-123 .1 mCi 200

Tc99m Sestamibi 1 - 30 mCi 50

Myoview 1-30 mCi 1700

Tc99m Neurolite 1-30 mCi 10

In-111 Octreotide per study 10

In-111 Oxine 1 mCi 15

Tc99m MAA 1-7 mCi 80

Tc99m MDP 1-25 mCi 1000

Tc99m Sulfur Colloid 8 mCi 120

Tc99m Tc04 1 mCi 10000

Tc99m Filtered Sulfur Colloid

1 mCi 40

Tc99m PYP 1-25 mCi 60

Tc99m Ceretec 1-30 mCi 10

Tc99m Mebrofenin 1-10 mCi 200

Tc99m ROTOP DMSA 5 mCi 20

WBC Kit-Base each 15

WBC Labeling - Base per study 15

Delivery Charge 50

Tc99m DTPA (Ventilation) 26-40 mCi 80

STAT Delivery 75

RP on call Charge 30

I-131 Diagnostic Caps 1 mCi 20

I-123 MIBG 10 mCi 5

I-123 MIBG each add'l mCi 100

3RD OPTION YEAR: 01 OCT

2024 - 30 SEP 2025

UNIT OF ISSUE QUANTITY PRICE TOTAL

PRICE

Gallium 67 1 mCi 30

Tc99m MAG 3 1-15 mCi 60

I-131 Capsule 1 mCi 2500

201 Thallium Chloride 1 mCi 600

I-123 .2 mCi 200

I-123 .1 mCi 200

Tc99m Sestamibi 1 - 30 mCi 50

Myoview 1-30 mCi 1700

Tc99m Neurolite 1-30 mCi 10

In-111 Octreotide per study 10

In-111 Oxine 1 mCi 15

Tc99m MAA 1-7 mCi 80

Tc99m MDP 1-25 mCi 1000

Tc99m Sulfur Colloid 8 mCi 120

Tc99m Tc04 1 mCi 10000

Tc99m Filtered Sulfur Colloid

1 mCi 40

Tc99m PYP 1-25 mCi 60

Tc99m Ceretec 1-30 mCi 10

Tc99m Mebrofenin 1-10 mCi 200

Tc99m ROTOP DMSA 5 mCi 20

WBC Kit-Base each 15

WBC Labeling - Base per study 15

Delivery Charge 50

Tc99m DTPA (Ventilation) 26-40 mCi 80

STAT Delivery 75

RP on call Charge 30

I-131 Diagnostic Caps 1 mCi 20

I-123 MIBG 10 mCi 5

I-123 MIBG each add'l mCi 100

(End of Summary of Changes)