08_AUG_2018_OPTION_CLIN_Structure.pdf

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Idaho Medical Case Management
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W912J7-18-T-0011
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Option Year CLIN Structure

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

1001 1 Job $

Non-Clinical Case Nurse

Manager/Registered Nurse III

FFP

1920 billable hours at $ per hour POP

12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

PSC CD: R499

1002 1 Job $

Non-Clinical Case Nurse

Manager/Registered Nurse II

FFP

1920 billable hours at $ per hour POP

12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

PSC CD: R499

AMOUNT

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT

1003 3 Job

Administrative Care Coordinator

FFP

5760 billable hours at $ per hour POP

12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

PSC CD: R499

UNIT PRICE

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

1004 1

Master Social Worker/Nurse Case Manager

FFP

1920 billable hours at $ per hour POP

12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

Job $ $

1005 3 Job $

Licensed Clinical Social Worker

FFP

5760 billable hours at $ per hour POP

12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

ITEM NO SUPPLIES/SERVICES QUANTITY

1006 1

CMRA

FFP

POP 12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award PSC CD: R499

UNIT UNIT PRICE

Job $ $100

$ $100

ITEM NO SUPPLIES/SERVICES QUANTITY

1007 1

TRAVEL

FFP

POP 12-SEP-2019 TO 11-SEP-2020

FOB: Destination

PURCHASE REQUEST NUMBER: At award

PSC CD: R499

UNIT

Job

UNIT PRICE

$ $10,000

$ $10,000_

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