27_July_18_CLIN_Structure.pdf

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Idaho Medical Case Management
Solicitation number
W912J7-18-T-0011
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Base Year CLIN Structure

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ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

0001 1 Job $____________

AMOUNT

Non-Clinical Case Nurse Manager/Registered Nurse III

FFP

1920 billable hours at $_____per hour POP

12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

0002 1 Job $_________

AMOUNT

Non-Clinical Case Nurse Manager/Registered Nurse II

FFP

1920 billable hours at $_____ per hour POP

12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT

0003 3 Job

UNIT PRICE

AMOUNT

Administrative Care Coordinator

FFP

5760 billable hours at $______ per hour POP

12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

0004 Job $__________

AMOUNT

$___________1

Master Social Worker/Nurse Case Manager

FFP

1920 billable hours at $______ per hour POP

12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

0005 3 Job $___________

AMOUNT

Licensed Clinical Social Worker

FFP

5760 billable hours at $______ per hour POP

12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE

0006 1 Job $__ ______

AMOUNT

CMRA

FFP

POP 12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award PSC CD: R499

ITEM NO SUPPLIES/SERVICES QUANTITY

0006 1

ITEM NO SUPPLIES/SERVICES QUANTITY

000 1

FFP

POP 12-SEP-2018 TO 11-SEP-2019

FOB: Destination PURCHASE REQUEST NUMBER: At award

PSC CD: R499

UNIT

Job

UNIT PRICE

AMOUNT

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