6505--Glatiramer Acetate Injections

Continuation of SF-1449, Block 3:

The following information shall be entered by the Contracting Officer at the time of contract award according to the timeframes specified in this solicitation s Section B, Scope of Contract, Section 1.4 Contract Effective Date, Implementation Period, and Ordering Period.

Contract Award/Effective Date: ___________________

Implementation Period: __________________________

Ordering Period (Base Year): _____________________

Offerors shall not enter information into the above fields.

Continuation of SF-1449, Blocks 19 through 24:

To be considered for award, offerors must submit a price for the base year and all four option years for each line item that the offeror is proposing. Evaluation and award will be made by solicitation line item. Offerors are not required to submit an offer for both line items; however, the offeror must meet all contract requirements for each item offered. Offered prices shall not exceed two decimal places.

Note: NDC is defined as National Drug Code. ANDA is defined as Abbreviated New Drug Application.

The estimated quantities indicated for both line items are per pre-filled syringe. The price evaluation will be computed by multiplying the estimated quantity of the individual syringes by the individual syringe prices offered for the base year and option years and adding the results. The evaluation and award decision will be made by line item. While the price evaluation will be conducted based on the individual syringe price, offerors may propose and provide the products in any pack size offered commercially (i.e. 12 syringes or 30 syringes per box/pack). Offerors shall indicate the number of syringes per box/pack for each proposed line item below.

Line Item 1

Glatiramer Acetate 20mg/ML INJ, SYR, 1ML

NDC # __________________

ANDA#_________________

Syringes per box/pack___________

Schedule of Supplies Quantity Unit Unit Price Amount

Base Year 95,694 Syringe $_________ $__________

Option Year One 95,694 Syringe $_________ $__________

Option Year Two 95,694 Syringe $_________ $__________

Option Year Three 95,694 Syringe $_________ $__________

Option Year Four 95,694 Syringe $_________ $__________

Line Item 2

Glatiramer Acetate 40mg/ML INJ, SYR, 1ML

NDC # __________________

ANDA#_________________

Syringes per box/pack___________

Schedule of Supplies Quantity Unit Unit Price Amount

Base Year 198,386 Syringe $_________ $__________

Option Year One 198,368 Syringe $_________ $__________

Option Year Two 198,368 Syringe $_________ $__________

Option Year Three 198,368 Syringe $_________ $__________

Option Year Four 198,386 Syringe $_________ $__________

D.3 ATTACHMENT C

ESTIMATED ANNUAL REQUIREMENTS BY AGENCY

ITEM

DESCRIPTION

PKG SIZE (Syringe)

VA EST. ANNUAL USAGE (Syringes)

DOD EST. ANNUAL USAGE (Syringes)

BOP EST. ANNUAL USAGE (Syringes)

IHS EST. ANNUAL USAGE (Syringes)

TOTAL EST. ANNUAL USAGE (BT)

1

Glatiramer Acetate 20mg/ML INJ, SYR, 1ML

1

74,000

21,600

1

93

95,694

2

Glatiramer Acetate 40mg/ML INJ, SYR, 1ML

1

125,088

73,056

16

226

198,386

Evaluation and award will be made by solicitation line item. Offerors are not required to submit an offer for both line items; however, the offeror must meet all contract requirements for each item offered.

The estimated quantities indicated for both line items are per pre-filled syringe. However, offerors may propose and provide the products in any pack size offered commercially (i.e. 12 syringes or 30 syringes per box). Offerors shall indicate the number of syringes per pack for each proposed line item on Page 2 and 3 of the SF-1449.

N/A