Free Motion for Preliminary Injunction - District Court of Federal Claims - federal

Page 1. or

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 1 of 41

MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM
For eMS Use Only
Bidder No: 1000155 Date Application Received: Competitive Bid Area: Miami-Fort Lauderdale-Miami Beach, FL

Supplier's Identifying Information

Supplier's legal Business Name: CHaRI CORP Primary Supplier's legal Business Name (if applicable) :


FORM B: BIDDING SHEET FOR Supplies


Miami-Fort Lauderdale-Miami Beach, FL - Oxygen Equipment and


Individual Form MUST be submitted for each Product category. Primary Supplier Completes for Network.
Information supplied must be aggregate information for the Network.


0-250,000 1 million - 3 million

250,000 - 500,000 3 million - 6 million

500,000 - 750,000 6 million - 10 million

750,000 - 1 million more than 10 million

0-100/0 51-60%

11-200/0 61-700/0

21-300/0 71-800/0

31-40% 81-90%

41-50% 91-1000/0

0-25 101-300

26-50 301-500

51-75 501-750

76-100 751-1000 more tha n 1000

0-100/0 51-600/0

11-200/0 61-700/0

21-300/0 71-800/0

31-400/0 81-900/0

41-500/0 91-1000/0
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Page 3 ot 'I

Broward, Hendry, Martin, Counties: Miami-Dade, Palm Beach

Zipcodes:

HCPCS CODE

NO. OF TOTAL UNITS PROVIDED

NO. OF UNITS PROVIDED TO MEDICARE BENEFICIARIES

E1390 E0431 E0439

13024 6956 345

10414 3321
37

Current
Staff (manpower) Financing (funding levels) Facilities (square footage, facility) 158 6.428,600 32 facilities, 118,720 so ft 185


Expansion Plan
8,357,180
35 facilities, 130,00059 ft
computer bar-code svstem
75 vehicles, Mail-order:
UPS/USPS/DHUFedEx
null


Inventory Control (method of tracking inventory) manual Distribution Methods (vehicles, mail order) Other-OY.!L 62 vehicles, Mail-order: UPS/USPS

Legal Name
A&C Medical Rental Ambulatory and Professional Medical Eq,
Baizan Medical Equipment Inc

Bi C:olJntv Mp.c1irnl SlJnnlv


Expected Function
service Miami zip 33135 service Miami zip 33172 service Miami zip 33172
~rvic:p.

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-_ ... _- ..._ .... -'r- - - - -

Page 3 of 41

_. - - _ ..·, .. __ . __ . --r-r-',

D.D.&G. Rental Equipment Inc
DOCTORS MEDICAL RENTALS CORP
Dependable Medical Supply
Doctor's Choice
Dubrock Medical Equipment Inc
Jorcyn Medical Services Inc
Professional Medical
R.A. Home Medical Equipment Inc
Superior Care Medical Supplies
Tebar Medical Supplies & Equipment
Verailles Home Health Medical Equipment


service Coral Gables, FL area service Miami Lakes area service Tamarac, FL area service Miami zip 33155 service Miami zip 33172 service Virginia Gardens, FL service Pine Crest Area service Miami zip 33016 service Medley, FL area service Miami zip 33172 service Hialeah, Fl area

HCPCS Code

Item Description

Rental or Purchase

Product Weight

Total Estimated Capacity

A4608

Transtracheal oxygen cath

Purchase

0.0000018644 18

A4615

Cannula

Purchase

0.0000020420 18

~4616

~ubing, per foot

.,.

Purchase

0.0000025747 18

~4617

Mouthpiece

Purchase

10.0000000444 18

~4620

Mask

Purchase

10.0000000444 18

Models to be Bid Price Name Provided Transtracheal Systems Scoop Transtracheal Catheter Scoop Transtracheal 50.63 Medline - catheter dynd40580 Invacare - Nasal Cannula - 7' MS3120 Medline - Adult Cannula 0.72 HCS4511 Medline - Adult Cannula 25ft HCS4515 Invacare - Nasal Cannula - 4' MS0149 0.07 Medline - Standard tubing 7ft HUD1115 Respironics - Angled Mouthpiece - 1004524 13.15 ~alter - mouth piece - 1003 Hudson RCI - Adult Nonrebreathing Mask - 1059 Mediline - Adult mask HUD1041 0.62 Medline - Adult Mask without ubing - HUD1049 Medline - Adult Mask with Universal tUb. - HUD1930 "'1anufacturer
~1odel

E0424

Payment Class A-Stationary tompressed gaseous oxygen ~stem, rental; includes container, ~ontents, regulator, flowmeter, humidifier, nebulizer, cannula or mask, and tubing. Class A includes HCPCS Codes E1390, E1391, E0424, and E0439. The same bid amount Rental must be submitted for the entire class of codes. The system will automatically enter the same bid amount for all codes in this class. Therefore, you do not need to submit a bid for each code. A change to one code in this class will chanQe all codes. Payment Class B-Portable gaseous

10.5371712028 18

Invacare - Shoulder Pack with D Cylindar - HP4121 108.57 luxfer - Alumium - M60 LifeGas - Medical Oxygen Gas -1136

...

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E0431

E0434

E0439

E0441

_ pxygen system, rental; InCluaes portable container, regulator, ~owmeter, humidifier, cannula or mask, and tubing. Class B includes HCPCS Codes E0431 and E0434. The same bid amount must be submitted for the entire class of Rental codes. The system will ~utomatically enter the same bid ~mount for all codes in this class. [fherefore, you do notneed to ~ubmit a bid for each code. A ~hange to one code in this class will thange all codes. Payment Class B-Portable liquid pxygen system, rental; includes portable container, supply reservoir, humidifier, flowmeter refill adaptor, ~ontents gauge, cannula or mask, ~nd tubing. Class B includes HCPCS ~odes E0431 and E0434. The same bid amount must be submitted for Rental he entire class of codes. The !system will automatically enter the lsame bid amount for all codes in his class. Therefore, you do not need to submit a bid for each code. IA change to one code in this class will change all codes. Payment Class A-Stationary liqUid pxygen system, rental; includes Ic:ontainer, contents, regulator, ~owmeter, humidifier, nebulizer, lcannula or mask, and tubing. Class IA includes HCPCS Codes E1390, E1391, E0424, and E0439. The !same bid amount must be Rental ~ubmitted for the entire class of Ic:odes. The system will ~utomatically enter the same bid ~mount for all codes in this class. Irherefore, you do not need to ~ubmit a bid for each code. A Ic:hange to one code in this class will Ic:hange all codes. Payment Class D-Oxygen contents, gaseous (for use with owned gaseous stationary systems or when both a stationary and protable ~aseous system are owned), 1 month supply equal to 1 unit. Class o includes HCPCS Codes E0441 and E0442. The same bid amount must Rental be submitted for the entire class of ~odes. The system will ~utomatically enter the same bid ~mount for all codes in this class. rTherefore, you do not need to ~ubmit a bid for each code. A ~hange to one code in this class will ~hange all codes. Payment Class D-Oxygen contents, liqUid (for use with owned liquid stationary systems or when both a stationary and portable liqUid system are owned), 1 month supply equal to 1 unit. Class D includes HCPCS Codes E0441 and E0442.

p.4181839664 ~985

Invacare - Homefill II 02 Filling System - IOH200 Medline - cylinder 0 with cart 23.87 ~nd reg. - LXFMD, HCSB8708, HCS Luxfer - aluminum - c

0.4181839664 312

Puritan Bennett - Helios liquid System - U46jH300 Puritan Bennet - Helios - H 23.87 300 caire - Spirit - 300

0.5371712028 48

Puritan Bennett - Helios pxygen System - U46 Puritan Bennett - Helios - U36 taire - Liberator - 37L taire - Liberator - 45L

108.57

0.0011852459 18

LifeGas - Medical Oxygen Gas ~1.59 1136

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Case 1:08-cv-00441-LMB
E0442

Document 10-3
~.0011852459 18

Filed 06/18/2008

Page 5 of 41
161.59

E0443

E0444

Irhe same bid amount must be Rental submitted for the entire class of codes. The system will automatically enter the same bid ~mount for all codes in this class. lTherefore, you do not need to submit a bid for each code. A change to one code in this class will --hanae all codes. Payment Class E-Portable oxygen Icontents, gaseous (for use only ~ith portable gaseous systems ~hen no stationary gas or liquid I5Ystem is used), 1 month supply [equal to 1 unit. Class E includes HCPCS Codes E0443 and E0444. Irhe same bid amount must be Rental submitted for the entire class of codes. The system will automatically enter the same bid amount for all codes in this class. trherefore, you do not need to Isubmit a bid for each code. A Ichange to one code in this class will chanae all codes. Payment Class E-Portable oxygen Icontents, liquid (for use only with portable liquid systems when no Stationary gas or liquid system is used), 1 month supply equal to 1 unit. Class E includes HCPCS Codes E0443 and E0444. The same bid amount must be submitted for the Rental !entire class of codes. The system Iwill automatically enter the same bid amount for all codes in this k:lass. Therefore, you do not need 1,,0 submit a bid for each code. A change to one code in this class will chanQe all codes. Humidifier supplemental w/ i Purchase

LifeGas - Medical Liguid Oxygen Gas - 17403

0.0016049650 18

LifeGas - Medical Oxygen gas ~1.24 1136

p.0016049650 18

LifeGas - Medical Liquid pxygen System - 17403

~1.24

E0560

~.0000189107 18

E0580

Nebulizer for use w/ regulat

Purchase

~.0000106539 18

E1353

Regulator

Purchase

~.0000000444 18

Pegasus Research Corp m,era-Mist Low-Flow Neb. 128.51 P3100N Salter - Humidifier - 7100 Smith's Medical - Nebulizer R30000N 110.16 Medline - Maxi Compressor MIN501 Invacare - Regulator w/Guage IRC2002 Medline - Intellaflow 28.99
~-iCSB8708M

E13S5

Stand/rack

Purchase

0.0000000444 18

Medline - Regulator HCSB8708 APM - Oxygen E-Cylindar cart OC20010A-4 21.83 Medline - E-Tank Stand HCS5300 Invacare - Profect02 5 Liter :Concentrator - IRC5P Medline - 5 Liter NDK90120GOO ~unrise - 5 Liter series - 515A ~irsep - Newlife Elite - AS005 ~ Page108.57 39
Rpc:;nirnnirc:; - Millpnillm -

E1390

Payment Class A-Oxygen Iconcentrator, single delivery port, !capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate. Class A includes HCPCS Codes E1390, E1391, E0424, and E0439. The same bid amount must be Rental submitted for the entire class of ..

0.5371712028 12500

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.·
~

Case 1:08-cv-00441-LMB
codes. The system will automatically enter the same bid amount for all codes in this class. Therefore, you do not need to submit a bid for each code. A change to one code in this class will chanoe all codes. Payment Class A-Oxygen Iconcentrator, dual delivery port, !capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate, each. Class A includes HCPCS Codes E1390, E1391, E0424, and E0439. The lsame bid amount must be Rental Isubmitted for the entire class of Icodes. The system will lautomatically enter the same bid lamount for all codes in this Iclass.Therefore, you do not need to !submit a bid for each code. A Ichange to one code in this class will IchanCle all codes. Payment Class C-Portable Oxygen Iconcentrator, rental. Class C includes HCPCS Codes E1392 and K0738. The same bid amount must be submitted for the entire class of Icodes. The system will Rental lautomatically enter the same bid lamount for all codes in this class. Irherefore, you do not need to !submit a bid for each code. A change to one code in this class will chanoe all codes. Payment Class C-Portable gaseous oxygen system, rental; home compressor used to fill portable bxygen cylinders; includes portable ~ontainers, regulator, flowmeter, humidifier, cannula or mask, and ubing. Class C includes HCPCS todes E1392 and K0738. The same Rental bid amount must be submitted for I"he entire class of codes. The IsYstem will automatically enter the lsame bid amount for all codes in ~his class.. Therefore, you do not need to submit a bid for each code. IA change to one code in this class !will chance all codes.

Document 10-3

Filed 06/18/2008 Page 6 of 41 .._- ..... _ - ..... _... _... ...
M605 Respironics - Everflow 1020001 Invacare - Invacare 5 IRC5LX

E1391

P.5371712028 ~2

,

Airsep - Intensity - AS094-1

108.57

E1392

0.0418183966 ~2

Respironics - Evergo Portable :Concentrator - 900-000 lAirsep - Lifestyle - AS081-1 140.77 lAirsep - Freestyle - AS095-1 ~equal - Eclipse - 5500 Evo - Inogen - IS 100

K0738

0.0418183966 18

Invacare - Venture Homefill II Fill Sys. - IOH200 thad - Total 02 - Chad - Total 140.77 102 Isunrise - iFiII - 515ADS

Form ADDroved OMB No. 0938-1016

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Case 1:08-cv-00441-LMB

Document 10-3

w/c

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~~~pagelot~ Page 7 of 41

Clt1£j001 2

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Case 1:08-cv-00441-LMB

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MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM
For eMS Use Only
Bidder No : 1000155 Date Application Received: Competitive Bid Area : Miami-Fort Lauderdale-Miami Beach, FL

Supplier's Identifying Information
Supplier's Legal Business Name: CHORI CORP Primary Supplier's Legal Business Name (if applicable) :

FORM B: BIDDING SHEET FOR Miami-Fort Lauderdale-Miami Beach, FL - Standard or Non-rehab Power Mobility Devices and Accessories
Individual Form MUST be submitted for each Product category. Primary Supplier Completes for Network.
Information supplied must be aggregate information for the Network.


0-250,000 1 million - 3 million

250,000 - 500,000 3 million - 6 million

500,000 - 750,000 6 million - 10 million

750,000 - 1 million more than 10 million

0-10 % 51-60%1

11-20°J'o
61-70%

21-30°J'o 71-80°J'o

31-40%

41-500/0 91-100%

81-90°J'o

0-25 101-300

26-50 301-500

51-75 501-750

76-100 751-1000 more than 1000

0-10°J'o 51-60°J'o

11-20°J'o
61-700/0

21-300/0 71-80%

31-400/0
81-90%

41-50% 91-1000/0
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_. ---- .·,

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Page 4 of8

. . __. __ . --rr'",

D.D.&G. Rental Equipment Inc
Dependable Medical Supply
Doctor's Choice
Doctors Medical Rentals Corp.
Dubrock Medical EqUipment Inc
Jorcyn Medical Services Inc
Professional Medical
R.A. Home Medical EqUipment Inc
Superior Care Medical Supplies
Tebar Medical Supplies and EqUipment
Versailles Home Health Medical EqUipment


Service Coral Gables, FL area
service Tamarac, FL area
service Miami zip 33155
service Miami Lakes, FI Area
service Miami zip 33172
service Virginia Gardens, FL area
service Pine Crest Area
service Miami zip 33135
service Medley, FL area
service Medley, FI
service Hialeah, FL area


HCPCS Code E0950 E0951 E0952 E0955 E0956 E0957 E0960

Item Description Tray Heel Loop/Holder, any type, with or without ankle strap, each Toe Loop/Holder, any type, each Cushioned headrest W/c liiteral trunk/hip suppor W/c medial thiQh support W/c shoulder harness/straps Wheelchair Accessory, adjustable height, detachable armrest, complete assembly, each ~heelchair accessory, positioning belt/safety belt/pelvic strap, each Seat upholstery replacement

Rental or Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

Product Weight P.0017016444 18 P.0241609211 18
~.0007236122 18

Total Estimated Capacity

Models to be Bid Price Provided Invacare - Lap Tray - LTCCL 170.95 Manufacturer 1'-1odel Name Invacare - Heel Loop w/ankle Istraps - 1600BK Invacare - Heel Loops - 1345 Invacare - Sm. Adj. Headrest I'fixed) - HROIS Invacare - SWing Away Laterals Itmed.) - TMSLM 000 Bock - Abductor - 446C1.1.7 Invacare - Airline Buckle Chest Ipos. stra - 7311BK Invacare - Desk Lenght/Adj. Height - T29 Invacare - Airline Buckle Seat pas.
~rap - 1311BK

15.21 15.19 162.29 79.34 111.27 173.25

0.0049066426 18 p.0034423753 18 p.0007087633 18 p.OO12109189 18

E0973

Purchase

p.0576652208 202

1'78.26

E0978

Purchase

P.0937132106 400

29.06

E0981

Purchase

0.0011696891 18

Invacare - Seat Upholstry Replacement - Dependant upon
~hair

37.96

E0982

Back upholstery replacement

Purchase

~.0007938762 18

Invacare - Seat Upholstry Replacement - Dependant upon thair Invacare - Manual Elevated Legrest - AT5544
~nvacare - Manual Legrest (rep!. Ipad) - AT5544

41.47

E0990 E0995 E1016 E1020 E1028 E2208 E2209 E2210

Wheelchair Accessory, elevating leg rest, complete assembly, Purchase
~ach

p.0530753020 18 p.0008423007 18
~.0006296717 18

~9.67

Wheelchair Accessory, calf rest/pad each ~hock Absorber for Power Wheelchair each Residual Limb Support System !for Wheelchair Iswingaway hardware for lioystick K:ylinder tank carrier, each ~heelchair Accessory, arm ~rough, each

Purchase Purchase Purchase Purchase Purchase Purchase

20.77 105.56

Invacare - Shock Fork - 9213-6

0.0009081764 18 0.0072261715 18 0.0100959061 18 0.0017530114 18 p.0080337399 18

Bearings any type, replacement Purchase

~plift Technologies - Uplift 195.68 IStumprest - Uplift Stumprest Invacare - Rem. and Adj. 166.04 Hardware - CP175HW Invacare - OXVQen Holder - P700 S5.34 Invacare - One-piece Channel ~6.25 Armpads - OB20400 Invacare - Replacement Wheel Page 43 5.28 D""~ ..;"",,I'" _ f\11'\ Put",A,,1 " ... ."" ...." ..

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Case 1:08-cv-00441-LMB
Power Wheelchair Accessory, 122NF sealed lead acid battery, leach, (e.g. gel cell, absorbed glassmat) Power Wheelchair Accessory, ~roup 24 sealed lead acid battery, each (e.g. gel cell, absorbed olassmat) Power Wheelchair Accessory, . U-l sealed lead acid battery, leach (e.g. gel cell, absorbed kllassmat) Power Wheelchair Accessory, battery charger, single mode, "'or use with only one battery !tYpe, sealed or non-sealed, each Power Wheelchair Accessory, battery charger, dual mode, for use with either battery type, !sealed or non-sealed, each Power Wheelchair component, motor. replacement onlv Power Wheelchair component, gear box, replacement only

Document 10-3

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Page 10 of 41

Page 5 of8

E2361

Purchase

1().0475953724 18

~nvacare - 22NF battery

22NFBattery

106.76

E2363

Purchase

p.0304221232 ~2

Invacare - 24 Gel Battery 24Battery

142.55

E2365

Purchase

p.1555523791 173

Invacare - U1Battery Installation - 1-0, UlINSTALL 1/8.0

E2366

Purchase

p.003677150918

Invacare - Single Mode Charger IcTE

20

1.97

E2367

Purchase

p.000449546S 18

Invacare - Lester 8-amp Battery Icharger - LESTR

1':>22.87 ~,

E2368 E2369 !E2370

Purchase Purchase

p.001111875718 p.0002092102 18 p.0032718435 18

Invacare - Component Motor Replacement - No Model Number 1414.33

~nvacare - Gear Box Replacement 1':>62.82
No Model Number
~,

E2371

Power Wheelchair component, motor and gear box Purchase ~ombination, replacement only Power Wheelchair accessory, group 27 sealed lead acid battery, (e.g. gel cell, absorbed Purchase IcIlassmat), each Pneum drive wheel tire Irube, pneum wheel drive tice Insert, pneum wheel drive Pneumatic caster tire rube, pneumatic caster tire Foam filled drive wheel tire Foam filled caster tire Foam drive wheel tire Foam caster tire lSolid drive wheel tire Solid caster tire Isolid caster tire, integrate Drive wheel excludes tire
~aster wheel excludes tire

~ombo Repl. - No Model Number
MK Battery - Group 27 battery M27SLDG

Invacare - Motor and Gear Box

1617.3

P.0003986900 18

121.55

E2381 E2382 E2383 E2384 E2385 E2386 !E2387 E2388 E2389 E2390 E2391 E2392 E2394 E2395 E2396 E2601

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase 22 in Purchase

p.0024079584 18 p.050576821918 0.0981272397 18 p.001138103518 p.0240387627 18 p.0009631834 18 10.0039833623 18 p.000963183418
~'>'0039833623 18

Invacare - Pneumatic Drive Wheel 16 ire rep - Pneumatic Drive Whee 1.48 Invacare - Replacement tube 16.73 Replacement Tube Invacare - Replacement Insert 121.77 Replacement Insert Invacare - Pneumatic Caster Tire - 1£:5 32 IV; · Pneumatic Caster Tir Invacare - Pneumatic Caster Tire ube - Pneumatic caster Tir
~9

.94

Invacare - Foam Filled drive wheel 12141 ire - Foam Filled drive wh . Invacare - Foam filled caster tire - 52 Foam filled caster t .36 Invacare - Foam filled drive wheel 140 7 ire - Foam filled drive wh . Invacare - Foam caster tire 22.08 Foam caster tire Invacare - Solid drive wheel tire - b4.56 Isolid dr. who tire P' Invacare - Solid Caster Tire - Solid taster Tire Invacare - Solid caster tire, inteorate - Solid caster tire i Invacare - Drive wheel wlo tire Drive wheel w/o tire Invacare - caster wheel wlo tire ~ster wheel wlo tir Invacare - Caster Fork - Caster Fork ROHO - Mosaic Cushion MOS1816C 16 55 . 143.45 61.89

0.0004815917 18 0.0011381035 18 p.0011381035 18 0.0000637836 18 0.000043372818

44.04

ICaster fork lGen

~.000028064e 18
p.0532904824 18

1A5.58
1"".

wlc cushion wdth <

149.03 Page 44

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Page 6of8

E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2611 E2612 E2613 E2614 E2615 E2616 E2618

~en w/c cushion wdth >=22 in Purchase

0.0022468155 kt8 0.0087065123 18 0.0006144147 18 0.0012975115 18 0.0001559892 18 0.0041324628 18 0.0002081897 18 0.0033820615 18 p.0001519580 18 0.0008925622 18 p.0000312284 18 0.0015588201 18 p.0000520474 18
~.0008664874 18

Skin protect wc cus wd <22in

Purchase

Skin protect wc cus wd>=22in Purchase Position wc cush wdth <22 in Purchase

Position wc cush wdth> =22 in Purchase Skin pro/pos wc cus wd <22in Purchase

Skin pro/pos wc cus wd>=22in Purchase Gen use back cush wdth <22in Purchase Gen use back cush wdth>=22in Purchase Position back cush wd <22in Position back cush wd>=22in Pos back postjlat wdth <22in Purchase Purchase Purchase

Hudson - PressureEez Wheelchair K:ushion - 263001 Hudson - Pressure EEZ comfort cushion - 265662 ROHO - Triumph Cushion TS1816C ROHO - Airlite Cushion - AL1816 ~nvacare - Ulti-mate Cushion UM/W18/D16 ROHO - Harmony Cushion H1816C ROHO - Triumph Contour Cushion -I- TC1816C ROHO - Jetstream Pro Standard
~SP16SF

f.}6.13 122.01 151.93 216.97 323.53 232.66 280.8 251.3
~40.73 ~17.42

Hudson - Pressure EEZ General Back - 2716 Sunrise - JAY J2 BACK - 2516K 5unrise - J2 Plus Back ~02023AH-8

1439.28

Pos back postjlat wdth>=22in Purchase Wc acc solid seat supp base Replacement cover for WC cushion Purchase

E2619

Purchase

0.0007660155 18

E2620 E2621 KOO15 KOO17 KOO18 KOO19 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 KOO44 K0045 K0046 K0047
KOOc;O

WC planar back cush wd <22in Purchase WC planar back cush wd>=22in Detachable, non-adjustable height armrest, each Detachable, adjustable height armrest, base, each Detachable, adjustable height ~rmrest, upper portion each ~rm pad,each Fixed, adjustable height ~rmrest, pair High mount flip-up footrest,
~ach

p.0000997065 18
~.0000040822 18

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

p.0021500175 18 p.0004385760 18 0.0001761448 18 0.0149954220 18 0.0004475057 18 0.0001155759 18 0.0006662069 18 0.0001876769 18 0.0103160021 18 p.0017608866 18 p.0002618189 18 0.0008613337 18 p.0004982775 18 p.0008705696 18 0.0001088403 18 0.0002457454 18
O.OOOOc;qqOC;fi 1 R

~

-,.. ,-

Leg Strap, each Leq Strap, H style. each ~djustable angle footplate,
~ach

Large size footplate, each Standard size footplate, each

Sunrise - Jay Care Back - 3502B ~65.16 5unrise - Jay Perfect Fit Contour 1491.27 POS ba - PFB1250 ~nvacare - Solid Back Insert 123.92 1r9130 Invacare - Replacement Cover for iCushion - Replacement Cover fo 141.41 ROHO - Replacement Cover for tushio - Replacement Cover Invacare - Infinity Uniback 442.32 IUBXMXSM h"he Comfort Company - Acta 464.18 Deep Back - BK-MDFC-18 Invacare - Non-adjustable armrest 146.69 I- Non-adjustable armre Invacare - Adjustable armrest 41.28 ~djustable armrest Invacare - Adjustable Height 23.06 Armrest/uppe - Replacement Part Invacare - Arm pad - Arm pad 13.16 Invacare - Fixed adjustable height 37.52 armres - Fixed adj. ht. armre Invacare - High-mount flip-up 38.89 Footrest Replacement Part 19.59 Invacare - Heel Loops - 1346 Invacare - H-Strap - 9342 143.45 Invacare - Adj. Angle Flip-up foot 60.21 plates - AT5543 Invacare - Extra-large alum. foot 142.7 plates - A1564 Invacare - Aluminum Footplates 29.42
~1562

Footrest, lower extension tube, Purchase each Footrest, upper hanger bracket, Purchase each Footrest, complete assembly Purchase

Elevating legrest, lower Purchase extension tube. each Elevating legrest, upper hanger Purchase bracket, each
R~trhpt ~c;c:;pmhlv
Pllrrh~c:;p

Invacare - Extension Tube 15.77 Replacement Part Invacare - Footrest Upper Hanger 13.44 Bracket - Replacement Part Invacare - Swingway Footrests 45.73 70NTAPER Invacare - Lower Extension Tube 15.77 Lower Extension Tube Invacare - Upper Hanger Bracket ~1.79 Upper Hanger Bracket Invacare - Rachet Assembly - Page 45 :>h.:>R . .

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7/19/2007

Page 7 of8
."'---
K0051 K0052 K0053 K0098 K0195

.

Case 1:08-cv-00441-LMB Document 10-3 --_. '-- ---_..._., . --_.. _- ------------

Filed 06/18/2008

Page 12 of 41
----

--

Rachet Assembly
~nvacare - CAM Release Assmebly

K0733

iCAM release assembly, footrest 1Purchase lor leqrest each ~wingaway, detachable Purchase ootrests, each Elevating footrests, articulating Purchase IftelesCOpinQ), each Drive belt for Power Wheelchair Purchase Elevating leg rests, pair (for use with capped rental wheelchair Purchase base) Power Wheelchair accessory, 12 to 24 AMP hour sealed lead Purchase acid battery, each (e.g. gel cell, absorbed Qlassmat) Adj skin pro w/c cus wd<22in Purchase

p.0002312028 18 0.0023263664 18 0.0009132791 18 0.0000709274 18 0.0460014968 506

142.33 CAM Release Assembly Invacare - Detachable Footrests ~1.33 T93HA Invacare - Smartleg Art. Legrests ~8.84 PHAL4A Invacare - Drive. Belt - Drive Belt 21.26 Invacare - SWingaway Elevating Legrests - PH904A 159.09

p.0050716636 18

MK Battery - 24 AMP - 24AMP ROHO - High Prol'i1e Cushion 1R109C ROHO - High Profile Cushion 1R1411C ROHO - Contour Select Cushion K:s109C ROHO - High Profile Dual Cushion r- 2R1210C Invacare - Lynx - L-3R

24.39

K0734 K0735 K0736 K0737 K0800

~.0039570324 18

255.88 340.5 270.3 341.53 807.04

Adj skin pro wc cus wd>=22in Purchase
~dj skin pro/pos wc cus<22in

~.0001755325 18

Purchase

0.0014577359 18 0.0000796019 18 0.0088381527 18

~dj skin pro/pos wc cus>=22> Purchase

Power operated vehicle, Group Purchase 1 Standard Power operated vehicle, Group Purchase 1 Heavy Duty

K0801

p.0008622588 18

K0802

Power operated vehicle, Group Purchase 1 Very Heavy Duty Power operated vehicle, Group 2 Standard Power operated vehicle, Group 2 Heavy Duty Power operated vehicle, Group 2 Very Heavy Duty Power Wheelchair, Group 1 Standard, portable, sling/solid seat/back Power Wheelchair, Group 1 Standard, portable, captains chair Power Wheelchair, Group 1 IStandard, sling/solid seat/back Power Wheelchair, Group 1 Standard, captains chair Power Wheelchair, Group 2 Standard, portable, sling/solid seat/back Power Wheelchair, Group 2 Standard, portable, captains chair Power Wheelchair, Group 2 Standard, slino/solid seat/back Power Wheelchair, Group 2 Standard captains chair Power Wheelchair, Group 2 Heavy Duty, sling/solid seat/back Power Wheelchair, Group 2
,",O~\I\'

~.0000718549 18

.1\Q806 K0807 K0808 K0813

Purchase Purchase Purchase Purchase

~.0009790230 18

p.0002290375 18 0.0000179637 18
~.0003572349 18

Invacare - HMV 400 - 4B18 Pride - Go-Go Elite Ultra X - Ultra 1303.68 ~ Pride - Go-Go Elite Traveller Irraveller Pride Mobility - Maxima 3-wheel ~ooter - 5C900 1472.44 Pride - Traveller - plus/plus HD Pride - Revo - Revo Pride - Go-Go Elite Traveler 976.3 !SC44LR Pride - Celebrity X 3-wheel scooter 1483.03 SC4001 Pride - Maxima 4-wheel scooter 2265.0 I5C940 Invacare - ATM Take Along Chair 1488.2 Configured Chair
~rahalTl Field - Everest Lite -

K0814 K0815 K0816 K0820

Purchase Purchase Purchase Purchase

~.OO03572349 18

2RLOO118

1904.85

p.0003251239 18 0.0003251239 18 p.0001505203 18

~olden Technologies - Compass2169.2 GP-601SS ~olden Technologies - Compass 2077.34 ~P601CC

Invacare - Pronto M71 - M71R Pride - Quantum - 1107 Invacare - Pronton M71 - M71 Pride - Quantum 1103 ultra Invacare - Neutron - R51 Invacare - Pronto M41 - M41 Pride - Jazzy 1420 - 2HD-SS Pride - Jazzy 1420 - 2HD-C

1589.5

K0821 K0822 K0823 K0824 K0825

Purchase Purchase Purchase Purchase Purchase

0.0001505203 18 0.0515673394 59 p.0515673394 18 0.0027204682 18
~.0027204682 18

2031.36 2454.87 2467.25 2977.03
Page 46 2721.21

,"",h,

r~nt~inC' rh~ir

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7/19/2007

Page 8 of

Case 1:08-cv-00441-LMB
··,,"u"y
..,u~y, "U,",~UI"~ .. "un

Document 10-3
0.0005632050 18 0.0005632050 18 0.0001034458 18

Filed 06/18/2008

Page 13 of 41
~867.51

K0826 K0827 K0828

K0829

Power Wheelchair, Group 2 rvery Heavy Duty, sling/solid Purchase seat/back Power Wheelchair, Group 2 Purchase Very Heavy Duty, captains chair Power Wheelchair, Group 2 Extra Heavy Duty, sling/solid Purchase seat/back Power Wheelchair, Group 2 Extra Heavy Duty, captains Purchase thair

Pride - Jazzy 1170 - 2VHD-SS Pride - Jazzy 1170 - 2VHD-C Pride - Jazzy 1650 - 2EHD-SS

B288.62
~261.65

0.0001034458 18

Pride - Jazzy 1650 - 2EHD-C

~911.07

Form Approved OMB No. 0938-1016

Page 47

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7/1

Page 1 of 10

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 14 of 41

Page 48

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7/19/2007

Page 2 of 10

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 15 of 41

MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM

For eMS Use Only
Bidder No : 1000155 Date Application Received : Competitive Bid Area : Miami-Fort Lauderdale-Miami Beach, FL

Supplier's Identifying Information

Supplier's Legal Business Name: CHaRI CORP Primary Supplier's Legal Business Name (if applicable) :


FORM B: BIDDING SHEET FOR Miami-Fort Lauderdale-Miami Beach, FL - Rehabilitative Power
Mobility Devices and Accessories

Individual Form MUST be submitted for each Product Category. Primary Supplier Completes for Network.
Information supplied must be aggregate information for the Netvvork.


0-250,000 1 million - 3 million

250,000 - 500,000 3 million - 6 million

500,000 - 750,000 6 million - 10 million

750,000 - 1 million more than 10 million

0-10% 51-60%

11-200/0 61-700/0

21-300/0 71-80%

31-40% 81-90%

41-50% 91-100%

0-25 101-300

26-50 301-500

51-75 501-750

76-100 751-1000 more than 1000

0-100/0 51-600/0

11-20% 61-70%

21-30% 71-80%

31-40% 81-90%

41-50°,10
91-100%
Page 49

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7/19/2007

CBSS

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 16 of 41 Page 3 of 10

Counties: Broward , Hendry, Martini Miami-Dade, Palm Beach

Zip~odes:

HCPCS CODE

NO. OF TOTAL
UNITS PROVIDED


NO. OF UNITS PROVIDED TO MEDICARE BENEFICIARIES
1

E1002

12

14


K0848 K0849

1


26


12


Current
Staff (manpower) Hnancing (funding levels) Facilities (square footage, facility) 158 $6.428,600 32 facilities, 118,720 sg ft 185

Expansion Plan
$8,357.180 35 facilities, 130.000 sg ft computer bar-code system 75 vehicles. Mail-order: UPS/USPS/FedEx/DHL. null

Inventory Control (method of tracking inventory) manual Distribution Methods (vehicles, mail order) Other----lli!1L 62 vehicles, Mail-order: UPS/USPS

Legal Name
Jorcyn Medical Services Inc
Superior Care Medical Supplies
Bi County Medical Supply

ARIC Mp.c1irnl Rp.ntt'll


Expected Function
service Virginia Gardens, FL area
service Medley, FL Area
service Miami zip 33016

sprvirp. Mit'lmi 7in

::n 1~S


Page 50

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7/19/2007

CBSS

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008
service Coral Gables, FL area service Miami zip 33172 service Miami zip 33172 service Miami zip 33172 service Hialeah, FL area service Miami zip 33155 service Miami zip 33172 service Tamarac, FL area service Miami Lakes, FL area 5elVice Miami zip 33135

Page 17 of 41 Page 4 of 10

D.D.&G. Rental Equipment Inc
Dubrock Medical Equipment Inc
Baizan Medical Equipment Inc
Tebar Medical Supplies and Equipment
Versailles Home Health Medical Equipment
Doctor's Choice
Ambulatory and Professional Medical Eq.
Dependable Medical Supply
Doctors Medical Rentals Corp.
R.A. Home Medical Equipment Inc


HCPCS Code E0950 E0951 E0952 E0955 E0956 E0957 E0960 E0973 E0978 E0981 E0982 E0990 E0995 E1002 E1003

Item Description

Rental or

Purchase

Product ~ VVeight.

Total Estimated

Capacity

riianufacturer

1'<10<121
~~JC1rne

j"/10dt::!:'j t.() be Provlded

B~Cf Pr~(e

h"ray Purchase Heel loop/holder, any type, with or Purchase Iwithout ankle strap, each h"oe lop/holder, any type, each Purchase !Cushioned headrest
~/c lateral trunk/hip suppor ~/c medial thigh support

0.0014060281 18 0.0199635917 ~6 0.0005979034 18
~.0040542416 18
~.0028443525 18

Purchase Purchase Purchase Purchase

0.0005856342 18 0.0010005533 18 0.0476473939 202 0.0774329864 ~04 0.0009664862 18 0.0006559609 32 0.0438548537 18 0.0006959729 18 p.0163150350 18
~.0001495167 18

.'w/c shoulder harness/straps

Invacare - Lap Tray - LTCCL Invacare - Heel Loop w/ankle straps - 1600BK Invacare - Heel Loops - 1345 Invacare - Small Adj. Headrest fixed) - HR01S Invacare - Swingaway Laterals Medium - TMSLM Otto Bock - Abductor 446C1.1.7 Invacare - Airline Buckle Chest Pas. Stra - 7311 BK Invacare - Desk.Jength - Adj. Height - T29

68.04 14.61 14.5 155.68 175.91 106.21 70.05 74.76

Wheelchair accessory, adjustable height, detachable armrest, Purchase complete assembly, each Wheelchair accessory, positioning Purchase belt/safety belt/pelvic strap, each Seat upholstery replacement Back upholstery replacement Wheelchair accessory, elevating leg rest, complete assembly, each Wheelchair accessory, calf rest/pad each Wheelchair Accessory, power ~ating system tilt only ~heelchair accessory, power seating system, recline only, without shear reduction Wheelchair accessory, power seating system, recline only, with mechanical shear reduction Wheelchair accessory, power seating system, recline only, with power shear reduction Wheelchair accessory, power seating system, combination tilt and recline, without shear reduction 'wheelchair accessory, power ~ating system, combination tilt
!::Inn fPrlinp with mprh;mir;:ll c::hp;:If

Purchase Purchase Purchase Purchase Purchase Purchase

Invacare - Airline Buckle - Seat 27.77 Pas. Str - 131lBK Tag - Seat Uphohlstry ~6.31 Replacement - CP3017 Irag - Back Upholstry l39.68 Replacement - CP3117 Invacare - Manual tlevated Leg 89.83 Rest - AT5544 I;wacare - Manual Leg Rest 19.9 !frep. pad) - AT5544 Pride - Tru-Balance 2 Power ~100.71 rrilt - No Item Number Redman - Chief - 107SRX 3381.3

E1004

Purchase

. ~)'0006412920 18

Pride - Synergy Tru-Balance Power Recl - No Model Number 3749.17 Pride - Power Wheelchair Option - Power Wheelchair Opt 4058.18
I
I

ElO05

Purchase

0.0003897355 18

E1006

Purchase

p.0001948677 18

Pride - Power Wheelchair f4970.89 ~ption - Power Wheelchair opt

E1007

Purchase

0.0041928449 18

rrilt R. Rpr - Nn Mnnpi Nllmhpf

Pride - Tru-Balance 2 Power Page 51 6730.78

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7119/2007

Page 5 of 10
~

reduction E1008

..- .__.... _, ........ ,--_.._... _- __
.
...".

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008
I .... '"'" . ,_ _

Page 18 of 41
· wv
I ,..,. _ _ -

t __ ··· _

......

El010

Wheelchair accessory, power :seating system, combination tilt and recline, with power shear reduction IWheelchair accesory, addition to power seating system, power leg !elevation system, including leg rest, pair iShock absorber for power IWheelchair, each Residual limb support system for IWheelchair 5wingaway hardware for joystick Ventilator tray, fixed Ventilator Tray, gimbaled Cylinder tank carrier, each Wheelchair accessory, arm through, each Bearings any type, replacement Power Wheelchair accessory, ~Iectronic connection between wheelchair controller and one power seating system motor, including all related electronics, indicator feature, mechanical function selection switch, and fixed mountinQ hardware Power Wheelchair accessory, !electronic connection between wheelchair controller and two or more power seating system motors, including all related electronics, indicator feature, mechanical function selection switch, and fixed mounting hardware Power Wheelchair accessory, hand tontrol interface, remote joystick, nonproportional, including all related electronics, mechanical Istop switch, and fixed mounting hardware Power Wheelchair accessory, hand control interface, multiple mechanical switches, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware Power Wheelchair accessory, specialty joystick handle for hand control interface, prefabricated Power Wheelchair Accessory, chin cup for chin control interface Power Wheelchair accessory, sip and puff interface, nonproportional, including all related electronics, mechanical !stop switch, and manual
_ ... : ___ ··· _ ·· ___ ·· _&..: __
'-_.~..J

Purchase

0.0028202675 18

Pride - Tru-Balance 2 Power 6731.38 [Tilt & Rec No Model Number

Purchase

0.0101947710 18

Redman - Chief - 107SRX Invacare - Shock Fork - 9213-6 Uplift Technologies - Uplift 5tumprest - Uplift Stumprest
~nvacare -

875.0

E1016 EI020 E1028 E1029 E1030 E2208 E2209 E2210

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

P.0005202827 18 P.0007S04045 18

101.11 187.43

O.005970~128 18
0.0002852155 18 b.0004800832 18 0.0083420060 18 0.0014484714 18 0.0066380873 18

159.04 Removable/adjustable hardware - CP175HW Otto Bock - Ventilator/Battery 284.55 Tray - PSOOA-VBT Otto Bock - Ventilator/Battery S97.26 Tray - PSOOA-VBT Invacare - Oxygen Tank Holder ~1.46 - P700 Invacare - One-piece Channel 82.51 Armpads - 0820400 Invacare - Bearinqs - 1104350 5.04

E2310

Purchase

0.0078354543 18

Invacare - SPJ with Joystick Actuator C - SPJAMP

901.08

~

E2311

Purchase

0.0073057684 18

Invacare - Multiple Interface Box - S4WSB

1824.28

E2321

Purchase

0.0036670564 18

Invacare - Mini Tash Joystick and Dig. In - S020M6

1223.61

E2322

Purchase

0.0006490867 18

Invacare - Wafer Board and Dig. Int. Box - 5018M6

1085.98

E2323 E2324

Purchase Purchase

0.0043614941 18 0.0002302982 18

Invacare - T Handle Flexible Joystick Ext - 1560 Invacare - Chin Cup - 1826

53.25 33.74

.

E2325

Purchase

p.0003649341 18

1

.... ___

Invacare - Sip-N-Puff/lnterface 1037.06 Box - SNPM6 Page 52

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Page 6 of 10

Case 1:08-cv-00441-LMB
E2326

Document 10-3
~.0004287090 18

Filed 06/18/2008

Page 19 of 41
267.3

E2327

E2328

E2329

E2330

E2351

E2361

E2363

ISwtngaway moun[lng narowar~ Power Wheelchair accessory, breath tube kit for sip and puff Purchase interface Power Wheelchair accessory, head control interface, mechanical, proportional, including all related Purchase electronics, mechanical direction change sWitch, and fixed mounting hardware Power Wheelchair accessory, head lControl or extremity control interface, electronic, proportional, Purchase Including all related electronics and ~xed mountina hardware Power Wheelchair accessory, head lControl interface, contact switch mechanism, nonproportional, including all related electronics Purchase mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware Power Wheelchair accessory, head ~ontrol interface, proximity switch mechanism, nonproportional, including all related electronics, Purchase mechanical stop switch, mechanical direction change switch, head array, and fixed mounting hardware Power Wheelchair accessory, electronic interface to operate Purchase ~peech generating device using 'power wheelchair control interface Power Wheelchair accessory, 22NF sealed lead acid battery, each, Purchase 'e.g. gel cell, absorbed glassmat) Power Wheelchair accessory, Group 24 sealed lead acid battery, Purchase each (e.g. gel cell, absorbed
~Iassmat)

Irherafin - Sip-N-Puff Breath !rube Kit - 32666

0.0001417220 18

Invacare - Proportional RIM Hd. Cont. wid - 1500M6

2011.53

0.0002093942 18

ASL - PASL-PMJ-M6 - PASL PMJ-M6

~815.6

0.0000425166 18

~SL - Head Array - PASLl05M6

1359.92

~100051728S2 18

Permobil - Head Control Interface - 110070

2635.01

p.0000779471. 18

Sunrise - Auxilliary Control Module - 097A42

537.95

0.0393269188 18

Invacare - 22NF Battery - 22NF 87.17 Battery Invacare - 24 Gel Battery 24BATTERY Invacare - U1 Battery Installation - UlINSTAL Invacare - Single Mode
~harger - CfE

p.0251370734 18

118.11

E2365

E2366

E2367

E2368 E2369 E2370

E2371

Power Wheelchair accessory, U-1 lead acid battery, each (e.g. gel cell absorbed glassmat) Power Wheelchair Accessory, battery charger, single mode, for use with only one battery type, !sealed or non-sealed, each Power Wheelchair Accessory, battery charger, dual mode, for use with either battery type, sealed or non-sealed, each Power Wheelchair component, motor, replacement only Power Wheelchair component, gear box, replacement only Power Wheelchair component, motor and gear box combination, replacement only Power Wheelchair accessory, Group 27 sealed lead acid battery, (e.g. gel cell, absorbed glassmat), each
~aled

Purchase

0.1285292135 18

70.67

Purchase

0.0030383412 18

167.4

Purchase

0.0003714498 18

Invacare - Lester 8 Amp Battery Charger - LESTR

266.12

Purchase Purchase Purchase

0.0009187163 18 0.0001728654 18 0.0027034461 18

Invacare - Motor Replacement 374.51 - 1040733 Invacare - Gear Box 326.21 Replacement - 1041778 Permobil - Motor/Gear Box iCombo - 1820460 582.06

Purchase

0.0003294280 18

MK Battery - Group 27 Battery 109.29 M27SLDG Invacare - Compact Joystick 931.65 Page 53 w/display - 1558MM6

E2373

Hand/chin ctrl spec joystick

Purchase

p.0035430496 18

https://cbss.cms.hhs.gov/cms/FonnBAction.do?method=summaryTab

7/19/2007

Page 7 of 10

Case 1:08-cv-00441-LMB
E2374 E2375 E2376 E2377 E238! E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2394 E2395 E2396 E2601 E2602 E2603 E2604 E2605 E2606 E2607 E2608 E2611 E2612 E2613 E2614 E2615 E2616 Hand/chin ctrl std joystick Non-expandable controller Expandable controller, repl Expandable controller, initl Pneum drive wheel tire Irube, pneum wheel drive tire Insert, pneum wheel drive Pneumatic caster tire Tube oneumatic caster tire Foam filled drive wheel tire Foam filled caster tire Foam drive wheel tire Foam caster tire Solid drive wheel tire Solid caster tire Solid caster tire, integrate Drive wheel excludes tire iCaster wheel excludes tire
~ster fork

Document 10-3
10.0015766571 18 10.0031887447 18 0.0031887447 18 0.1010052592 18 0.0019896385 18 0.0417904193 18 0.0810801932 18 0.0009403877 18 10.0198626552 18 10.0007958554 18 10.0032913571 18 0.0007958554 18 0.0032913571 18 0.0003979277 18 0.0009403877 18 10.0009403877 18 0.0000527029 18 0.0000358379 18 0.0000231893 18 0.0440326521 18 0.0018564900 149 0.0071939830 18 0.0005076761 18 10.0010721027 18 10.0001288901 18
~)'0034145553 18

Filed 06/18/2008

Page 20 of 41

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

tSL - MicroExtremity Ch:n 1411.2 PASL-l"-lEC-C-M6 Irag (Dynamic) - Non-ex. lController - RP471061/515156K 659.55 Invacare - Kit/Howe 1033.55 tontroller - 1145070/1122191 Pride - Quantum 420 Option ~71.57 !Chair option-no numb Permobil- Pneum. Drive Wheel 58.66 ITire - 2835483 Permobil - Tube - 612363-99-0 15.99 New Solutions - Tube for Pn. 116.95 Caster Tire - IS14 Permobil - Pneumatic caster ~2.3 Tire - 602569-08-0 38.12 New Solutions - Tube - 185 New Solutions - Foam Filled 115.89 Drive Wheel Tire - F58 New Solutions - Foam Filled 50.0 Caster Tire - F20C New Solutions - Foam Drive 38.8 Wheel Tire - F58 New Solutions - F20C - F20C 21.07 32.95 New Solutions - AL72 - AL72 New Soiutions - Soiid Cast~r 15.79 Tire - AL175 Permobil - Solid Caster Tire, 41.49 Integrate - 309350-99-0 Permobil - Drive Wheel 59.1 309351-19-0 Permobil - Caster Wheel 142.0 310450-19-0 Invacare - Caster Fork 43.53 1140984 ROHO - Mosaic Cushion 47.09 MOS1816C Hudson - Pressure EEZ ~H.94 !Wheelchair Cushio - 263001 Hudson - Pressure EEZ Comfort 116.72 tush ion - 265662 ROHO - Triumph Cushion 145.08 IrS1816C ROHO - Airlite Cushion 207.26 AL1816 Invacare - Ulti-mate Cushion 323.35 UM/W18/D16 ROHO - Harmony Cushion 223.18 H1816C ROHO - Triumph Contour 268.03 Cushion - TC1816C ROHO - Jetstream Pro 240.51 Standard - JSP16SF Hudson - Pressure EEl General 325.36 Back - 2716 Sunrise - Jay J2 Back - 2516K 302.64 Sunrise - J2 Plus Back 418.83 202023AH-8 Sunrise - Jay Care Back 348.29 3502B Sunrise - Jay Perfect Fit 468.61 Contour POS Bk - PFB1250 Page 54
T ________

lGen w/c cushion wdth < 22 in lGen w/c cushion wdth >=22 in Skin protect wc cus wd <22in ISkin protect wc cus wd>==22in Position wc cush wdth <22 in Position wc cush wdth> ==22 in Skin pro/pos wc cus wd <22in Skin pro/pos wc cus wd>=22in Gen use back cush wdth <22in Gen use back cush wdth> =22in Position back cush wd <22in Position back cush wd>==22in Pos back pOSt/lat wdth <22in Pos back pOSt/lat wdth> ==22in

0.0001720221 18 0.0027945166 18 0.0001255593 18 0.0007375028 18 0.0000258033 18 0.0012880158 18 0.0000430055 18

1""_1:-1

M _ _ I .. T _ _ _ -J..

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Page 8 of 10

Case 1:08-cv-00441-LMB
E2618 E2619 E2620 E2621 KOO15 KOO17 KOO18 KOO19 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 KOO44 K0045 K0046 K0047 K0050 KOOSl Wc acc solid seat supp base

Document 10-3
p.0007159579 18 p.0006329403 18 0.0000823851 18 0.0000033730 18 0.0017765081 18 0.0003623849 18 0.0001455442 18 0.0123903589 18 0.0003697633 18 0.0000954976 18 0.0005504709 18 0.0001550729 18 0.0085238660 18 0.0014549785 18 0.0002163347 18 0.0007116995 18 0.0004117148 18 0.0007193308 18 0.0000899322 18 0.0002030536 18 0.0000494985 18 0.0001910373 18

Filed 06/18/2008

Page 21 of 41
J.11~t::f l

Purchase

Replacement cover for WC cushion Purchase WC planar back cush wd <22in WC planar back cush wd>=22in Detachable, non-adjustable height armrest, each Detachable, adjustable height armrest, base each Detachable, adjustable height armrest, upper portion each !Arm pad, each Fixed, adjustavle height armrest, Ipair High mount flip-up footrest, each Leg Strap, each Leg strap, H style, each !Adjustable angle footplate, each Large size footplate, each Standard size footplate, each Footrest, lower extension tube, each Footrest, upper hanger bracket,
~ach

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

118.33 1r9130 ROHO - Replacement Cover For Cushion - No Item no. ~9.52 Replacem Invacare - Infinity Uniback !421.73 IUBXMXSM nne Comfort C1810mpany k;42.57 IActa Deep Back - BK-MDFC-18 Invacare - Armrest - 1108092 139.91

J./IVdLdft:: - :::JUIIU CdLK.

-

Invacare - Armrest - 1121162 89.35 Invacare - Armrest-Upper 21.98 Portion - 1031816 Invacare - Arm pad - 1121211 12.51 Permobil - Armrest 35.77 Replacement Part Invacare - Flip-up Footrest 37.08 Flip-up Footrest ~nvacare - Leg Strap - Leg 18.68 Strap Invacare - Leg Strap - Leg 41.49 Strap Invacare - Adj. Angle Footplate 57.5 1060432 Permobil - Large footplate 40.75 Larqe Footplate Permobil - Footplate 28.05 Footplate Invacare - Extension Tube 15.04 1123044 Invacare - Upper Hanger 12.81 Bracket - 1100818 Permobil - Footrest Assembly flO.77 Footrest Assembly Invacare - Lowe( extension 15.04 ube - 1022848 Invacare - Upper Hanger 58.89 Bracket 1114753 Invacare - Ratchet Assembly 23.4 1046328 Permobil - Cam Release 35.51 Assembly - cam Release Assembly Permobil - SWingaway De. 67.02 Footrest - Swingaway De. Footre Permobil - Elevating Footrests 73.96 Elevating Footrests . Invacare - Drive Belt - Drive 19.15 Belt Invacare - Swingaway Elevating Legrests - PH904A 142.06

Footrest, complete assembly

Elevating legrest, lower extension Purchase ube, each Elevating legrest, upper hanger Purchase bracketeach Ratchet assembly Purchase

Cam release assembly, footrest or Purchase leg rest, each iSwingaway, detachable footrests,
~ach

K0052 KOOS3 K0098 K0195

Purchase Purchase Purchase

0.0019222210 18 0.0007546207 18 0.0000586056 18 0.0380099375 1506

Elevating footrests, articulating telescooinq), each Drive belt for power wheelchair

K0733

Elevating legrests, pair (for use Purchase with capped rental wheelchair base) Power Wheelchair Accessory, 12 to 24 Amp hour sealed lead acid Purchase battery, each (e.g. gel cell, absorbed qlassmat) Adj skin pro w/c cus wd<22in Adj skin pro wc cus wd>=22in Adl skin or%os wc cus<22in Purchase Purchase Purchase

0.0041905944 18

MK Battery - 24 Amp - 24AMP 21.9 ROHO - High Profile Cushion 240.32 lRl09C ROHO - High Profile Cushion 305.79 lR1411C
Page 55 IR~~?: ~ontour Select Cushion 242.29

K0734 K0735 K0736

0.0032696013 18 0.0001450383 18 0.0012044923 18

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Case 1:08-cv-00441-LMB
~

Document 10-3
~.0000657732 18 ~.0146150798 18

Filed 06/18/2008
·
L::>LU~L

Page 22 of 41
306.72 2556.16

"

K0737 K0835

J\dj skin pro/pos wc cus> =22 in
Power Wheelchair, Group 2
~tandard, single power option,

Purchase Purchase

ROHO - High Profile Dual 'Cushion - 2R1210C
Invacare - Pronto M71 - M71T5

K0836

~ling/solid seat/back Power Wheelchair, Group 2 standard, single power option, captains chair

Purchase

~.O146150798 18

Pride - Jazzy 610 - 25P C Pride - Quantum 1420 25PHD-55 Pride - Quantum 1420 2SPHD-C Pride - Quantum 1420 25PVHD-55 Wheelchairs of Kansas Pverlander/PEV-2P 750 - 55

2671.76

K0837

K0838

Power Wheelchair, Group 2 heavy duty, single power option, Purchase ~linQ/solid seat/back Power Wheelchair, Group 2 heavy ~uty, single power option, captains Purchase
~hair

0.0006440477 18

3075.11

0.0006440477 18

2751.01

K0839

K0840

K0841

K0842

K0843 K0848 K0849 K08S0 K08S1 K0852 K0853 K0854 K0855 K0856

K0857

K0858

K0859

K0860

K0861

Power Wheelchair, Group 2 very heavy duty, single power option, ~ling/solid seat/back Power Wheelchair, Group 2 extra heavy duty, single power option, ~ling/solid Seat/back Power Wheelchair, Group 2 Standard, multiple power option, slinQ/solid seat/back Power Wheelchair, Group 2 ~andard, multiple power option, captains chair Power Wheelchair, Group 2 heavy CJuty, multiple power option, slinQ/solid seat/back Power Wheelchair, Group 3 Standard, slinQ/solid seat/back Power Wheelchair, Group 3 Standard, captains chair Power Wheelchair, Group 3 heavy (juW, sling/solid seat/back Power Wheelchair, Group 3 heavy (juw, captains chair Power Wheelchair, Group 3 very heavy duty, slinQ/solid seat/back Power Wheelchair, Group 3 very heavy duty, captains chair Power Wheelchair, Group 3 extra heavy duty, slinQ/solid seat/back Power Wheelchair, Group 3 extra heavy duty, captains chair Power Wheelchair, Group 3 standard, single power option, sling/solid seat/back Power Wheelchair, Group 3 ~andard, Single power option, captains chair Power Wheelchair, Group 3 heavy duty, single power option, sling/solid seat/back Power Wheelchair, Group 3 heavy CJuty, single power option, sling/solid seat/back, captains thair Power Wheelchair, Group 3 very heavy duty, single power option ~ling/solid seat/back Power Wheelchair, Group 3 Istandard, multiple power option, ~Iing/solid seat/back

Purchase

0.0001207589 18

~981.01

Purchase

0.0000402530 18

6031.42

Purchase

~.O060196413 18

IPride - Quantum 600 - 2MP 55 2742.31

Purchase

0.0060196413 18

Pride - Quantum 610 - 2MP C

2742.31

Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase Purchase

0.0010664579 18 p.0110135698 18 0.0110135698 18 0.0006640017 18 0.0006640017 18 0.0001959349 18 0.0001959349 18 0.0000435411 18 0.0000435411 18 p.0100746617 18

Pride - Quantum 600 - 2MPHD ~301.75 55 Invacare - Pronto M91 - M91R ~329.17 Invacare - Pronto M91 - M91 Invacare - Pronto M91 M91RHD Invacare - Pronto M9l M91HD Invacare - Pronto M94 - M94 Invacare - Pronto M94 - M94 Pride - Jazzy 1650 - 3EHD 55 Pride - Jazzy 16S0 - 3EHD C Invacare - Pronto M91 - M91T5 3226.24

~892.42
3742.5 4497.45 4620.01 6120.51 5781.74 3573.5S

Purchase

0.0100746617 18

Pride - Jazzy 600 - 3SP C Invacare - Pronto 1\1191 M91HD Pride - Quantum 1420 35PHD-C Pride - Quantum 1420 3SPVHD-55 Invacare - TDX 5P MCG

3645.18

Purchase

0.0004990385 18

14468.88

Purchase

~.0004990385 18

f4261.93

Purchase

0.0001108975 18

6384.35

Purchase

0.0108842485 18

3607.69

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Case 1:08-cv-00441-LMB
..
K0862

Document 10-3
0.0008290736 18

Filed 06/18/2008

Page 23 of 41
14468.88

K0863

K0864

Power Wheelchair, Group 3 heavy ~uty, multiple power option Purchase sling/solid seat/back Power Wheelchair, Group 3 very heavy duty, mUltiple power option Purchase Isling/solid seat/back Power Wheelchair, Group 3 extra heavy duty, multiple power option Purchase slinQ/solid seat/back

Invacare - 3G Ranger X I3GRXCG Pride - Quantum 1420 I3MPVHD 55

0.0003109026 18

6384.35

10.0001036342 18

No SADtJlERC Approved Items 17597.46 See Notes - NA

Form ADDroved OMB No. 0938-1016

I CLOSE I

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Document 10-3

Filed 06/18/2008

Page 24 of 41

Page 1 of4

. . . . - ...

r!lJJi7i1i &:§!PilPELfJJtJYiE!JJ11)
~

~

~'.!:J~j.:J~~.'

~1ltiF1:~¥7~lm ~&~Wl

J ..

GAI~

S)lO-~-f;tIL Svp~\\~

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Page 2 of4
Case 1:08-cv-00441-LMB Document 10-3 Filed 06/18/2008 Page 25 of 41

MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM
For eMS Use Only
Bidder No : 1000155 Date Application Received: Competitive Bid Area : Miami-Fort Lauderdale-Miami Beach, FL

Supplier'S Identifying Information
Supplier's Legal Business Name: CHaRI CORP

. Primary Supplier's Legal Business Name (if applicable) :

FORM B: BIDDING SHEET FOR Order Only)

Miami-Fort Lauderdale-Miami Beach, FL - Diabetic Supplies (Mail

Individual Form MUST be submitted for each Product Category. Primary Supplier Completes for Network.
Information supplied must be aggregate information for the Network.


0-250,000

250,000 - 500,000

500,000 - 750,000 6 million - 10 million

750,000 - 1 million

1 million - 3 million

3 million - 6 million

more than 10 million

11-20°.10 61-70°.10

21-30% 71-80%

31-40% 81-90%

41-500/0 91-100%

0-25 101-300

26-50 301-500

51-75 501-750

76-100 751-1000

more than 1000

0-100/0 51-600/0

11-20% 61-70%

21-30% 71-800/0

31-40% 81-900/0

41-50% 91-1000/0
Page 59

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Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 26 of 41

Counties: Broward, Hendry, Martin, Miami-Dade, Palm Beach

Zipcodes:

HCPCS CODE

NO. OF TOTAL UNITS PROVIDED

NO. OF UNITS PROVIDED TO MEDICARE BENEFICIARIES

A4253 A4256 A4259

11082 302 5066

5682 88 2797

.-,.,.

Current
Staff (manpower)
Financing (funding levels)
Facilities (square footage, facility)


Expansion Plan
185
$8.357.1~0

158 $6.428.600 32 facilities. 118.720 sa ft

35 facilities, 130,000 sa ft
computer bar-code system

Inventory Control (method of tracking inventory) manual Distribution Methods (vehicles, mail order) Othe r----D..Y..!L

62 vehicles, Mail-order: UPS/USPS

75 vehicles, Mail-order: UPS/USPS/DHUFedEx
null

Legal Name
Jorcyn Medical Services, Inc.
Superior Care Medical Supplies
Bi County Medical Supply

A~l.

Expected Function
service Virginia Gardens, FL area
Servic-e Medley, FL area
service Miami zip 33016

c;prvic:p Minmi 7in 1111::1


Page 60

Mprlilill Rpntnl


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Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 27 of 41

D.D. & G. Rental Equipment Inc
Dubrock Medical Equipment Inc
Baizan Medical Equipment Inc
Tebar Medical Supplies and Equipment
Versailles Home Health Medical Equipment
Doctor's Choice
Ambulatory & Professional Medical Equip.
Dependable Medical Supply Doctors Medical Rentals Corp R.A. Home Medical EqUipment Inc Professional Medical

service Coral Gables, FL area
service Miami zip 33172
service Miami zip 33172
service Miami zip 33172
service Hialeah, FL area
service Miami zip 33155
service Miami zip 33172
service Tamarac, FL area
service Miami Lakes, Fl area
service Miami zip 33135
service Pine Crest Area


FORM B: BIDDING SHEET

SUPPLIER'S IDENTIFYING INFORMATION
PRIMARY SUPPUER'S LEGAL BUSINESS NAME (IF

SUPPUER BIDDER NO. 1000155 SUPPUER'S LEGAL BUSINESS NAME: CHORI CORP

HCPCS Code
~4233

Item Description
~Ikaline battery

Rental or Purchase Purchase Purchase Purchase Purchase

Product
Weiqht

Total Estimated
Capacity

0.0046510217 ~6 0.0004147532 36 0.0097933169 72 0.0004398805 18

~4234

P-cell battery Lithium battery
~i1ver oxide battery

~4235
~4236

~4253

Blood glucose/reagent
~rips
.~

Purchase

0.6787869405 ~818

~4256
~4258

taIibrator
~Iution/chips

Purchase Purchase

0.0560973169 105
~.0280931067 468

Lancet device each

Nodels to be Bid Price Provided Name Supremen Technologies - 9-volt battery p.68 9VAMl MK Battery - 6.0V Alk - BMED01242 ~.08 Roche - Simplicity lithium Battery - 30969 1.99 hitichi - maxwell - CR3022 Panasonic - Panasonic - CR3022 Battery Mart - 357 Energizer SO Battery 1.43 357 Lifescan - One-Touch Test Strips - 0198R Inforpia USA, LLC - Eclipse - CE0123 Hypoguard - QuickTek - SQTEK5 22.54 Hypoguard - Advance - SAD15 PHSS - Smartest Protege - 88524-0001-03 Hypoguard - Micro-draw - SADV5MD Lifescan - One-Touch Control Solution ~.02 0272 Roche - Soft-Touch Lancet - 580 15.23 Invacare - Lancing Device - ISG171510 Owen-Mumford - Unistik - OWNAT0702 Lifescan - One-Touch Fine Point Lancet Po46 Infopia USA, LLC - EasyGLuco - 28G lancets 1'<1anufacturer Nipro Diabetes Systems - GlucoPro Lancets 28G - LGPl Nipro Diabetes Systems - GlucoPro Lancet 7.0 ~OG - LGP130 Kendail - Monolet - KND8881602018 Can-am Care - E-Z ject lancets CANOO6106 Vitalcare - Lancet 28G - 24-081028 Vitalcare - Lancet 30G - 24-081303

I

~:lodel

I

~4259

Lancets per box

Purchase

p.2217236636 ~356

Form Approved OMB No. 0938-1016

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~

Case 1:08-cv-00441-LMB

Document 10-3

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Page 28 of 41

Page 1 of6

Page 62

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Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 29 of 41

MEDICARE DMEPOS COMPETITIVE BIDDING PROGRAM

For eMS Use Only
Bidder No : 1000155 Date Application Received: Competitive Bid Area : Miami-Fort Lauderdale-Miami Beach, FL

Supplier's Identifying Information

Supplier's Legal Business Name: CHaRI CORP Primary Supplier's Legal Business Name (if applicable) :


FORM B: BIDDING SHEET FOR Formulas,Pumps,and Supplies


Miami-Fort Lauderdale-Miami Beach, FL - Enteral Nutrition


Individual Form MUST be submitted for each Product Category. Primary Supplier Completes for Network.
Information supplied must be aggregate information for the Network.


0-250,000 1 million - 3 million

250,000 - 500,000 3 million - 6 million

500,000 - 750,000

750,000 - 1 million more than 10 million

6 million - 10 million

0-10%

11-20%

21-30%

31-40% 81-90%

41-50% 91-100%

51-600/0

61-700/0

71-80%

0-25 101-300

26-50 301-500

51-75 501-750

76-100 751-1000 more than 1000

0-10%
51-60%

11-20%
61-70%

21-30% 71-80%

31-40% 81-90%

41-500/0 91-100%
Page 63

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Document 10-3

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Page 30 of 41

Page 3 of6

8roward, Hendry, Martin, Counties: Miami-Dade, Palm 8each

Zipcodes:

HCPCS CODE

NO. OF TOTAL UNITS PROVIDED

NO. OF UNITS PROVIDED TO MEDICARE BENEFICIARIES

84035 84150 84154

59839 803554 53749

37986 232149 31868

Current
Staff (manpower) Financing (funding levels) Facilities (square footage, facility) 158 $6.428,600 32
faciiities~

Expansion Plan
185 $8,357,180

118,720 sa ft

35 facilities 130,000 sa ft computer bar-code system 75 vehicles Mail order: UPS/USPS/FedEx/DHL null

Inventory Control (method of tracking inventory) manual Distribution Methods (vehicles, mail order) Other----.nYlL 62 vehicles, Mail Order: UPS/USPS

Legal Name
A&C Medical Rental D.D.&G. Rental Equipment Inc Dubrock Medical Equipment Inc

Expected Function
service Miami zip 33135 service Coral Gables, FL area service Miami zip 33172 c:;prvic:p Mittmi 7in ::n 172

Bai7ttn Mpc1ir.ttI EnlJinmpnt Tnc:

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Page 4 of

Case 1:08-cv-00441-LMB

Document 10-3

Filed 06/18/2008

Page 31 of 41

Tebar Medical Supplies & EqUipment
Versailles Home Health Medical EqUipment
Doctor's Choice
Ambulatory and Professional Medical Eq.
Dependable Medical Supply
Doctors Medical Rentals Corp.
R.A. Home Medical Equipment Inc.
Jorcyn Medical Services Inc
Superior Care Medical Supplies
Bi County Medical Supply
Professional Medical


service Miami zip 33172
service Hialeah, FL area
service Miami zip 33155
service Miami zip 33172
service Tamarac, FL area
service Miami Lakes, FL area
service Miami zip 33135
service Virginia Gardens, FL area
service Medley, FL area
service Miami zip 33016
service Pine Crest Area


HCPCS Code B4034

Item Description Enter feed supkit syr by ktay

Rental or Purchase Purchase

Product Weight

Total Estimated
Capacity

0.0123856160 20500

B4035

Enteral feed supp pump per d

Purchase

0.0383174109 ~5580

84036

Enteral feed sup kit grav by Enteral ng tubing
~Iet

Purchase

~.OO49994448 SO00

84081 84082 B4083

w/ stylet Purchase
Purchase Purchase

~.0000015972 18 ~.0000023225 18

Bid Price Provided Medline - Feeding/Irrigation Syringe 5.05 DYND70641 Kendall - 1000ml Pump Set - 713650 Ross - Flexiflo top-fill enteral ROSOOO71 Medline - 1000ml pump set - ENT70552 6.67 Invacare - Easy-feed - ROS52048 Novartis - Compat 1000ml pump set Compat Kendall - Enteriflush - KND8884773642 Medline - Gravity Feeding Set ENT70503 17.09 Ross - Flexiflo Gravity feeding set ROSOO061 Ross - FlexFlow Enteral Feeding Tube 20.14 00471
r~lanufacturer
~jame

i'tlodel

Mode!s to be

Enteral ng tUbing w/o Enteral stomach tube levine

Ross - FlexiFlow Feeding Tube - 00477 14.99 Kendall - Stomach Tube 155710 2.32

p.OOOOOl6404 18

B4086

k:iastrostomy/jejunostomy Purchase ube

0.0001095402 18

84149

EF blenderized foods

Purchase

b.0032133805 5000

Ross - Easy Feed Gastro Tube - 50112 Ross - Magna-port - ROS51358 Ross - Gastrostomy tube - ROSOO152 32.09 Ballard - Kimberly-Clark Gasto.Tube BLD011212LV Ballard - Mic-Key - BLD01201408 Novartis - Compleat 14010000 1.42 Novartis - Pediatric - SND142400 Novartis - Boost - Depends on flavor Invacare - powder nutritional supplement - ISG712250 Ross - Jevity 1 cal - ROS00143 Ross - Osmolite - ROS00709 Ross - Osmolite 1 cal - ROS00735 Ross - Ensure Powder - ROS00750 Ross - Ensure Complete - ROS50460 Ross - Fiber w/FOS - ROS50650 Ross - Promote - ROS50774 Ross - Promote with fiber - ROS51872 Ross - Ensure High Protein - ROS52100 Ross - Jevity 1.2 - ROS53118
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Case 1:08-cv-00441-LMB
84150 EF complet w/intact nutrient Purchase

Document 10-3
0.5049960396 278570

Filed 06/18/2008

Page 32 of 41

Ross - Osmolite 1.2 - ROS53120 0.45 Ross - Prosure - ROS57024 Nestle Clinical Nutrition - Nutren 1.0 Fiber - NES9871616055 Nestle Clinical Nutrition - Replete NES9871616249 Nestle Clinical Nutrition - Nuten Probalace - NES9871616204 Nestle Clinical Nutrition - Nutren 1.0Fiber - NES981616210 Novartis - lsocal - SND03552500 Novartis - Boost - SND16741700 Novartis - Fibersource - SND183500 Novartis - Ultracal - SND43590300 Novartis - Fibersource HN - SND185500 Novartis - Boost Plus - depends on *'Iavor Ross - TwoCal HN - ROS00729 Ross - Ensure Plus - ROS50464 Ross - Ensure Plus HN - ROS00721 Ross - Jevity 1.5 cal - ROS57333 Nestle Clinical Nutrition - Carnation ~nstant Breakfast - NES9871633888 Nestle Clinical Nutrition - Nuttren 1.5 ~147 NES9871616220 Nestle Clinical Nutrition - Nutren 2.0 NES9871616230 Novartis - Comply - SND00890400 Novartis - Deliver 2.0 van -

84152

EF calorie ~ense>/=1.5Kcal

Purchase

p.1840815263 25000

I

~ND04620400

84153

EF hydrolyzed/amino acids Purchase

0.0152416041 42000

Novartis - Isosource 1.5 cal ::,ND181500 Novartis - Tolerex - 04580500 Ross - O