price list & product catalog | 2011
TRANSCRIPT
C O N T E N T SP O l i C i E S
Directory of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iTable of Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiGeneral Terms and Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iiiBilling and Payment; Returned Goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv – vEquipment Rental Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viWarranties and Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viiAnnex A - Home Patient Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1 – A-2Annex B - Hospital and Center Accounts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1 – B-3
P E R i T O N E A l D i A lY S i SDianeal PD Solution, UltraBag System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD1Dianeal PD Solution, Single Bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD2 – PD3extraneal (icodextrin) PD Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD4HomeCHoiCe Pro Automated Peritoneal Dialysis System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD5 – PD6HomeCHoiCe Automated Peritoneal Dialysis System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD5 – PD6APD Drain Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD6APD Miscellaneous Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD6Disconnect Y-Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD7Miscellaneous CAPD Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD7Assist Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD7Transfer Sets, Catheter Supplies, Disconnect Caps, and Clamps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PD8 Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PDTM
A C U T E D i A lY S i SaQUariUS System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AC1Dialysis Solutions for CRRT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AC2 Acute PD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AC2 Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ACTM
H E M O D i A lY S i S HemaviSion Disposable Blood Chamber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD1Dialyzers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD2 – HD3Blood Tubing Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD4Fistula Needles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD5 – HD6Disposable Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD7Concentrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HD8 Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HDTM
S O F T W A R E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SO1Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOTM
A N C i l l A R i E SSponges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN1Dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN1Tape . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN2Antiseptics/Chemicals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN3Gloves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN3Blood Pressure Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN4Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN4Permanent Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN4Miscellaneous Ancillary Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AN5 Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ANTM
P R E S C R i P T i O N F O R M S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PF1 – PF3
Trademarks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PFTM
N U M E R i C A l i N D E x . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IN1 – IN3
Prices stated here are applicable to the U.S. only.Baxter may, at its sole discretion, revise or amend this price list and product catalog without prior notice to the customer .
Effective April 1, 2011
U.S. Renal Division
Baxter Healthcare Corporation1620 Waukegan RoadMcGaw Park, IL 600851-888-736-2543
Baxter’s U .S . Renal Division develops, manufactures and markets a comprehensive selection of products and services used in the treatment of kidney disease .
D i R E C T O RY O F S E R v i C E S
Customer Service/Order Entry
All home patient orders 1-800-284-4060
Hospital and center orders
DISPOSABLES 1-888-229-0001
Hospitals #1
Centers #4
EQUIPMENT/PARTS and Service 1-800-553-6898
Includes repair, technical support and training inquiries
Clinical Support for Health Care Practitioners 1-888-736-2543, #2
Product Surveillance 1-888-736-2543, #3
Sales/Clinical Specialist Voicemail Center 1-888-736-2543, #4
Pharmacy Services 1-888-736-2543, #5
Credit and Collections 1-888-270-3189
includes invoice and statement inquiries
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TA B l E O F C O N T E N T S
I. GENERAL TERMS & CONDITIONS 1
II. BILLING AND PAYMENT; RETURNED GOODS 2
III. EQUIPMENT RENTAL PROGRAM 5
IV. WARRANTIES 7
V. DEFINITIONS 7
Annex A Home Patient Account Terms
Annex B Hospital and Center Account Terms
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i . G E N E R A l T E R M S & C O N D i T i O N S
A. General. This Section I identifies general terms and conditions with respect to the purchase of certain products from Baxter . Each purchase is subject to additional terms and conditions specific to a particular type of purchaser, found in the appropriate annex to this Product Catalog document .
1 . Home Patient Accounts. Home patient account purchasers should refer to Annex A attached hereto for additional terms and conditions governing purchases with respect to this Product Catalog .
2 . Hospital and Center Accounts. Hospital and center account purchasers should refer to Annex B attached hereto for additional terms and conditions governing purchases with respect to this Product Catalog .
B. Selling Unit of Measure. Order quantities must be in the selling unit of measure indicated . Pack factors are noted for ease of ordering .
C. Purchase Orders.
1 . All orders, with the exception of warranty orders or EQUIPMENT service orders covered under a service agreement, require a purchase order, supply contract or credit card authorization .
2 . When using a purchase order form, only the listing and quantity of PRODUCTS, and the specific shipping instructions and information requested by the customer shall be applicable to Baxter . Any modifications regarding pricing, terms of sale, general ordering information, or any other terms or conditions shall not be effective unless accepted in advance and in writing by an authorized representative of Baxter .
3 . See ‘Ordering and Shipping Information’ (subsection A of the applicable Annex hereto) for more detail .
D. Credit Approval. All orders are subject to credit approval and acceptance at Baxter’s home office .
E. Delivery. Baxter shall use commercially reasonable efforts to fill orders, but Baxter shall not be liable for nonperformance or delays caused by a supply shortage of raw materials or components or finished goods, manufacturing problems, delivery or labor problems, acts of regulatory or other governmental or quasi-governmental entities, discontinuation of a product line, Acts of God, and unforeseen events or causes beyond its control . Customer agrees that in any and all such events, Baxter may allocate products among its customers without liability or other negative outcome with customer .
F. Acceptance of Delivery. Customer must count and visually inspect all orders received prior to acceptance of delivery from the carrier . Any exception must be noted at the time of delivery on the packing list accompanying the shipment, along with the carrier’s freight bill or bill of lading, and signed by the customer . The driver should countersign the packing list and the carrier’s freight bill or bill of lading . Baxter must be notified within two (2) business days of receipt of any delivery exception for credit eligibility consideration under Baxter’s Returned Goods Policy . See ‘Returned Goods Policy’ (Section II .B) for details and appropriate Baxter contact information .
G. Proof of Shipment. Please maintain Baxter’s invoice and packing list as your proof of shipment . Subject to availability and within thirty (30) days following the date of shipment, requests for additional documentation of shipment or delivery (i .e ., carrier delivery logs) are subject to a $40 service charge per shipment .
H. Expedited Processing & Delivery. When customer requires expedited order processing and delivery, customer is responsible for processing and delivery charges for all PRODUCTS .
i. Billing and Payment information. General billing and payment information is described in Section II below .
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i i . B i l l i N G A N D PAY M E N T; R E T U R N E D G O O D S
A. Billing and Payment information.
1 . Prices.
i . PRODUCTS are priced at the published amount indicated for the selling unit of measure indicated .
ii . EQUIPMENT service and separately billable PRODUCT processing and delivery charges are priced as described in the Product Catalog .
2 . Taxes. Published PRODUCT prices are exclusive of all taxes . Customer shall be responsible for payment of all applicable state and local sales, use, and/or gross receipt tax resulting from transactions with Baxter, regardless of legal liability for the tax .
3 . Invoices. Payment must be made within terms of sale as indicated on the invoice furnished by Baxter .
4 . Terms of Sale. Subject to credit approvals, standard payment terms are net 30 from the date on the invoice .
5 . Payment. Payment is to be made to the “remit to” address indicated on the invoice . Credit card payment is subject to an additional processing charge .
6 . Disputes. Only amounts that are validly disputed may be withheld from payment pending resolution . Any portion of an invoice not validly in dispute must be remitted within the terms of sale . All disputes must be submitted to Baxter Credit & Collections within thirty (30) days from the date of invoice . All disputes or rights are waived unless the customer’s complaint has been received by Baxter within such thirty (30) day period .
7 . Late Payment Charges. Any invoice not paid when due shall bear interest at the lesser of 18% per annum or the highest rate allowed by applicable law .
8 . Statements. Statements of account are issued monthly .
9 . Returned Checks. A fifty dollar ($50 .00) service charge will be assessed for returned checks .
10 . Electronic Data Interchange / e-Commerce Billing and Payment.
i . Electronic commerce can be an easy, automated way to send your invoice and payment . Baxter can help you get started and facilitate your transition to electronic invoicing and payment .
ii . Contact your Electronic commerce representative to learn how easy it is to implement electronic invoicing and payment at 1-877-334-2298, or visit Baxter’s e-Commerce site via the web at www .ecomm .baxter .com
11 . Inquiries. Call 1-888-270-3189 .
B. Returned Goods Policy.
1 . General Requirements.
i . This policy applies to all PRODUCTS originally delivered to hospitals, centers or home patients unless otherwise indicated . See ‘Specific Return Situations’ below .
ii . PRODUCTS must be stored in accordance with the following Baxter storage requirement to be eligible for return or credit:
1 . Stored at the originally delivered site, in the original, unopened and undamaged carton or package .
2 . Stored in a sanitary manner .
3 . Stored to avoid liquid contamination .
4 . Stored at room temperature to avoid excessive heat or freezing (solution products with 2B, 5B, or 5M prefixes only) .
5 . For home patient account returns, verification of proper storage by both the patient or designee and Baxter personnel is required for credit .
iii . PRODUCTS provided at no charge are not eligible for credit .
iv . Prior notification to return PRODUCTS is required . Credit will not be issued without prior notification of the return . Baxter shall have no responsibility or liability for PRODUCTS returned without prior notification .
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2 . Specific Return Situations.i . Damages or Shortages . Baxter must be notified of any shipping disputes within two (2) business days of receipt . Due to
the nature of Baxter’s PRODUCTS, the contents are subject to damage in transit to the customer . In an effort to minimize any delay in resolving a damage or shortage claim, all orders will be deemed counted and inspected prior to customer’s acceptance of delivery from the carrier . Any exception must be noted on customer’s copy of the carrier’s packing list and freight bill or bill of lading . The carrier should countersign the packing list and freight bill or bill of lading . The signed packing list and freight bill or bill of lading must be forwarded by the customer to Baxter Credit & Collections at the following address: Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015 .
ii . Shipped in Error by Baxter . Baxter must be notified of any shipping disputes within two (2) business days of receipt . PRODUCTS shipped in error by Baxter must be returned within thirty (30) days of shipment in order to qualify to receive 100% credit . Contact customer service to arrange for the removal/return of such PRODUCTS . DISPOSABLES and PARTS returned after thirty (30) business days of shipment shall be considered EXCESS STOCK (see subsection 3 below regarding ‘Excess DISPOSABLES and PARTS’) .
iii . Ordered in Error by Customer . Baxter must be notified of any shipping disputes within two (2) business days of shipment . PRODUCTS ordered in error by customer must be returned within thirty (30) days of shipment to qualify to receive credit . Any solutions returned from HOME PATIENTS will receive no credit . Customer is responsible for all costs and expenses incurred by Baxter related to the return of the PRODUCTS . DISPOSABLES and PARTS returned after thirty (30) business days of shipment shall be considered EXCESS STOCK (see subsection 3 below regarding ‘Excess DISPOSABLES and PARTS’) .
3 . Excess DISPOSABLES and PARTS.i . DISPOSABLES and PARTS not shipped in error, or not ordered in error, shall be considered EXCESS STOCK when
returned .
ii . Customer is responsible for all costs and expenses incurred by Baxter related to the return of EXCESS STOCK .
iii . DISPOSABLES and PARTS returned from a HOSPITAL OR CENTER will be credited at 50% .
iv . DISPOSABLES and PARTS will not be eligible for return or credit under the following circumstances:
1 . Returned after ninety (90) days from shipment .2 . Less than three (3) months remaining to expiration .3 . 5K or 5Q prefix .4 . All solutions returned from HOME PATIENTS .5 . Sold on a no return basis .
4 . Equipment.i . Purchased EQUIPMENT cannot be returned for credit unless shipped in error by Baxter or ordered in error by customer .
ii . Leased, rental, trade-in, or evaluation EQUIPMENT must be in the same condition as when shipped to customer, reasonable wear and tear excepted . Customer is responsible for all costs and expenses incurred by Baxter related to the returned EQUIPMENT .
iii . Customer must ensure EQUIPMENT is packed properly for return shipping .
iv . See ‘EQUIPMENT Rental Program’ (Section III) .
5 . Product Pick-Up and Return Requests.i . Baxter can arrange for pick-up of returned PRODUCTS . A ninety-five dollar ($95 .00) returned goods pick-up charge will
be applied, if applicable, against any credit due on DISPOSABLES returned . Any portion of the charge that is not covered by a returned goods credit will be invoiced separately . Baxter reserves the right to charge a pick-up fee for EQUIPMENT returns as well as a fee for pick-up appointments missed by the customer .
ii . HOSPITAL OR CENTER RETURNS
1 . DISPOSABLES: Call 1-888-229-0001 (option 1 (Hospitals) or option 4 (Centers)) or fax 1-888-229-0020 .2 . EQUIPMENT: Call 1-800-553-6898 (select 1 for English, then prompt 5, option 2) .3 . PARTS: Call 1-800-553-6898 (select 1 for English, then prompt 2, option 1) .
iii . HOME PATIENT RETURNS: Call 1-800-284-4060 or fax 1-800-666-8457 .
6 . Return Credit Inquiries.i . For DISPOSABLES and EQUIPMENT: Call 1-888-270-3189 .
ii . For PARTS: Call 1-800-553-6898 (select 1 for English, then prompt 2, option 1) .
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i i i . E Q U i P M E N T R E N TA l P R O G R A MA. General. Baxter offers a monthly Rental Program for EQUIPMENT . The terms and conditions of the Rental Program are as follows .
1 . Terms and Conditions. All terms and conditions of the Product Catalog in effect during the Rental Program shall apply to the sales contract except to the extent such terms and conditions are inconsistent with the provisions of the Rental Program, in which event, the provisions of the Dialysis Products Purchase Agreement or other applicable sales document, if any, shall govern . Customer may not assign or otherwise transfer its rights or obligations under the Rental Program except with the prior written consent of Baxter .
B. Commencement and Monthly Fee.
1 . The Rental Program shall begin on the EQUIPMENT Effective Date (i .e ., the date that is five (5) days after the date of shipment), and shall continue until the EQUIPMENT is returned to Baxter . Customer may terminate the Rental Program at any time by giving notice to Baxter and returning the EQUIPMENT to Baxter . Rental Fees will be billed monthly . If the EQUIPMENT Effective Date is any day other than the first of the month, the first monthly rental fee shall be prorated . Thereafter, full monthly rental fees shall be due for each month through the month in which the EQUIPMENT is returned and the Rental Program terminates . Renter is responsible for all rental fees until such time as the EQUIPMENT is returned to Baxter .
2 . The Rental Program for Evaluator EQUIPMENT (i .e ., Equipment delivered to customer for evaluation purposes only) shall begin on the forty-fifth (45th) day after Baxter provides the first in-service for the Evaluator EQUIPMENT (such forty-fifth (45th) day being the “Evaluator Rental Commencement Date”) . Customer may terminate the Rental Program at any time by giving notice to Baxter and returning the Evaluator EQUIPMENT to Baxter . Rental Fees will be determined by Baxter and billed monthly . If the Evaluator Rental Commencement Date is any day other than the first of the month, the first monthly rental fee shall be prorated . Thereafter, full monthly rental fees shall be due for each month through the month the Evaluator EQUIPMENT is returned to Baxter and the Rental Program terminates . Customer is responsible for all rental fees until such time as the Evaluator EQUIPMENT is returned to Baxter .
C. Service Change. If the order is initially placed without service and later changed to add service, a pre-inspection of the EQUIPMENT by Baxter is required at the customer’s expense .
D. Warranties. Applicable warranties in Section IV extend to the Rental Program .
E. Customer Obligation. Customer shall use the EQUIPMENT only for the purposes and according to the instructions indicated in the labeling as well as those included with the EQUIPMENT . Customer shall not make modifications, alterations, or additions to the EQUIPMENT without prior written consent of Baxter . The EQUIPMENT shall remain personal property at all times regardless of how it is attached or installed . Baxter shall have the right, during normal business hours, to enter customer’s premises or any EQUIPMENT site to inspect the EQUIPMENT . Title to the EQUIPMENT remains with Baxter . During the Rental Program, customer assumes the risk of loss of, and has responsibility for, damage to the EQUIPMENT from any cause . Customer shall indemnify and hold Baxter harmless from any and all liability and expense, except to the extent directly caused by the sole negligence of Baxter, arising out of the selection, possession, operation, maintenance, delivery, or return of the EQUIPMENT . Such protection shall include, but not be limited to, claims for personal injury or death or property damage arising out of any act or omission of the customer or its patients . Such protection also shall include all costs and expenses, including without limitation attorneys’ fees incurred by Baxter, in connection with any suits or actions resulting from any such liability .
F. Default.
1 . The following shall constitute events of default:
i . Customer fails to pay monthly rental fee within the terms of sale stated on the invoice .
ii . Customer fails to perform any other of its obligations under the Rental Program and such failure continues for thirty (30) calendar days after Baxter gives customer written notice of such failure .
iii . A petition in bankruptcy is filed by the customer or the customer makes an assignment for the benefit of creditors, or consents to the appointment of a trustee or receiver, or a trustee or receiver is appointed by the customer for any part of the EQUIPMENT, or for a substantial part of the customer’s assets without its consent, and is not dismissed within a period of thirty (30) calendar days, or bankruptcy, reorganization, or insolvency proceedings are instituted against the customer and are not dismissed within thirty (30) calendar days thereafter .
2 . Upon the happening of any event of default, Baxter may, at its sole option, take immediate possession of any or all of the EQUIPMENT, and, for such purposes, enter upon the customer’s premises or site where the EQUIPMENT is located and remove it, without liability for so doing or require the customer, at its expense, to return the EQUIPMENT to Baxter as provided in the Returned Goods Policy in Section II .B .
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i v. WA R R A N T i E SA. General Warranty
1 . PRODUCT warranties extend only to the original customer, and are not assignable or transferable .
2 . Baxter warrants that the PRODUCTS it manufactures shall be free from defects in material and workmanship when delivered to the original customer .
3 . Baxter warrants that the PRODUCTS it manufactures, when used in accordance with the directions on the labeling, are fit for the purposes and indications described in labeling .
4 . PRODUCTS distributed by Baxter are warranted by their manufacturer . More specific warranties may accompany these PRODUCTS .
5 . Unless the PRODUCT is used in accordance with its instructions, the PRODUCT warranties are void and of no effect .
6 . THERE ARE NO OTHER EXPRESSED OR IMPLIED WARRANTIES, INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE . BAXTER SHALL NOT BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES .
7 . Baxter’s sole obligation, and customer’s exclusive remedy for breach of any warranty, shall be, at Baxter’s option, to repair or replace the PRODUCT .
B. limitation to Warranty for Equipment. Baxter’s sole obligation and customer’s exclusive remedy shall be limited to repair or replacement, at Baxter’s option and expense, of the defective part or unit for a period of one hundred eighty (180) days, except for the HomeChoice or the HomeChoice Pro system which shall be for a period of ninety (90) days, following the date of initial delivery . Modifications, alterations, recalibrations, or abuse, and service by anyone other than a Baxter authorized representative may void the warranties . Preventative maintenance service made necessary by changes to the operating environment or operating parameters of any equipment are not covered under Baxter’s standard or extended warranties . These services can be purchased by calling 1-800-553-6898 (select 1 for English, prompt 5, option 3) . Requests for service or replacements outside of Baxter’s normal working hours will be subject to additional charges .
C. Warranty for Service and Parts. Parts and labor are subject to a ninety (90) day conditional warranty .
v. D E F i N i T i O N SThe following definitions apply to this Product Catalog:
A. DiSPOSABlE(S) is defined as any product manufactured or sold by Baxter, other than EQUIPMENT or PARTS .
B. EQUiPMENT is defined as durable medical equipment or, what Baxter generally refers to in this catalog as devices, hardware, instruments and instrumentation, used primarily for dialysis, which is manufactured or sold by Baxter for its intended use .
C. PART(S) is defined as components manufactured or sold by Baxter for EQUIPMENT .
D. PRODUCT(S) is defined as DISPOSABLES, EQUIPMENT, PARTS or any combination thereof .
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A-1 Effective Date 4/1/11
A N N E x A
H O M E PAT i E N T A C C O U N T S
A. Ordering & Shipping information.
1 . Before shipping to home patients, Baxter requires a copy or facsimile of a prescription signed and dated by a physician, listing the product codes and quantities and the allowable refill period not to exceed one (1) year .
2 . Documentation Requests .
i . PRESCRIPTIONS: Subject to availability, upon request, Baxter shall provide copies of signed patient prescriptions . A $40 service charge per prescription shall apply .
ii . OTHER: Fulfillment of some documentation requests, subject to availability, may incur processing charges quoted by Baxter .
B. To Place an Order. Please call 1-800-284-4060 or fax 1-800-666-8457 .
C. lead Time. Baxter requires the following minimum lead time for order fulfillment processing . See ‘Expedited Order Processing Charge’ (subsection D .3 below) if less lead time is provided .
1 . DISPOSABLES. Five (5) business days lead time for DISPOSABLES orders .
2 . EQUIPMENT.
i . Five (5) business days lead time for Peritoneal Dialysis EQUIPMENT .
ii . Sixty (60) business days lead time for Hemodialysis and Acute Dialysis EQUIPMENT .
3 . TRAVEL ORDERS.
i . Fourteen (14) business days lead time for all continental U .S . destinations .
ii . Thirty (30) business days lead time for all Alaska and Hawaii destinations .
iii . Sixty (60) business days lead time for all international destinations .
iv . Saturdays, Sundays and annually identified Baxter holidays are not considered business days .
D. Order/Delivery Types.
1 . SCHEDULED.
i . Each home patient will receive a calendar indicating his or her twenty-eight (28) day schedule for ordering and delivery of PRODUCTS for a twelve (12) month period . Each calendar will indicate order, ship and delivery dates . Each DISPOSABLE order shipped according to this calendar is to be a SCHEDULED order . To avoid additional processing and delivery charges, SCHEDULED orders must be placed at least five (5) business days prior to the ship date noted on the calendar . Orders placed on the scheduled ship date are considered to be OFF SCHEDULE orders . (See below .)
ii . Baxter shall have the right to make modifications in DISPOSABLES order and delivery schedules, and the customer will not incur additional charges resulting solely from such modifications . If Baxter modifies a schedule, it will provide the home patient with a revised calendar reflecting the new twenty-eight (28) day schedule for a twelve (12) month period . Any order shipped according to the revised calendar (not a prior calendar) is a SCHEDULED order .
2 . OFF SCHEDULE. DISPOSABLES orders requiring delivery on a day other than a scheduled delivery day are considered OFF SCHEDULE and are subject to additional processing and delivery charges .
3 . EXPEDITED. PRODUCT(S) orders placed for delivery with less lead time than required (See ‘Lead Time’ (subsection C above)) are considered to be EXPEDITED orders and are subject to additional processing and delivery charges .
E. Order Processing and Delivery Charges.
1 . DISPOSABLES.
i . Published prices for DISPOSABLES include normal processing and delivery charges for SCHEDULED orders and deliveries .
ii . All DISPOSABLES orders subject to the Off Schedule Processing Charge, Expedited Order Processing Charge and Re-Delivery Charge policies must be approved by the customer prior to shipment except in the case of an emergency .
2 . Off Schedule Processing Charge.
i . Orders requiring OFF SCHEDULE delivery are subject to a $75 charge in addition to any applicable Expedited Order Charges .
ii . Exempt from this policy are travel orders, new patient orders, prescription change orders, usage change orders and orders necessitated by a significant, unplanned medical event involving a home patient .
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Effective Date 4/1/11 A-2
3 . Expedited Order Processing Charge.
i . EXPEDITED orders for existing home patients requiring either SCHEDULED or OFF SCHEDULE delivery are subject to an Expedited Order Charge as outlined below:
Business Days from Order Placement to Delivery
Same Business Day* Next Business Day* Two (2) Three (3) Four (4) Business Days Business Days Business Days
$95 $65 $45 $35 $25
* When and where possible
ii . SAME BUSINESS DAY and NEXT BUSINESS DAY deliveries to all geographies outside of a radius of 100 miles to the closest Baxter warehouse facility incur Expedited Order Charges PLUS delivery charges quoted by Baxter .
iii . Additional policies for EXPEDITED OFF SCHEDULE orders only:
a . Baxter reserves the right to deliver in multiple shipments if the order quantity is in excess of normal and customary requirements .
b . Orders requiring expedited processing, at the customer’s request, after business hours or on weekends/holidays are subject to a $125 fee PLUS delivery charges quoted by Baxter .
c . Deliveries to Hawaii: deliveries to locations other than on Oahu are subject to Expedited Order Charges PLUS delivery charges quoted by Baxter .
d . Deliveries to Alaska: deliveries outside a radius of 250 miles to Anchorage are subject to Expedited Order Charges PLUS delivery charges quoted by Baxter .
e . Deliveries to international destinations are subject to processing and delivery charges quoted by Baxter .
4 . Home Hemodialysis Minimum Order Charge. Home hemodialysis orders totaling less than $250 will be assessed a minimum order charge of $40 .
5 . Re-delivery Charge. DISPOSABLES orders are subject to a $75 re-delivery charge in the event the customer is not available to accept a delivery for which Baxter has previously communicated the delivery date . This charge may be waived if changes to delivery arrangements are made in advance and agreed to by Baxter or if changes are necessitated by a significant, unplanned medical event involving a home patient .
6 . EQUIPMENT.
i . Published prices for EQUIPMENT exclude delivery, handling and installation . These charges are billed separately, if applicable .
ii . EQUIPMENT orders requiring expedited delivery at a customer’s request are subject to an expedited processing and delivery charge quoted at the time of order placement .
iii . EQUIPMENT orders requiring expedited processing, at a customer’s request, after business hours or on weekends/holidays are subject to a $125 fee PLUS delivery charges quoted by Baxter .
A N N E x A
H O M E PAT i E N T A C C O U N T S Polic
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B-1 Effective Date 4/1/11
A N N E x B
H O S P i TA l S A N D C E N T E R A C C O U N T S
A. Ordering and Shipping information. Customer shall maintain all licenses necessary for the purchase of prescription PRODUCTS (e .g ., state pharmacy license, physician’s license), permits and other authorizations and approval(s), and shall promptly forward a copy of the same to Baxter upon request .
B. DiSPOSABlES.
1 . Lead Time.
i . Orders
a . For all dialyzers, blood tubing and fistula needles: Orders must be received and processed prior to 12:00 noon local time in order to be delivered within three (3) to five (5) business days .
b . For all other DISPOSABLES orders: Orders must be received and processed prior to 12:00 noon local time in order to be processed for next scheduled deliveries .
c . Lead time and transportation mode may vary based on order volume and customer location . Some exceptions may exist . Please contact customer service at 1-888-229-0001 .
ii . Scheduled deliveries may be available for customers based on customer’s geography and the frequency and volume of purchases . Contact customer service at 1-888-229-0001 to establish scheduled deliveries and to document required delivery services .
iii . See ‘Expedited Order Processing’ (subsection 6 below) if less lead time is provided .
2 . Order Placement & Processing.
i . Please call 1-888-229-0001 (option 1 (Hospitals) or option 4 (Centers)) or fax 1-800-284-4062 .
ii . Please include the following information:
a . Account numberb . Hospital or center namec . Complete delivery addressd . Delivery date requiremente . Purchase order numberf . Product code(s) and quantity g . Contact name and telephone numberh . Any special instructions
3 . Electronic Data Interchange / e-Commerce Ordering. Electronic Commerce can be an easy, automated way to send your order to Baxter . Baxter can help you get started and facilitate your transition to electronic ordering . Contact your Baxter Electronic Commerce representative to learn how easy it is to implement electronic ordering at 1-877-334-2298, or visit Baxter’s e-Commerce site via the Web at www .ecomm .baxter .com
4 . Minimum Order Charge. DISPOSABLES orders totaling less than $250 will be assessed a minimum order charge of $40 .
5 . Delivery. Delivery to receiving, or loading dock, is standard, while inside delivery is an added service and may result in additional charges .
6 . Expedited Order Processing.
i . Published prices for DISPOSABLES include normal processing and delivery charges .
ii . DISPOSABLES orders requiring expedited delivery at a customer’s request are subject to an expedited processing fee and delivery charge quoted at the time of order placement .
III . DISPOSABLES orders requiring expedited processing, at the customer’s request, after business hours or on weekends/holidays are subject to a $125 fee PLUS delivery charges .
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C. EQUiPMENT
1 . Lead Time. Baxter requires the following minimum lead time for order fulfillment processing:
i . Peritoneal Dialysis EQUIPMENT . Five (5) business days lead time .
ii . Hemodialysis and Acute Dialysis EQUIPMENT . Sixty (60) business days is required .
2 . Order Placement & Processing.
i . Please call 1-800-553-6898 (select 1 for English, then prompt 2, option 2) . Customer Service Representatives are available during the hours of 8:30 AM to 5:00 PM EST, Monday – Friday .
ii . Please have the following information available:
a . Account numberb . Hospital or center namec . Complete delivery addressd . Contact name and telephone numbere . Any special instructionsf . Purchase order number or credit card authorizationg . Product code(s) and quantity
3 . Processing & Delivery.
i . Published prices for EQUIPMENT exclude delivery, handling and installation . These charges are billed separately, if applicable .
ii . EQUIPMENT orders requiring expedited delivery at a customer’s request are subject to an expedited processing and delivery charge quoted at the time of order placement .
iii . EQUIPMENT orders requiring expedited processing, at the customer’s request, after business hours or on weekends/holidays are subject to a $125 fee PLUS delivery charges quoted by Baxter at the time of order placement .
D. SERviCE SPARE PARTS
1. Order Placement & Processing.
i . Please call 1-800-553-6898 (select 1 for English, then prompt 2, option 1) . Customer Service Representatives are available during the hours of 7:00 AM to 7:00 PM EST, Monday – Friday .
ii . Please have the following information available:
a . Account numberb . Hospital or center namec . Complete delivery addressd . Contact name and telephone numbere . Any special instructionsf . Purchase order number or credit card authorizationg . Part number(s) and quantity
2 . Processing & Delivery. Published prices for PARTS exclude delivery and handling . These charges are billed separately .
E. EQUiPMENT SERviCE & CHARGES
1 . Hemodialysis and Acute Dialysis.
i . Baxter Global Technical Service provides the scheduling and actual on-site service of Hemodialysis and Acute Dialysis EQUIPMENT by qualified Service Engineers . Normal service hours are 8:00 AM to 5:00 PM, Monday-Friday, in the time zone where service is requested .
ii . Hemodialysis and Acute Dialysis EQUIPMENT field service will be performed during Baxter’s normal business hours at Baxter’s then current standard labor rate . Field service performed after Baxter’s normal business hours and on weekends and holidays will be charged at a premium labor rate .
iii . Field service contracts are available . Information can be obtained by calling 1-800-553-6898 (select 1 for English, then prompt 5, option 3) .
Effective Date 4/1/11 B-2
A N N E x B
H O S P i TA l S A N D C E N T E R A C C O U N T S Polic
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2 . Peritoneal Dialysis
i . Baxter Global Technical Service also provides the scheduling and replacement of Peritoneal Dialysis EQUIPMENT .
ii . Replacement of Peritoneal Dialysis EQUIPMENT will be performed on a next day basis .
iii . Expedited replacements are those requiring same-day delivery . Expedited replacements are subject to an additional processing and delivery charge quoted at the time service is requested .
3 . To Request On-Site Service
i . Please call 1-800-553-6898, (select 1 for English, then prompt 3) during the hours of 8:00 AM to 10:00 PM EST, 365 days a year .
ii . Please have the following information available:
a . Account numberb . Hospital or center namec . Complete service addressd . Contact name and telephone numbere . Date service is requiredf . Any special instructionsg . Purchase order number h . Brief description of problemi . Model & serial number of equipment
4 . Technical Telephone Support.
i . Please call 1-800-553-6898 (select 1 for English, then prompt 4 (Hemodialysis) or select 1 for English, then prompt 1 (Peritoneal Dialysis and Acute Dialysis)) .
ii . Hours of Service:
a . Hemodialysis: 8:30 AM to 5:00 PM EST, Monday – Fridayb . Peritoneal Dialysis, Acute Dialysis: 24 hours/7 days a week/ 365 days year
iii . Please have the following information available:
a . Account numberb . Hospital or center namec . Complete addressd . Contact name and telephone numbere . Brief description of problemf . Model & serial number of equipment
B-3 Effective Date 4/1/11
A N N E x B
H O S P i TA l S A N D C E N T E R A C C O U N T S Polic
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Effective Date 4/1/11 PD1
P e r i t o n e a l D i a l y s i s Dianeal PD Solution, UltraBag System
Dianeal low Ca lc ium PD So lu t ion
Product Dextrose Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
5B9765P 1.5% 1500 2000 8/case $264.63 5B9775P 2.5% 1500 2000 8/case $271.94 5B9795P 4.25% 1500 2000 8/case $274.00 5B9766 1.5% 2000 2000 6/case $185.50 5B9776 2.5% 2000 2000 6/case $206.97 5B9796 4.25% 2000 2000 6/case $208.86 5B9768P 1.5% 2500 3000 5/case $171.58 5B9778P 2.5% 2500 3000 5/case $176.45 5B9798P 4.25% 2500 3000 5/case $180.23 5B9757 1.5% 3000 5000 4/case $151.825B9758 2.5% 3000 5000 4/case $155.18 5B9759 4.25% 3000 5000 4/case $159.92
Dianeal PD-2 PD So lu t ion
5B9866 1.5% 2000 2000 6/case $185.50 5B9876 2.5% 2000 2000 6/case $206.97 5B9896 4.25% 2000 2000 6/case $208.86 5B9868P 1.5% 2500 3000 5/case $171.58 5B9878P 2.5% 2500 3000 5/case $176.45 5B9898P 4.25% 2500 3000 5/case $180.235B9857 1.5% 3000 5000 4/case $151.82 5B9858 2.5% 3000 5000 4/case $155.18 5B9859 4.25% 3000 5000 4/case $159.92
Na Ca Mg Cl LactateDianeal Low Calcium PD Solution (mEq/L) 132 2.5 0.5 95 40Dianeal PD-2 PD Solution (mEq/L) 132 3.5 0.5 96 40
DIANEAL PD-2 and Low Calcium peritoneal dialysis solutions in Ultrabag containers are indicated for use in chronic renal failure patients being maintained on continuous ambulatory peritoneal dialysis when nondialytic medical therapy is judged to be inadequate.
Important Risk Information for Dianeal Solutionsn Not for Intravenous Injection.n Use aseptic technique. Contamination of connector may result in
peritonitis.n Adverse reactions to peritoneal dialysis include mechanical and
solution related problems as well as the results of contamination of equipment.
n Solution-related adverse reactions may include peritonitis, electrolyte and fluid imbalances, hypovolemia, hypervolemia, hypotension, hypertension, disequilibrium syndrome, allergic symptoms, and muscle cramping.
n Please see full prescribing information. DIANEAL Low Calcium PD Solution in ULtRAbAg Product Insert DIANEAL PD-2 PD Solution in ULtRAbAg Product Insert
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PD2 Effective Date 4/1/11
P e r i t o n e a l D i a l y s i s Dianeal PD Solution, Single Bag (aMBU-FleX Container)
D ianeal low Ca lc ium PD So lu t ion , Sp ike (aMBU-FleX i i i Conta iner )
Product Dextrose Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
5B4825 1.5% 2000 2000 6/case $110.63 5B9727 2.5% 2000 3000 6/case $133.59 5B9747 4.25% 2000 3000 6/case $134.93 5B9901 1.5% 3000 3000 4/case $127.995B9902 2.5% 3000 3000 4/case $130.615B9903 4.25% 3000 3000 4/case $133.595B4826 1.5% 5000 5000 2/case $68.815B5202 2.5% 5000 5000 2/case $70.64 5B5203 4.25% 5000 5000 2/case $72.385B9770 1.5% 6000 6000 2/case $82.595B9771 2.5% 6000 6000 2/case $84.76 5B9772 4.25% 6000 6000 2/case $86.85
Dianeal low Ca lc ium PD So lu t ion , luer (aMBU-FleX i i Conta iner ) *
Product Dextrose Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
L5B4825 1.5% 2000 3000 6/case $117.38L5B9727 2.5% 2000 3000 6/case $140.70 L5B9747 4.25% 2000 3000 6/case $142.46 L5B9901 1.5% 3000 3000 4/case $134.33L5B9902 2.5% 3000 3000 4/case $136.21L5B9903 4.25% 3000 3000 4/case $139.14L5B4826 1.5% 5000 6000 2/case $71.99 L5B5202 2.5% 5000 6000 2/case $73.67L5B5203 4.25% 5000 6000 2/case $75.46 L5B9770 1.5% 6000 6000 2/case $86.03 L5B9771 2.5% 6000 6000 2/case $87.90 L5B9772 4.25% 6000 6000 2/case $90.33
*Baxter is pleased to introduce Luer connection for all DIANEAL solution in AMbU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area.
Na Ca Mg Cl LactateDianeal Low Calcium PD Solution (mEq/L) 132 2.5 0.5 95 40Dianeal PD-2 PD Solution (mEq/L) 132 3.5 0.5 96 40
n Please see important safety information on page PD1.n Please see full prescribing information.
DIANEAL Low Calcium Peritoneal Dialysis Solution Product Insert
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Effective Date 4/1/11 PD3
P e r i t o n e a l D i a l y s i s Dianeal PD Solution, Single Bag (aMBU-FleX Container) (Cont.)
Dianeal P D - 2 P D S o l u t i o n , L u e r (aMBU-FleX I I C o n t a i n e r ) *
Product Dextrose Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
L5B5163 1.5% 1000 1000 12/case $339.98 L5B5173 2.5% 1000 1000 12/case $354.71L5B5183 4.25% 1000 1000 12/case $365.62 L5B5166 1.5% 2000 3000 6/case $118.20L5B5177 2.5% 2000 3000 6/case $141.36 L5B5187 4.25% 2000 3000 6/case $143.73 L5B5169 1.5% 3000 3000 4/case $132.98 L5B5179 2.5% 3000 3000 4/case $135.84L5B5189 4.25% 3000 3000 4/case $139.59L5B5193 1.5% 5000 6000 2/case $71.99 L5B5194 2.5% 5000 6000 2/case $73.66 L5B5195 4.25% 5000 6000 2/case $75.28L5B9710 1.5% 6000 6000 2/case $85.37 L5B9711 2.5% 6000 6000 2/case $87.61 L5B9712 4.25% 6000 6000 2/case $89.86
*Baxter is pleased to introduce Luer connection for all DIANEAL solution in AMbU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area.
$295.76 $317.95 $316.86 $110.63 $133.59 $134.93 $127.99 $130.61 $133.59 $68.81 $70.64 $72.38 $82.59 $84.76 $86.85
$339.98 $354.71 $365.62 $118.20 $141.36 $143.73 $132.98 $135.84 $139.59 $71.99 $73.66 $75.28 $85.37 $87.61 $89.86
Dianeal P D - 2 P D S o l u t i o n , S p i k e (aMBU-FleX I I I C o n t a i n e r )
Product Dextrose Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
5B5163 1.5% 1000 1000 12/case $295.76 5B5173 2.5% 1000 1000 12/case $317.955B5183 4.25% 1000 1000 12/case $316.86 5B5166 1.5% 2000 2000 6/case $110.63 5B5177 2.5% 2000 3000 6/case $133.59 5B5187 4.25% 2000 3000 6/case $134.93 5B5169 1.5% 3000 3000 4/case $127.99 5B5179 2.5% 3000 3000 4/case $130.615B5189 4.25% 3000 3000 4/case $133.59 5B5193 1.5% 5000 5000 2/case $68.81 5B5194 2.5% 5000 5000 2/case $70.64 5B5195 4.25% 5000 5000 2/case $72.38 5B9710 1.5% 6000 6000 2/case $82.59 5B9711 2.5% 6000 6000 2/case $84.76 5B9712 4.25% 6000 6000 2/case $86.85
n Please see important safety information on page PD1.n Please see full prescribing information.
DIANEAL PD-2 Peritoneal Dialysis Solution Product Insert
Na Ca Mg Cl LactateDianeal Low Calcium PD Solution (mEq/L) 132 2.5 0.5 95 40Dianeal PD-2 PD Solution (mEq/L) 132 3.5 0.5 96 40
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PD4 Effective Date 4/1/11
eXtraneal PD So lu t ion , UltraBag Sys tem
Product Icodextrin Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
5B4984 7.5% 2000 2000 6/case per contract5B4986 7.5% 2500 3000 5/case per contract
eXtraneal PD So lu t ion , S ing le Bag , Sp ike (aMBU-FleX i i i ) Conta iner
Product Icodextrin Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
5B4974 7.5% 2000 2000 6/case per contract5B4976P 7.5% 2500 3000 5/case per contract
eXtraneal PD So lu t ion , S ing le Bag , luer (aMBU-FleX i i ) Conta iner *
Product Icodextrin Fill Volume (mL) Container Size (mL) Pack Factor Price/Case
L5B4974 7.5% 2000 2000 6/case per contractL5B4976 7.5% 2500 3000 5/case per contract
*Baxter is pleased to introduce Luer connection for all EXtRANEAL solution in AMbU-FLEX containers. The conversion will be introduced in a phased roll out. Your Baxter Account Executive will provide specific information regarding timing in your area.
Na Ca Mg Cl Lactateextraneal (icodextrin) PD Solution (mEq/L) 132 3.5 0.5 96 40
P e r i t o n e a l D i a l y s i s eXtraneal (icodextrin) PD Solution
Extraneal (icodextrin) Peritoneal Dialysis (PD) solution is indicated for a single daily exchange for the long (8 to16 hour) dwell during Continuous Ambulatory Peritoneal Dialysis (CAPD) or Automated Peritoneal Dialysis (APD) for the management of End-Stage Renal Disease (ESRD). Extraneal is also indicated to improve (compared to 4.25% dextrose) long-dwell ultrafiltration and clearance of creatinine and urea nitrogen in patients with high-average or greater transport characteristics, as defined using the Peritoneal Equilibration Test (PET).
Important Risk Information EXtRANEAL (icodextrin) Peritoneal Dialysis (PD) SolutionDangerous Drug-Device InteractionOnly use glucose-specific monitors and test strips to measure blood glucose levels in patients using Extraneal (icodextrin) PD Solution. Blood glucose monitoring devices using glucose dehydrogenase pyrroloquinolinequinone (GDH-PQQ) or glucose-dye-oxidoreductase (GDO)-based methods must not be used. Use of GDH-PQQ or GDO-based glucose monitors and test strips has resulted in falsely elevated glucose readings due to the presence of maltose and has led patients or health care providers to withhold treatment of hypoglycemia or to administer insulin inappropriately. Both of these situations have resulted in unrecognized hypoglycemia, which has led to loss of consciousness, coma, permanent neurological damage, and death. Plasma levels of Extraneal and its metabolites return to baseline within approximately 14 days following cessation of Extraneal administration. Therefore falsely elevated glucose levels may be measured up to two weeks following cessation of Extraneal therapy when GDH-PQQ or GDO-based blood glucose monitors and test strips are used. Because GDH-PQQ and GDO-based blood glucose monitors may be used in hospital settings, it is important that the health care providers of peritoneal dialysis patients using Extraneal carefully review the product information of the blood glucose testing system, including that of test strips, to determine if the system is appropriate for use with Extraneal (icodextrin) PD Solution. To avoid improper insulin administration, educate patients to alert health care providers of this interaction whenever they are admitted to the hospital. Information regarding glucose monitor and test strip methodology can be obtained from their manufacturers. For a list of toll free numbers for glucose monitor and test strip manufacturers, please contact the Baxter Renal Clinical HelpLine 1-888-RENAL-HELP or visit www.glucosesafety.com.
n Extraneal is contraindicated in patients with a known allergy to cornstarch or icodextrin, maltose or isomaltose intolerance, pre-existing severe lactic acidosis, and in patients with glycogen storage disease
n Extraneal is not for intravenous injectionn Patients with insulin-dependent diabetes may require modification of insulin dosage following initiation of treatmentn A patient’s volume status should be carefully monitored to avoid hyper- or hypovolemia and potentially severe consequences including congestive heart
failure, volume depletion and hypovolemic shock. An accurate fluid balance record must be kept and the patient’s body weight monitoredn In clinical trials, the most frequently reported adverse events occurring in > 5% of patients, and more common in Extraneal patients than in control
patients, were peritonitis, upper respiratory infection, hypertension, and rash. The most common treatment-related adverse event for Extraneal patients was skin rash. Additional adverse reactions have been reported in the post-marketing setting and are detailed in the full prescribing information
general Peritoneal Dialysis-Relatedn Encapsulating Peritoneal Sclerosis (EPS) is considered to be a known, rare complication of peritoneal dialysis therapy. EPS has been reported in patients
using peritoneal dialysis solutions including Extraneal. Infrequent but fatal outcomes have been reportedn Aseptic technique should be used throughout the peritoneal dialysis procedure to reduce the possibility of infection, such as peritonitisn Fluid status, hematologic indices, blood chemistry, and electrolyte concentrations, including calcium, potassium, sodium, magnesium and bicarbonate,
should be monitored periodically. Abnormalities in any of these parameters should be treated promptly under the care of a physiciann Overinfusion of peritoneal dialysis solution volume into the peritoneal cavity may be characterized by abdominal distention, feeling of fullness and/or
shortness of breath. Treatment of overinfusion is to drain the peritoneal dialysis solution from the peritoneal cavityn Treatment should be initiated and monitored under the supervision of a physician knowledgeable in the management of patients with renal failuren Please see full prescribing information. EXtRANEAL Product Insert and EXTRANEAL Medication Guide.
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P e r I t o n e a l D I a l y s I s S Y S T E M S
Automated Peritoneal Dialysis
HOMECHOiCE PRO and HOMECHOiCE Automated Peritoneal Systems
Product Description Pack Factor Price
D e v i c e s
5C4471 HomeCHoiCe Automated PD System 1/each $17,203 .56 5C8310 HomeCHoiCe Pro Automated PD System 1/each $19,661 .22
HomeCHoiCe Pro System HomeCHoiCe System
S p i k e D i s p o s a b l e S e t s
5C4469C Automated PD Set with Cassette - 4 Prong 30/case $845 .92 5C4531C Integrated APD Set 30/case $1,238 .07 5C8302C Low Recirculation Volume APD Set with cassette 30/case $2,660 .28
L u e r D i s p o s a b l e S e t s *
R5C4479C Automated PD Set with Cassette - 4 Prong 30/case $938 .48 L5C4531 Integrated APD Set 30/case $1,265 .81N5C8305C Low Recirculation Volume APD Set with cassette 30/case $2,705 .67
nIntegrated APD Set has 3 supply lines, and 22’ patient and drain lines .nLow Recirculation Volume APD Set has in-line medication port, a shrouded patient connector, and a smaller internal
diameter and shorter patient line length . Recirculation volume 17mL .
*Baxter is pleased to introduce Luer connection for all APD Disposable Sets . The conversion will be introduced in a phased roll out . Your Baxter Account Executive will provide specific information regarding timing in your area .
Effective Date 4/1/11 PD5
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APD Drain Supplies
5C4145P 15 Liter Drainage Bag 30/case $294 .60 5C4464P Sterile Drain Extension Line, 12 feet 30/case $165 .99 5C4476 Effluent Sample Bag, 150mL 6/case $56 .32 5C4512 APD Drain Manifold (Connects two 15 liter drain bags) 30/case $213 .39
APD Miscellaneous Supplies
5C4462 Empty Sterile Bag, 3 Liter 48/case $592 .36 5C4446 AMP/Medionics 5-Prong Manifold Set (Spike) 15/case $222 .04 L5C4446 5-Prong Manifold Set (Luer) 15/case $261 .00 5C4971 QUietCoil Device 1/each $46 .78
P e r I t o n e a l D I a l y s I s S Y S T E M S
Automated Peritoneal Dialysis
HOMECHOiCE PRO and HOMECHOiCE Automated Peritoneal Systems (Cont.)
Product Description Pack Factor Price
D a t a C a r d s
R5C4522 HomeCHoiCe Pro Card 6/case $318 .27 R5C4526 HomeCHoiCe Pro Patient Data Card Adapter 1/each $196 .97 C a r r y i n g C a s e s
5C4406 Carrying Case 1/each $149 .02 5C8346 Hard Carrying Case with Wheels 1/each $440 .30 E x t e n s i o n L i n e s
5C4480C 12 Foot Patient Extension Line with eaSy-loCk Connector 30/case $239 .42
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P e r I t o n e a l D I a l y s I s S Y S T E M S
CAPD
Product Description Pack Factor Price
D i s c o n n e c t Y- S e t s
5C4366P UltraSet Disposable Disconnect Y-Set (Spike) 60/case $536 .51 L5C4366 UltraSet Disposable Disconnect Y-Set (Luer) 30/case $305 .89 M i s c e l l a n e o u s C A P D S u p p l i e s
5C4530 Spike Protector II (protective cover for aseptic transfer set spikes) 48/case $569 .77 5C4190 CAPD Drainage Bracket 1/each $106 .61
Effective Date 4/1/11 PD7
Assist Devices
CxD ii Compact Exchange Device for APD Patients
Product Description Pack Factor Price/Each
D e v i c e
5C4275 Compact Exchange Device (CXD II) 1/each $640 .89 C a r r y i n g C a s e
5C4942 Compact Exchange Device Carrying Case 1/each $83 .59
Product Description Pack Factor Price/Each
5C4505 EZ-Aide Assist Device 1/each $195 .06
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PD8 Effective Date 4/1/11
P e r i t o n e a l D i a l y s i s P a t i e n t C o n n e C t o l o g Y
Product Description Pack Factor Price/Case
transfer Sets 5C4442 Extended Life Easy-Lock Transfer Set (6”) 6/case $366.56 5C4449 Minicap Extended Life PD Transfer Set (6”) with Roller Clamp 6/case $366.56 5C4482 Minicap Extended Life PD Transfer Set (6”) with Twist Clamp 6/case $333.98 5C4483 Minicap Extended Life PD Transfer Set Extra Short (4”) 6/case $349.89 with Twist Clamp 5C4160 Transfer Set with Spike Connector (48”) 12/case $241.33
5C4150A Transfer Set Change Kit for PD 20/case $258.20 transfer Set adapters
5C4136 Easy-Lock-to-Spike Adapter Set 12/case $106.69 5C4137 PD Spike-to-Easy-Lock Adapter Set 12/case $106.69 5C4413 Spike/Syringe Adapter (connects spike on patient transfer set to luer-type syringe) 10/case $51.57 transfer Sets For Straight line CaPD 5C4213P Connection Shield II-K with Povidone-Iodine Solution 60/case $276.83 5C4215P Locking Connection Shield 60/case $445.58 Catheter Supplies 5C4129 Locking Titanium Adapter (2 piece) 5/case $1,138.02 5C4169 Locking cap for Baxter PD Catheter Adapter 25/case $120.39 5C4319 Immobile catheter and transfer set stabilizing device 30/case $149.36 5C4381 iMMobiLizEr catheter stabilizing device 30/case $463.09 Disconnect Caps5C4212P Disconnect Cap (Walnut Cap) 60/case $365.20 5C4456 FLExicap Disconnect Cap for High Dose Therapy 30/case $91.77 5C4466P Minicap Disconnect Cap 60/case $304.31 Clamps 5C4527 Outlet Port Clamp with Short Nose 12/case $76.58 5C4957 ULtracLaMp Clamp (not for use as outlet port clamp) 12/case $76.58
Locking Titanium Adapter
FLExicap Disconnect Cap
MiniCap Disconnect Cap
Outlet Port Clamp
ULtracLaMp Clamp
nConvenient kit includes everything necessary for a transfer set change except povidone iodine. 2 Masks, 10 Gauze pads, 1 Towel, 1 Catheter Clamp, 3 Pair Gloves, 1 Tray, 1 Drape, 1 Wrap.
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The following is a listing of trademarks of Baxter International Inc:
AMBU-FLEX
Baxter
Dianeal
Easy-Lock
EXtrAnEAL
FlexiCap
HomeChoice
HomeChoice PrO
Immobilizer
MiniCap
QuietCoil
UltraBag
UltraClamp
UltraSet
t r a D e M a r K sFor peritoneal dialysis products listed on pages PD1-PD8
Effective Date 4/1/11 PDTM
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Effective Date 4/1/11 AC1
CRRT - Continuous Renal Replacement Therapy - Critical Care Nephrology
AQUARiUS System
a C u t e D I a l y s I s
Product Description Pack Factor Price
instrument GEF09800 aQUariUS System 1/each Please contact Baxter aQUariUS Tubing Sets US10006 aQUaline (standard) Tubing Set 10/case $1,909 .62US10106 aQUaline S (low-volume) Tubing Set 10/case $2,333 .98 Hemofilters 5M3121 HF400 Hemofilter 0 .30m2 12/case $1,570 .86 5M3122 HF700 Hemofilter 0 .71m2 12/case $1,653 .55 5M3123 HF1200 Hemofilter 1 .25m2 12/case $1,736 .23 5M3074 HF2000 Hemofilter 1 .98m2 12/case $1,799 .775M3134 Minifilter Plus Hemofilter 700cm2 4/case $918 .655M3127 Hanson Adapters 48/case $264 .57 Disposable Supplies US14006 aQUaSPike 4-Prong Manifold (2 per pouch) 20 pair $933 .59US17006 Aquasafe Pressure Release Device (3 per pouch) 10 sets $466 .80 US19006 aQUariUS Ultrafiltration Bag, 5000 mL 75/case $1,576 .515M3076 Spike with Luer - replacement 50/case $164 .76
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Dialysis Solutions for CRRT
CRRT - Continuous Renal Replacement Therapy - Critical Care Nephrology
Bicarbonate Buffer SolutionProduct Description Pack Factor Price/Case5B9248 ACCUSOL Dialysis Solution 2 .5L 35 Bicarbonate K4 4/case $101 .72 5B9249 ACCUSOL Dialysis Solution 2 .5L 35 Bicarbonate K2 4/case $101 .725B9250 ACCUSOL Dialysis Solution 2 .5L 35 Bicarbonate K0 0 Dextrose 4/case $101 .725B9251 ACCUSOL Dialysis Solution 2 .5L 30 Bicarbonate K2 4/case $101 .725B9252 ACCUSOL Dialysis Solution 2 .5L 30 Bicarbonate K2 0 Calcium 4/case $101 .72
lactate Buffer Solution
5B7860 Premixed Dialysate for Hemodiafiltration-5 liter bag 2/case $80 .12
AC2 Effective Date 4/1/11
Catheter Supplies
Acute PD
Product Description Pack Factor Price/Case
2C7565 INTERLINk System with Add-On BURETROL 48/case $529 .92
Disposable Sets
5C4446 5-Prong Manifold Set 15/case $222 .04
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The following is a listing of trademarks of Baxter International Inc:
Accusol
Aqualine
Aqualine S
Aquarius
Aquaspike
Baxter
Buretrol
InterLink
t r a D e M a r K sFor acute dialysis products listed on pages AC1-AC2
Effective Date 4/1/11 ACTM
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Effective Date 4/1/11 HD1
Hemavision Disposable Blood Chamber
Product Description Pack Factor Price
HCT1000B Hemavision Disposable Blood Chamber 288/case $1,817.96
H e m o D i a l y s i s
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HD2 Effective Date 4/1/11
DiCEA High Performance Dialyzers, Cellulose Diacetate, High efficiency
Product Description Pack Factor Price/Case
5M2591 DiCea 90 dialyzer (for single-use only) 24/case $1,084 .955M2592 DiCea 110 dialyzer (for single-use only) 24/case $1,200 .895M2593 DiCea 130 dialyzer (for single-use only) 24/case $1,245 .925M2594 DiCea 150 dialyzer (for single-use only) 24/case $1,287 .955M2595 DiCea 170 dialyzer (for single-use only) 24/case $1,360 .925M2596 DiCea 210 dialyzer (for single-use only) 24/case $1,466 .75
H e M o D I a l y s I s D i A l Y z E R S
SiNGlE-USE
xENiUM xPH Dialyzers, High Flux, synthetic
ExElTRA High Flux Dialyzers, Cellulose triacetate
Product Description Pack Factor Price/Case
5M2119 exeltra 150 dialyzer (for single-use only) 24/case $1,365 .61 5M2120 exeltra 170 dialyzer (for single-use only) 24/case $1,405 .235M2121 exeltra 190 dialyzer (for single-use only) 24/case $1,450 .225M2132 exeltra Plus 210 dialyzer (for single-use only) 24/case $1,485 .52
Product Description Pack Factor Price/Case
5M6400 xeniUm 110 dialyzer (for single-use only) 24/case $748 .225M6401 xeniUm 130 dialyzer (for single-use only) 24/case $793 .565M6402 xeniUm 150 dialyzer (for single-use only) 24/case $888 .465M6403 xeniUm 170 dialyzer (for single-use only) 24/case $943 .005M6404 xeniUm 190 dialyzer (for single-use only) 24/case $1,006 .965M6405 xeniUm 210 dialyzer (for single-use only) 24/case $1,085 .00
Product Description Pack Factor Price/Case
H25601A xeniUm XPH 110 dialyzer (for single-use only) 24/case $748 .22 H25602A xeniUm XPH 130 dialyzer (for single-use only) 24/case $793 .56H25603A xeniUm XPH 150 dialyzer (for single-use only) 24/case $888 .46H25604A xeniUm XPH 170 dialyzer (for single-use only) 24/case $943 .00H25605A xeniUm XPH 190 dialyzer (for single-use only) 24/case $1,006 .96H25606A xeniUm XPH 210 dialyzer (for single-use only) 24/case $1,085 .00
xENiUM Dialyzers, High Flux, synthetic
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Effective Date 4/1/11 HD3
CA-HP High Performance Cellulose Diacetate Hollow Fiber Dialyzers, High efficiency
Product Description Pack Factor Price/Case
5M2731 Ca-HP 90 dialyzer 24/case $1,084 .95 5M2732 Ca-HP 110 dialyzer 24/case $1,200 .89 5M2733 Ca-HP 130 dialyzer 24/case $1,245 .92 5M2734 Ca-HP 150 dialyzer 24/case $1,287 .95 5M2735 Ca-HP 170 dialyzer 24/case $1,360 .925M2736 Ca-HP 210 dialyzer 24/case $1,466 .75
H e M o D I a l y s I s D i A l Y z E R S
REUSE
CT Cellulose Triacetate Hollow Fiber Dialyzers, High Flux
Product Description Pack Factor Price/Case
5M1542 Ct 110G dialyzer 24/case $1,395 .68 5M1546 Ct 190G dialyzer 24/case $1,504 .45
CA Cellulose Acetate Hollow Fiber Dialyzers, Conventional
Product Description Pack Factor Price/Case
5M1729 Ca 50 dialyzer (for single-use only) 24/case $834 .39 5M1730 Ca 70 dialyzer (for single-use only) 24/case $834 .39
SiNGlE-USE
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H e M o D I a l y s I s B l O O D T U B i N G S E T S
Blood tubing with pre-attached transducer protectors and priming set with needleless access port
Product Description Pack Factor Price/Case
*5M9634 8 mm pump segment, pre-pump pillow, post-pump arterial chamber 24/case $207 .77*A201V801 1/4” pump segment, pre-pump arterial chamber 24/case $207 .77*A203V801 8 mm pump segment, pre-pump arterial chamber 24/case $207 .77*A204V801 8 mm pump segment, post-pump arterial chamber 24/case $207 .77A209YV803 8 mm pump segment, pre-pump arterial chamber, Y-port saline set 24/case $207 .77 A210V803 8 mm pump segment, post-pump arterial chamber 24/case $207 .77 A217YV806 8 mm pump segment, post-pump arterial chamber, Y-port saline set 24/case $207 .77
NiPRO SET Blood Tubing Sets by Nipro Corporation
*These tubing sets are compatible with selected Baxter Hemodialysis Instruments .
Please refer to the recommended blood tubing Set Matrix for baxter Hemodialysis Instruments. baxter cannot recommend using sets outside the sets listed in the matrix. Please also refer to the blood tubing Set-up guide for proper set-up for each recommended blood tubing set. For a copy of either the blood tubing Set Matrix or the blood tubing Set-up guide please contact renal technical Support at 1-800-553-6898, Select 1 for English, Prompt 4, Option 1.
HD4 Effective Date 4/1/11
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H e M o D I a l y s I s F i S T U l A N E E D l E S
Nipro SAFETOUCH ii Safety Fistula Needle, Single Needle Set with Back-Eye
Product Description Pack Factor Price/Case
FS1425BC Safety Fistula 14G x 1”, fixed hub 500/case $876 .52FS1525BC Safety Fistula 15G x 1”, fixed hub 500/case $876 .52FS1525BCR Safety Fistula 15G x 1”, rotating hub 500/case $904 .65 FS1532BC Safety Fistula 15G x 11⁄4”, fixed hub 500/case $876 .52FS1625BC Safety Fistula 16G x 1”, fixed hub 500/case $876 .52FS1625BCR Safety Fistula 16G x 1”, rotating hub 500/case $904 .65 FS163230BC Safety Fistula 16G x 11⁄4”, fixed hub 500/case $876 .52 FS1725BC Safety Fistula 17G x 1”, fixed hub 500/case $876 .52 FS173230BC Safety Fistula 17G x 11⁄4”, fixed hub 500/case $876 .52
Nipro SAFETOUCH ii Safety Fistula Needle, Twin Pack Needle Set, Arterial Needle with Back-Eye, venous Needle without Back-Eye
Product Description Pack Factor Price/Case
FS142530TP Safety Fistula 14G x 1”, fixed hub 250 pair/case $876 .52 FS142530TPR Safety Fistula 14G x 1”, rotating hub 250 pair/case $904 .65FS152530TP Safety Fistula 15G x 1”, fixed hub 250 pair/case $876 .52FS152530TPR Safety Fistula 15G x 1”, rotating hub 250 pair/case $904 .65FS162530TP Safety Fistula 16G x 1”, fixed hub 250 pair/case $876 .52 FS162530TPR Safety Fistula 16G x 1”, rotating hub 250 pair/case $904 .65 FS172530TP Safety Fistula 17G x 1”, fixed hub 250 pair/case $876 .52 FS172530TPR Safety Fistula 17G x 1”, rotating hub 250 pair/case $904 .65
Nipro BioHole Dull Needles
Product Description Pack Factor Price/Case
FD152530BC 15G x 1” Fixed Hub w/Backeye 50/case $93 .06 FD162530BCQ 16G x 1” Fixed Hub w/Backeye 50/case $93 .06 FD172530BCQ 17G x 1” Fixed Hub w/Backeye 50/case $93 .06 FD152530BCRQ 15G x 1” Rotating Hub w/Backeye 50/case $95 .77FD162530BCRQ 16G x 1” Rotating Hub w/Backeye 50/case $95 .77FD172530BCRQ 17G x 1” Rotating Hub w/Backeye 50/case $95 .77
Effective Date 4/1/11 HD5
Nipro TUliP Safety Fistula Needle, Single Needle Set with Back-Eye
Product Description Pack Factor Price/Case
FT152530BC TULIP 15G x 1” Fixed Hub w/Backeye 300/case $525 .91 FT153230BC TULIP 15G x 11/4” Fixed Hub w/Backeye 300/case $525 .91 FT162530BC TULIP 16G x 1” Fixed Hub w/Backeye 300/case $525 .91 FT152530BCR TULIP 15G x 1” Rotating Hub w/Backeye 300/case $543 .22 FT162530BCR TULIP 16G x 1” Rotating Hub w/Backeye 300/case $543 .22
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H e M o D I a l y s I s F i S T U l A N E E D l E S
Nipro TUliP Safety Fistula Needle, Twin Pack Needle Set, Arterial Needle with Back-Eye, venous Needle without Back-Eye
Product Description Pack Factor Price/Case
FT142530TP TULIP 14G x 1”, Fixed Hub Twin Pack 120 pair + 10 singles/case $438 .25 FT152530TP TULIP 15G x 1” Fixed Hub Twin Pack 120 pair + 10 singles/case $438 .25FT162530TP TULIP 16G x 1” Fixed Hub Twin Pack 120 pair + 10 singles/case $438 .25 FT172530TP TULIP 17G x 1” Fixed Hub Twin Pack 120 pair + 10 singles/case $438 .25
HD6 Effective Date 4/1/11
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H e M o D I a l y s I s D i S P O S A B l E S U P P l i E S
Nipro Dosesaver Syringes
Micellaneous Nipro Supplies
Product Description Pack Factor Price/Case
JD01D2238 Dosesaver Syringe 1cc 22G x 1 1/2” 1000/case $541 .06 JD01D2516 Dosesaver Syringe 1cc 25G x 5/8” 1000/case $557 .29 JD03D2238 Dosesaver Syringe 3cc 22G x 1 1/2” 1000/case $546 .47
Product Description Pack Factor Price/Case
TPSURE1 Transducer Protector 1000/case $1,113 .95 PS01 Priming Set 200/case $200 .19
intravenous injections in viAFlEx Plastic Containers (Saline) sodium Chloride Injections
Product Description Container Size (mL) Pack Factor Price/Case
2B1321 0 .9% Sodium Chloride Injection, USP 150 36/case $193 .322B1322Q 0 .9% Sodium Chloride Injection, USP 250 36/case $193 .322B1323Q 0 .9% Sodium Chloride Injection, USP 500 24/case $128 .882B1324X 0 .9% Sodium Chloride Injection, USP 1000 14/case $81 .34
irrigation Solutions in Plastic Containers
Product Description Container Size (mL) Pack Factor Price/Case
2F7112 Sterile Water For Irrigation, USP 250 24/case $146 .642F7115 Sterile Water For Irrigation, USP 1500 9/case $87 .932F7122 0 .9% Sodium Chloride Irrigation, USP 250 24/case $153 .122F7124 0 .9% Sodium Chloride Irrigation, USP 1000 12/case $89 .882F7125 0 .9% Sodium Chloride Irrigation, USP 1500 9/case $91 .80
Effective Date 4/1/11 HD7
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Bicarbonate Concentrate (B-Side) by Minntech Renal Systems
T h r e e S t r e a m
Product Description Pack Factor Price/Case
5M7828 Bicarbonate Concentrate Powder for Conventional Proportioning Systems - 2.5 gal 20 packets/case $104.97 5M7829 Liquid Bicarbonate Concentrate for use with Conventional Proportioning Systems 4/case $58.43 (1 gal; 3.78 liters) C O B E ( B - S i d e )
Product Description Pack Factor Price/Case
5M7905 Bicarbonate Concentrate Powder for COBE Proportioning Systems (2.1 gal: 8 liters) 20 packets/case $104.97 5M7906 Liquid Bicarbonate Concentrate for use with COBE (45x) Proportioning Systems 4/case $58.43 (1 gal; 3.78 liters)
H e m o D i a l y s i s C o n C e n t R a t e S
acid Concentrate (a-Side) by Minntech Renal Systems
T h r e e S t r e a m ( C o n v e n t i o n a l ) P r o p o r t i o n i n g S y s t e m s ( 3 6 . 8 3 x d i l u t i o n ) Final dialysate composition approximates mEq/L when diluted with purified water and any B-side Bicarbonate product listed below
Product Na K Ca Mg Cl Acetate Dextrose Bicarbonate Pack Price/Case Factor
5M7818 140 1.00 2.50 1.00 105.50 4.0 200 35.0 4/case $45.45 5M7820 139 2.00 3.50 1.00 106.50 4.0 200 35.0 4/case $45.45 5M7821 139 1.00 3.50 1.00 105.50 4.0 200 35.0 4/case $45.45 5M7822 143 2.00 3.00 1.00 110.00 4.5 200 35.5 4/case $45.455M7823 140 0.00 2.50 1.00 104.50 4.0 200 35.0 4/case $45.455M7824 139 2.00 2.50 1.00 105.50 4.0 200 35.0 4/case $45.455M7825 139 3.00 3.00 1.00 107.00 4.0 200 35.0 4/case $45.455M7856 139 0.00 0.00 1.00 101.00 4.0 200 35.0 4/case $45.455M7857 139 3.00 2.50 0.75 106.25 4.0 200 35.0 4/case $45.45 CoBe P r o p o r t i o n i n g S y s t e m s ( 4 5 x d i l u t i o n )
Product Na K Ca Mg Cl Acetate Dextrose Bicarbonate Pack Price/Case Factor
5M7901 137 0.00 2.25 0.75 103.00 5.0 200 32.0 4/case $49.78 5M7902 137 2.00 2.50 0.75 105.25 4.0 200 33.0 4/case $49.78 5M7903 137 1.00 3.00 0.75 104.75 4.0 200 33.0 4/case $49.785M7904 137 2.00 3.00 0.75 105.75 4.0 200 33.0 4/case $49.785M7909 137 1.00 2.25 0.75 104.00 5.0 200 32.0 4/case $49.78 5M7911 137 3.00 3.00 0.75 106.75 4.0 200 33.0 4/case $49.78
HD8 Effective Date 4/1/11
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The following is a listing of trademarks of Baxter International Inc:
Baxter
CA
CA-HP
Ct
DICEA
EXELtrA
Hemavision
Viaflex
XEnIUM
The following is a listing of trademarks of VascA, Inc:
LifeSite
The following is a listing of trademarks of Cardian NBCT, Inc:
COBE
The following is a listing of trademarks of Nipro Corporation:
nipro Set
Safetouch II
tulip
t r a D e M a r K sFor hemodialysis products listed on pages HD1-HD8
Effective Date 4/1/11 HDTM
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s o F t w a r e
Renal Software Suite (for use with HOMECHOiCE PRO Automated PD System)
Product Description Pack Factor
5M5730 Renal Software Suite, Single User License 1/each5M5730U Renal Software Suite, User License Upgrade 1/each
RENAlSOFT Clinical Software - Medical Record, CKD, PD, HD modules
RENLSFT renalSoFt Clinical Software 1/each Contact your Baxter representative for more information
Renal Software interface
5M5720 Renal Software Interface CD 1/each Contact your Baxter representative for more information
Effective Date 4/1/11 SO1
Softw
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SOTM Effective Date 4/1/11
The following is a listing of trademarks of Baxter International Inc:
Baxter
HomeChoice PrO
renalSoft
t r a D e M a r K sFor software products listed on page SO1
Softw
are
Effective Date 4/1/11 AN1
Sponges
Product Description Pack Factor Price/Box5K7458P SorB-it IV Sponge (split) 2” x 2” 6-ply Sterile 35/box $16 .97 5K7407P exCilon Drain Sponge (split) 4” x 4” 6-ply Sterile 25/box $37 .58 5K7424P CUrity Gauze Sponge 2” x 2” 8-ply Sterile 50/box $8 .965K7505P CUrity Gauze Sponge 4” x 4” 8-ply Sterile 25/box $10 .11 5K7416P CUrity Gauze Sponge 4” x 4” 12-ply Sterile 25/box $11 .125K7426P CUrity Gauze Sponge 2” x 2” 12-ply Non-Sterile 200/box $11 .43 5K7425P CUrity Gauze Pad 2” x 2” 12-ply Sterile 100/box $27 .53 5K7567P verSalon All Purpose Sponge 2” x 2” 4-ply Sterile 25/box $4 .31 5K7559P verSalon All Purpose Sponge 3” x 3” 4-ply Sterile 25/box $7 .98 5K7589P verSalon All Purpose Sponge 4” x 4” 4-ply Sterile 25/box $10 .44 5K7428P CUrity Cover Sponge 4” x 3” Sterile 25/box $11 .58 5K7543P CUrity Cover Sponge 4” x 4” Sterile 25/box $12 .96 5K7427P CUrity Cover Sponge 3” x 3” Non-Sterile 100/box $10 .05 5K7525P CUrity Cover Sponge 4” x 3” Non-Sterile 100/box $13 .93 5K7430P CUrity Cover Sponge 4” x 4” Non-Sterile 100/box $19 .21
a n C I l l a r I e s
Gauze Sponge
IV Sponge
Dressings
Product Description Pack Factor Price/Box5K7401P Coverlet Adhesive Bandage, Flexible 1” x 3” 100/box $23 .785K7479P BioPatCH Antimicrobial Dressing - 1” disk w/7 .0 mm center hole 10/box $175 .47 5K7538P PrimaPore Adhesive Dressing 4” x 31/8” Sterile 20/box $46 .15 5K7548P PrimaPore Adhesive Dressing 6” x 31/8” Sterile 20/box $50 .37 5K7568P PrimaPore Adhesive Dressing 8” x 4” Sterile 20/box $64 .43 5K7532P telFa Adhesive Island Dressing 2” x 31/2” Sterile 50/box $21 .07 5K7588P telFa Adhesive Island Dressing 4” x 5” Sterile 25/box $80 .58 5K7522P viaSorB Wound Dressing 2” x 3” Sterile 20/box $106 .095K7523P viaSorB Wound Dressing 4” x 6” Sterile 20/box $146 .83 5K7459P oPSite Post Op Dressing 61/8” x 33/8” Sterile 20/box $85 .33 5K7580P tegaDerm Transparent Dressing 23/8” x 23/4” Sterile 100/box $121 .33 5K7579P tegaDerm Transparent Dressing 4” x 43/4” Sterile 50/box $189 .62 5K7578P tegaDerm Transparent Dressing 6” x 8” Sterile 10/box $86 .39
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AN2 Effective Date 4/1/11
Cloth Tape
Paper Tape
Plastic Tape
a n C I l l a r I e s
Tape
Product Description Pack Factor Price/Box5K7624 Cloth Tape 1” x 10 yds 1/ea $2 .17 5K7630 Cloth Tape 2” x 10 yds 1/ea $4 .79 5K7639 Soft Cloth Tape 2” x 10 yds 1/ea $20 .30 5K7615 Paper Tape 1” x 10 yds 1/ea $1 .84 5K7617 Paper Tape 2” x 10 yds 1/ea $3 .52 5K7660 Paper Tape 1” x 10 yds w/Dispenser 1/ea $1 .82 5K7667 Paper Tape 2” x 10 yds w/Dispenser 1/ea $3 .66 5K7619 Plastic Tape 1” x 10 yds 1/ea $2 .98 5K7627 Plastic Tape 2” x 10 yds 1/ea $6 .77
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Effective Date 4/1/11 AN3
Antiseptics/Chemicals
Product Description Pack Factor Price
5K4075 manUgel 85 Antiseptic Hydroalcoholic Gel, 500 mL with Pump 1 ea $21 .62 5K4227 Cal Stat PlUS Hand Rub No Rinse - 4 oz . 1 ea $10 .84 5K4070 Liquid Soap Antimicrobial - 16 oz . w/pump 1 ea $9 .09 5K4066 exSePt PlUS Skin Antiseptic 500 mL 1 ea $30 .06 5K4054P SHUr-ClenS Skin Wound Cleanser - 20 mL 25/box $93 .62 5K4005 alCaviS 50 - 500 mL 1 ea $19 .93 5K4027 BetaSePt Surgical Scrub 4% - 32oz . with Pump 1 ea $24 .78 5K4001 Alcohol Isopropyl 70% - 16oz . 1 ea $3 .58 5K4172P Alcohol Prep Medium 21/4” x 11/4” 2-ply 200/box $7 .74 5K4012P Povidone-Iodine Swab-aid 13/4” x 11/4” 100/box $21 .79 5K4013P Povidone-Iodine Swabstick 3/pk 25/box $22 .02 5K8148P Skin-PreP Protective Dressing 50/box $24 .33 5K8058P Adhesive Remover Pad 100/box $28 .91 5K4033P HemaStix Reagent Strips 50/box $75 .32 5K4265P Serim Cholorine Residual Test Kit 1 ea $151 .63 5K4290P Bleach Wipes for Surface and Equipment - 2 towels/pk 50/box $61 .73 5K4226 aCtril Cold Sterilant for Machine and Surface Disinfectant - Gallon 1 ea $46 .05 5K4225P aCtril Residual Test Strips 100/bottle $69 .33 5K4285 minnCare Cold Sterilant for use on RO Membranes - Quart 1 ea $84 .46 5K4286P minnCare Residual Test Strip 100/box $86 .12 5K4077 Conductivity Standard Solution 14 .0 M/HHOS - 32oz . 1 ea $52 .06
a n C I l l a r I e s
Surgical Scrub
Gloves
Product Description Pack Factor Price/Box
5K7742P Latex Exam Glove . Non-sterile . Powder Free . Small 100/box $16 .715K7743P Latex Exam Glove . Non-sterile . Powder Free . Medium 100/box $16 .715K7744P Latex Exam Glove . Non-sterile . Powder Free . Large 100/box $16 .715K7797P Latex Free Exam Glove . Non-sterile . Powder Free . Small 100/box $26 .015K7798P Latex Free Exam Glove . Non-sterile . Powder Free . Medium 100/box $26 .015K7799P Latex Free Exam Glove . Non-sterile . Powder Free . Large 100/box $26 .01
Anci
llarie
s
Blood Pressure Units
Product Description Pack Factor Price/Each
5K3966 Digital Auto Inflate Blood Pressure Unit w/medium cuff (arm girth 9 .4” - 14 .2”) 1/each $181 .32 5K3967 Digital Auto Inflate Blood Pressure Unit w/small cuff (arm girth 6 .3” - 9 .4”) 1/each $175 .11 5K3968 Digital Auto Inflate Blood Pressure Unit w/large cuff (arm girth 14 .2” - 17 .7”) 1/each $197 .09
Scales
Product Description Pack Factor Price/Each
5K3517 Scale Pediatric Digital (Capacity: 44 lbs x 1/2 oz / 20 kg x 0 .01 kg) 1/each $543 .28 5K3545 Scale Digital w/detachable display (Capacity: 400 lbs x 0 .2 lbs / 180 kg x 0 .1 kg) 1/each $324 .21 5K3575 Scale Digital 1-1/2” Display (Capacity: 400 lbs x 0 .1 lbs / 180 kg x 0 .05 kg) 1/each $112 .72 5K3582 Scale Spring (5000 gm x 100 gm) 1/each $20 .47 5K3585 Scale Spring Pediatric (250 gm x 10 gm) 1/each $20 .05
Permanent Equipment
Product Description Pack Factor Price/Each
5K3961 Heating Pad - King Size 3 Heat Setting 1/each $81 .17 5Q3810 I .V . Pole Double-Hook Free Standing 47” x 84” 1/each $113 .98 5K3572 Thermometer, Digital 1/each $13 .46 5K3826 Dialysis Bath Conductivity Meter 1/each $397 .00 5K8100 PD Simulator and Case “Dummy Tummy” 1/each $1,174 .10
a n C I l l a r I e s
AN4 Effective Date 4/1/11
Anci
llarie
s
Miscellaneous Ancillary Supplies
Product Description Pack Factor Price/Each
5K7444P Underpad Plastic Lined 17” x 24” 100/box $20 .26 5K7402P Sterile Field 18” x 26” 50/box $47 .31 5K4500 Beta-CaP Clamp 1 ea $5 .38 5K3739 Forcep 41⁄4” Blue Plastic Dravon A-Clamp Smooth Jaw 1 ea $5 .86 5K7406P Cotton-Tipped Applicator Sterile 6” Long - 2/pkg 100/box $22 .13 5K8123P Face Mask White Paper Pleated 50/box $7 .80 5K8070P Face Mask - Yellow Pleated 50/box $14 .97 5K8032P Face Mask - Blue Molded Fluid Resistant 50/box $26 .78 5K8065P Can Liner, 33 Gal, Black 250/box $76 .21
a n C I l l a r I e s
Face Mask
Effective Date 4/1/11 AN5
Anci
llarie
s
The following is a listing of trademarks of Alcavis HDC, LLC: Alcavis Exsept Plus Manugel
The following is a listing of trademarks of Bayer Healthcare LLC: Hemastix
The following is a listing of trademarks of BSN Medical gmbh Corporation: Coverlet
The following is a trademark of Covidien AG: Beta-Cap Viasorb
The following is a listing of trademarks of E-Med Corporation: IV Strip
The following is a trademark of E .R . Squibb & Sons, LLC: Shur-Clens
The following is a listing of trademarks of Johnson & Johnson Corporation: BioPatch
The following is a listing of trademarks of Minntech Corporation: Actril Minncare
The following is a trademark of Nitto Denko Corp .: Xtrata
The following is a listing of trademarks of Purdue Frederick Company: Betasept
The following is a listing of trademarks of Serim Research Corporation: Serim
The following is a listing of trademarks of Smith & Nephew Medical Limited: Opsite Primapore Skin-Prep
The following is a trademark of Steris Inc .: Cal-Stat
The following is a listing of trademarks of Tyco Healthcare Group LP Curity Excilon Sorb-It telfa Versalon
The following is a trademark of 3M Company: tegaderm
t r a D e M a r K sFor ancillary products listed on pages AN1-AN5
ANTM Effective Date 4/1/11
Anci
llarie
s
Pro
duct
%
Dex
trose
Fi
ll
Cont
. Pa
ck
Ord
M
ax C
ode
Vo
l Si
ze
Fact
or
Qty
Qty
DIA
NEAL
: Lo
wCa
l PD
II 5
B 1 .
5%
L L
5B
L
L
5
B 2 .
5%
L L
5B
L
L
5
B 4 .
25%
L
L
5
B
L L
5B
EXTR
ANEA
L PD
II L
L
5
B EX
TRAN
EAL
PDII
L L
HOM
ECHO
ICE:
5
C831
0 HO
MEC
HOIC
E PR
O Cy
cler
1
5
C447
1 HO
MEC
HOIC
E Cy
cler
1
5
C440
6 HO
MEC
HOIC
E Ca
se
1
5
C446
9C
4-Pr
ong
Cycl
er S
et
30
5C4
531C
In
tegr
ated
Cyc
ler S
et
30
5C4
466P
M
iniC
ap
60 5
C452
7 Ou
tlet P
ort C
lam
p
12
5C4
480C
12
” Pa
tient
Ext
ensi
on L
ine
30
D
rain
Opt
ion:
5
C446
4P
12’ D
rain
Ext
ensi
on L
ine
30
5
C414
5P
15 L
iter D
rain
age
Bag
30
Pro
duct
Pack
Or
d M
ax C
ode
Desc
riptio
n Fa
ctor
Qty
Qt
y A
ntis
eptic
s/Cl
eans
ers:
5K4
027
Surg
ical
Scr
ub 3
2 oz
. with
Pum
p 1
Wip
es:
5K4
075
MAN
UGEL
85
Antis
eptic
1
Per
man
ent E
quip
(as
need
ed):
5K3
961
Heat
ing
Pad,
Kin
g Si
ze
1 5
Q381
0 “R
ams
Horn
” IV
Pol
e 1
5K3
582
Sprin
g Sc
ale
1 5
K396
6 Bl
ood
Pres
sure
Uni
t 1
5K3
572
Ther
mom
eter
-Dig
ital
1 5
K357
5 Sc
ale,
Dig
ital,
11 /2 ” Di
spla
y 1
5C4
275
Com
pact
Exc
hang
e De
vice
(CXD
II)
1 O
ther
(If N
eede
d):
Pro
duct
Pack
Or
d M
ax C
ode
Desc
riptio
n Fa
ctor
Qty
Qt
y D
ress
ings
: 5
K741
6P
Gauz
e Sp
onge
4”
x 4”
12-
ply
25 5
K745
8P
IV S
pong
e 2”
x 2
” 6-
ply
35 U
nder
pad:
5
K744
4P
Unde
rpad
Pla
stic
Lin
ed 1
7” x
24”
10
0 F
ace
Mas
ks:
5K8
123P
Fa
ce M
asks
, Whi
te, P
leat
ed P
aper
50
Tap
e:
5K7
615
Pape
r Tap
e 1”
1
5K7
619
Plas
tic T
ape
1”
1 5
K762
4 Cl
oth
Tape
1”
1
Patie
nt N
ame
Phon
e
DOB
Addr
ess
City
Stat
e
Zip
Alte
rnat
e Co
ntac
t
Phon
eES
RD P
atie
nt S
elec
tion:
Bill
sup
plie
s to
:
(b
illing
com
pany
nam
e)Da
te S
elec
tion
Sign
ed
/
/
Ap
plie
d fo
r Med
icar
e:
Yes
D
ate
Appl
ied
/
/
N
oM
edic
are
#
/
/
Effe
ctive
Dat
e
/
/
If Ba
xter
will
hold
the
Assi
gnm
ent o
f Ben
efits
, the
follo
win
g fo
rms
are
requ
ired:
HCFA
-150
0 Fo
rm
Sel
ectio
n (H
CFA-
382)
For
m
Hea
lth In
sura
nce
Form
Clin
ic/H
ospi
tal
Ph
one
Addr
ess
City
St
ate
Zi
pCo
ntac
t
PO
#If
Diab
etic
cho
ose
type
:
Typ
e 1
Insu
lin D
epen
dent
T
ype
2 In
sulin
Dep
ende
nt
Typ
e 2
Non
Insu
lin D
epen
dent
Da
ys re
serv
e:__
____
____
____
Max
imum
Sol
utio
n Ca
se Q
uant
ity p
er 2
8 Da
y cy
cle
___
____
Ex
chan
ges/
Day
___
____
Li
ters
/Day
___
____
ONE
YEAR
REF
ILL
unle
ss o
ther
wis
e no
ted
___
____
____
Rena
l Div
isio
n B
axte
r Hea
lthca
re C
orpo
ratio
n, 1
620
Wau
kega
n Ro
ad, M
PGR-
A1S,
McG
aw P
ark,
IL 6
0085
-673
0 F
AX: 8
00 6
66 8
457
Hom
eCar
e Se
rvic
es
AP
D P
re
sc
rip
tio
n F
or
m PF1
USE
AS D
IrEC
tED
For
new
Yor
k St
ate
Pres
crip
tions
Onl
y:Pr
ESCr
IPIt
On
S W
ILL
BE F
ILLE
D G
EnEr
ICAL
LY
UnLE
SS P
rESC
rIBE
r W
rItE
S “d
aw”
In t
HE
BOX
BELO
W
Disp
ense
As
Writ
ten
This
ESR
D or
ESR
D an
d Di
abet
ic p
atie
nt h
as b
een
trai
ned
in H
ome
Perit
onea
l Dia
lysi
s an
d w
ill r
equi
re th
e su
pplie
s lis
ted
belo
w.
Phys
icia
n:
Sign
atur
e (S
ubst
itutio
n Pe
rmitt
ed)
Date
(D
ispe
nse
as W
ritte
n)
Phys
icia
n Na
me
Prin
ted
Pres
crip
tion
Form
s
Pro
duct
%
Dex
trose
Fi
ll
Cont
. Pa
ck
Ord
M
ax C
ode
Vo
l Si
ze
Fact
or
Qty
Qty
DIA
NEAL
ULT
RABA
G:
Low
Cal
PD
II
5B
1 .5%
L
L
5
B
L L
5B
2 .5%
L
L
5
B
L L
5B
4 .25
%
L L
5B
L
L
5
B EX
TRAN
EAL
PDII
L L
5B
EXTR
ANEA
L PD
II L
L
D
evic
es:
5C4
466P
M
iniC
ap
60 5
C421
2P
Disc
onne
ct C
ap
60
5C4
527
Outle
t Por
t Cla
mp
12 5
C495
7 UL
TRAC
LAM
P
12
Patie
nt N
ame
Phon
e
DOB
Addr
ess
City
Stat
e
Zip
Alte
rnat
e Co
ntac
t
Phon
eES
RD P
atie
nt S
elec
tion:
Bill
sup
plie
s to
:
(b
illing
com
pany
nam
e)Da
te S
elec
tion
Sign
ed
/
/
Ap
plie
d fo
r Med
icar
e:
Yes
D
ate
Appl
ied
/
/
N
oM
edic
are
#
/
/
Effe
ctive
Dat
e
/
/
If Ba
xter
will
hold
the
Assi
gnm
ent o
f Ben
efits
, the
follo
win
g fo
rms
are
requ
ired:
HCFA
-150
0 Fo
rm
Sel
ectio
n (H
CFA-
382)
For
m
Hea
lth In
sura
nce
Form
Clin
ic/H
ospi
tal
Ph
one
Addr
ess
City
St
ate
Zi
pCo
ntac
t
PO
#If
Diab
etic
cho
ose
type
:
Typ
e 1
Insu
lin D
epen
dent
T
ype
2 In
sulin
Dep
ende
nt
Typ
e 2
Non
Insu
lin D
epen
dent
Da
ys re
serv
e:__
____
____
____
Max
imum
Sol
utio
n Ca
se Q
uant
ity p
er 2
8 Da
y cy
cle
___
____
Ex
chan
ges/
Day
___
____
Li
ters
/Day
___
____
ONE
YEAR
REF
ILL
unle
ss o
ther
wis
e no
ted
___
____
____
Rena
l Div
isio
n B
axte
r Hea
lthca
re C
orpo
ratio
n, 1
620
Wau
kega
n Ro
ad, M
PGR-
A1S,
McG
aw P
ark,
IL 6
0085
-673
0 F
AX: 8
00 6
66 8
457
Hom
eCar
e Se
rvic
es
CA
PD
P
re
sc
rip
tio
n F
or
m PF2
Phys
icia
n:
Sign
atur
e (S
ubst
itutio
n Pe
rmitt
ed)
Date
(D
ispe
nse
as W
ritte
n)
Phys
icia
n Na
me
Prin
ted
This
ESR
D or
ESR
D an
d Di
abet
ic p
atie
nt h
as b
een
trai
ned
in H
ome
Perit
onea
l Dia
lysi
s an
d w
ill r
equi
re th
e su
pplie
s lis
ted
belo
w. P
rodu
ct
Pa
ck
Ord
Max
Cod
e De
scrip
tion
Fact
or Q
ty
Qty
Ant
isep
tics/
Clea
nser
s: 5
K402
7 Su
rgic
al S
crub
32
oz . w
ith P
ump
1 W
ipes
: 5
K407
5 M
ANUG
EL 8
5 An
tisep
tic
1
P
erm
anen
t Equ
ip (a
s ne
eded
): 5
K396
1 He
atin
g Pa
d, K
ing
Size
1
5Q3
810
“Ram
s Ho
rn”
IV P
ole
1 5
K358
2 Sp
ring
Scal
e 1
5K3
966
Bloo
d Pr
essu
re U
nit
1 5
K357
2 Th
erm
omet
er-D
igita
l 1
5K3
575
Scal
e, D
igita
l, 11 /2 ”
Disp
lay
1
Oth
er (I
f Nee
ded)
: US
E AS
DIr
ECtE
DFo
r n
ew Y
ork
Stat
e Pr
escr
iptio
ns O
nly:
PrES
CrIP
ItO
nS
WIL
L BE
FIL
LED
GEn
ErIC
ALLY
Un
LESS
PrE
SCrI
BEr
WrI
tES
“daw
” In
tHE
BO
X BE
LOW
Disp
ense
As
Writ
ten
Pro
duct
Pack
Or
d M
ax C
ode
Desc
riptio
n Fa
ctor
Qty
Qt
y D
ress
ings
: 5
K741
6P
Gauz
e Sp
onge
4”
x 4”
12-
ply
25 5
K745
8P
IV S
pong
e 2”
x 2
” 6-
ply
35 U
nder
pad:
5
K744
4P
Unde
rpad
Pla
stic
Lin
ed 1
7” x
24”
10
0 F
ace
Mas
ks:
5K8
123P
Fa
ce M
asks
, Whi
te, P
leat
ed P
aper
50
Tap
e:
5K7
615
Pape
r Tap
e 1”
1
5K7
619
Plas
tic T
ape
1”
1 5
K762
4 Cl
oth
Tape
1”
1
Pres
crip
tion
Form
s
Pro
duct
Pack
Or
d M
ax C
ode
Desc
riptio
n Fa
ctor
Qty
Qt
y 2
B Sa
line
____
____
____
5
M
Acid
Con
c __
____
____
____
_
5
M
Bica
rb C
onc
____
____
_
5
M
Bica
rb P
wdr
___
____
____
5M
Di
alyz
er _
____
____
____
____
Fi
stul
a _
___
Gx _
___”
Bl
ood
Tubi
ng S
et
Tr
ansd
ucer
Pro
tect
or
5M
4110
Pr
imin
g Se
t
5
K407
7 Co
nduc
tivity
STD
Sol
14 .
0 1
5K4
226
ACTR
IL M
ach
Disi
nfec
t Gal
1
5
K400
1 Al
coho
l 70%
16o
z .
1
Pro
duct
Pack
Or
d
Max
Cod
e De
scrip
tion
Fact
or Q
ty
Qty
5K4
033P
HE
MAS
TIX
Strip
s 50
5K4
225P
AC
TRIL
Tes
t Stri
p 10
0
5K4
027
Surg
ical
Scr
ub 3
2 oz
. with
Pum
p 1
5K4
075
MAN
UGEL
85
Antis
eptic
1
5K4
Al
coho
l Pre
p Pa
d 10
0 5
k401
2P
PVP
Prep
Pad
10
0 5
K401
3P
PVP
Swab
stick
s 3/
pkg
25
Per
man
ent E
quip
men
t (as
nee
ded)
: 5
K382
6 Co
nduc
tivity
Met
er
1 5
K357
5 Sc
ale,
Dig
ital,
11 / 2” D
ispl
ay
1 5
K396
6 Bl
ood
Pres
sure
Uni
t 1
5K3
739
Forc
eps
41 / 4”
1
Pro
duct
Pack
Or
d M
ax C
ode
Desc
riptio
n Fa
ctor
Qty
Qt
y G
uaze
/Spo
nge:
5K7
416P
Ga
uze
Spon
ge 4
”x4”
12-
ply
25 5
K745
8P
IV S
pong
e 2”
x2”
6-pl
y 35
Tap
e:
5K7
615
Pape
r Tap
e 1”
1
5K7
619
Plas
tic T
ape
1”
1 5
K762
4 Cl
oth
Tape
1”
1
Und
erpa
ds:
5K7
444P
Un
derp
ad P
last
ic L
ined
17”
x 2
4”
100
Glo
ves:
5
K77_
__
Glov
es
100
Fac
e M
asks
: 5
K812
3P
Face
Mas
ks, W
hite
, Ple
ated
Pap
er 5
0
Patie
nt N
ame
Phon
e
DOB
Addr
ess
City
Stat
e
Zip
Alte
rnat
e Co
ntac
t
Phon
eES
RD P
atie
nt S
elec
tion:
Bill
sup
plie
s to
:
(b
illing
com
pany
nam
e)Da
te S
elec
tion
Sign
ed
/
/
Ap
plie
d fo
r Med
icar
e:
Yes
D
ate
Appl
ied
/
/
N
oM
edic
are
#
/
/
Effe
ctive
Dat
e
/
/
If Ba
xter
will
hold
the
Assi
gnm
ent o
f Ben
efits
, the
follo
win
g fo
rms
are
requ
ired:
HCFA
-150
0 Fo
rm
Sel
ectio
n (H
CFA-
382)
For
m
Hea
lth In
sura
nce
Form
Clin
ic/H
ospi
tal
Ph
one
Addr
ess
City
St
ate
Zi
p
Cont
act
PO#
If Di
abet
ic c
hoos
e ty
pe:
T
ype
1 In
sulin
Dep
ende
nt
Typ
e 2
Insu
lin D
epen
dent
T
ype
2 No
n In
sulin
Dep
ende
nt
ONE
YEAR
REF
ILL
unle
ss o
ther
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Pre
sc
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n F
orm PF3
Phys
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n:
Sign
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e (S
ubst
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n Pe
rmitt
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Date
(D
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as W
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Phys
icia
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me
Prin
ted
USE
AS D
IrEC
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For
new
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Pres
crip
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Onl
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ESCr
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S W
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S “d
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In t
HE
BOX
BELO
W
Disp
ense
As
Writ
ten
Pres
crip
tion
Form
s
The following is a listing of trademarks of Baxter International Inc .:
Baxter
Dianeal
EXtrAnEAL
HomeChoice
HomeChoice PrO
MiniCap
UltraBag
UltraClamp
The following is a listing of trademarks of Minntech Corporation:
Actril
The following is a listing of trademarks of Bayer Healthcare LLC:
Hemastix
The following is a listing of trademarks of Alcavis HDC,LLC:
Manugel
t r a D e M a r K sFor prescription forms listed on pages PF1-PF3
Effective Date 4/1/11 PFTM
Pres
crip
tion
Form
s
n u M e r I C a l I n D e x
2B1321 HD7
2B1322Q HD7
2B1323Q HD7
2B1324X HD7
2C7565 AC2
2F7112 HD7
2F7115 HD7
2F7122 HD7
2F7124 HD7
2F7125 HD7
5B4825 PD2
5B4826 PD2
5B4974 PD4
5B4976P PD4
5B4984 PD4
5B4986 PD4
5B5163 PD3
5B5166 PD3
5B5169 PD3
5B5173 PD3
5B5177 PD3
5B5179 PD3
5B5183 PD3
5B5187 PD3
5B5189 PD3
5B5193 PD3
5B5194 PD3
5B5195 PD3
5B5202 PD2
5B5203 PD2
5B7860 AC2
5B9248 AC2
5B9249 AC2
5B9250 AC2
5B9251 AC2
5B9252 AC2
5B9710 PD3
5B9711 PD3
5B9712 PD3
5B9727 PD2
5B9747 PD2
5B9757 PD1
5B9758 PD1
5B9759 PD1
5B9765P PD1
5B9766 PD1
5B9768P PD1
5B9770 PD2
5B9771 PD2
5B9772 PD2
5B9775P PD1
5B9776 PD1
5B9778P PD1
5B9795P PD1
5B9796 PD1
5B9798P PD1
5B9857 PD1
5B9858 PD1
5B9859 PD1
5B9866 PD1
5B9868P PD1
5B9876 PD1
5B9878P PD1
5B9896 PD1
5B9898P PD1
5B9901 PD2
5B9902 PD2
5B9903 PD2
5C4129 PD8
5C4136 PD8
5C4137 PD8
5C4145P PD6
5C4150A PD8
5C4160 PD8
5C4169 PD8
5C4190 PD7
5C4212P PD8
5C4213P PD8
5C4215P PD8
5C4275 PD7
5C4319 PD8
5C4366P PD7
5C4381 PD8
5C4406 PD6
5C4413 PD8
5C4442 PD8
5C4446 PD6, AC2
5C4449 PD8
5C4456 PD8
5C4462 PD6
5C4464P PD6
5C4466P PD8
5C4469C PD5
5C4471 PD5
5C4476 PD6
5C4480C PD6
5C4482 PD8
5C4483 PD8
5C4505 PD7
5C4512 PD6
5C4527 PD8
5C4530 PD7
5C4531C PD5
5C4942 PD7
5C4957 PD8
5C4971 PD6
5C8302C PD5
5C8310 PD5
5C8346 PD6
5K3517 AN4
5K3545 AN4
5K3572 AN4
5K3575 AN4
5K3582 AN4
5K3585 AN4
5K3739 AN5
5K3826 AN4
5K3961 AN4
5K3966 AN4
5K3967 AN4
5K3968 AN4
5K4001 AN3
5K4005 AN3
5K4012P AN3
5K4013P AN3
5K4027 AN3
5K4033P AN3
5K4054P AN3
5K4066 AN3
5K4070 AN3
5K4075 AN3
5K4077 AN3
5K4172P AN3
5K4225P AN3
5K4226 AN3
5K4227 AN3
5K4265P AN3
5K4285 AN3
5K4286P AN3
5K4290P AN3
5K4500 AN3
5K7401P AN1
5K7402P AN5
5K7406P AN5
5K7407P AN1
5K7416P AN1
5K7424P AN1
5K7425P AN1
5K7426P AN1
5K7427P AN1
5K7428P AN1
5K7430P AN1
5K7444P AN5
5K7458P AN1
5K7459P AN1
5K7479P AN1
5K7505P AN1
5K7522P AN1
5K7523P AN1
5K7525P AN1
5K7532P AN1
5K7538P AN1
5K7543P AN1
5K7548P AN1
5K7559P AN1
5K7567P AN1
5K7568P AN1
5K7578P AN1
5K7579P AN1
5K7580P AN1
5K7588P AN1
5K7589P AN1
5K7615 AN2
5K7617 AN2
5K7619 AN2
5K7624 AN2
Code Page Code Page Code Page Code Page
Effective Date 4/1/11 IN1
Num
eric
al In
dex
IN2 Effective Date 4/1/11
5K7627 AN2
5K7630 AN2
5K7639 AN2
5K7660 AN2
5K7667 AN2
5K7742P AN3
5K7743P AN3
5K7744P AN3
5K7797P AN3
5K7798P AN3
5K7799P AN3
5K8032P AN5
5K8058P AN3
5K8065P AN5
5K8070P AN5
5K8100 AN4
5K8123P AN5
5K8148P AN3
5M1542 HD3
5M1546 HD3
5M1729 HD3
5M1730 HD3
5M2119 HD2
5M2120 HD2
5M2121 HD2
5M2132 HD2
5M2591 HD2
5M2592 HD2
5M2593 HD2
5M2594 HD2
5M2595 HD2
5M2596 HD2
5M2731 HD3
5M2732 HD3
5M2733 HD3
5M2734 HD3
5M2735 HD3
5M2736 HD3
5M3074 AC1
5M3076 AC1
5M3121 AC1
5M3122 AC1
5M3123 AC1
5M3127 AC1
5M3134 AC1
5M5720 SO1
5M5730 SO1
5M5730U SO1
5M6400 HD2
5M6401 HD2
5M6402 HD2
5M6403 HD2
5M6404 HD2
5M6405 HD2
5M7818 HD8
5M7820 HD8
5M7821 HD8
5M7822 HD8
5M7823 HD8
5M7824 HD8
5M7825 HD8
5M7828 HD8
5M7829 HD8
5M7856 HD8
5M7857 HD8
5M7901 HD8
5M7902 HD8
5M7903 HD8
5M7904 HD8
5M7905 HD8
5M7906 HD8
5M7909 HD8
5M7911 HD8
5M9634 HD4
5Q3810 AN4
A201V801 HD4
A203V801 HD4
A204V801 HD4
A209YV803 HD4
A210V803 HD4
A217YV806 HD4
FD152530BCRQ HD5
FD162530BCRQ HD5
FD172530BCRQ HD5
FD152530BC HD5
FD162530BCQ HD5
FD172530BCQ HD5
FS1425BC HD5
FS142530TP HD5
FS142530TPR HD5
FS1525BC HD5
FS1525BCR HD5
FS1532BC HD5
FS152530TP HD5
FS152530TPR HD5
FS1625BC HD5
FS1625BCR HD5
FS162530TP HD5
FS162530TPR HD5
FS163230BC HD5
FS1725BC HD5
FS172530TP HD5
FS172530TPR HD5
FS173230BC HD5
FT152530BC HD5
FT153230BC HD5
FT162530BC HD5
FT152530BCR HD5
FT162530BCR HD5
FT142530TP HD6
FT152530TP HD6
FT162530TP HD6
FT172530TP HD6
GEF09800 AC1
H25601A HD2
H25602A HD2
H25603A HD2
H25604A HD2
H25605A HD2
H25606A HD2
HCT1000B HD1
JD01D2238 HD7
JD01D2516 HD7
JD03D2238 HD7
L5B4825 PD2
L5B4826 PD2
L5B4974 PD4
L5B4976 PD4
L5B5163 PD3
L5B5166 PD3
L5B5169 PD3
L5B5173 PD3
L5B5177 PD3
L5B5179 PD3
L5B5183 PD3
L5B5187 PD3
L5B5189 PD3
L5B5193 PD3
L5B5194 PD3
L5B5195 PD3
L5B5202 PD2
L5B5203 PD2
L5B9710 PD3
L5B9711 PD3
L5B9712 PD3
L5B9727 PD2
L5B9747 PD2
L5B9770 PD2
L5B9771 PD2
L5B9772 PD2
L5B9901 PD2
L5B9902 PD2
L5B9903 PD2
L5C4366 PD7
L5C4446 PD6
L5C4531 PD5
N5C8305C PD5
R5C4479C PD5
PS01 HD7
R5C4522 PD6
R5C4526 PD6
RENLSFT SO1
TPSURE1 HD7
US10006 AC1
US10106 AC1
US14006 AC1
US17006 AC1
US19006 AC1
n u M e r I C a l I n D e x
Code Page Code Page Code Page Code Page
Num
eric
al In
dex