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BK:00025 PG:0015 <br />FY 12 -13 Proposed Vaccine - <br />Support Staff <br />Vaccine Cost Supply Cost Time Nursing Time Admin Time Total Price of <br />Item Description Per dose Per Item per 15 min per 15 min per 15 min Vaccine <br />Menactra Meningitis <br />25x1 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />MMR <br />25x5/8 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Rotateq Oral Rotavirus <br />No needle used <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Varivax Chickenpox <br />25x5/8 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Engerix -B Hep B Adult <br />25x1 Safety Glide Needle <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Prevnar 13 Pneumoccocal <br />25x1 Safety Glide Needle <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />104.73 <br />0.56 Y <br />0.02 - <br />0.01 <br />i I ! <br />0.01 <br />` -- 0_.01..''� -- - - <br />5.13 8.45 <br />I, <br />i <br />7.61 __- 126.53 ..j <br />52.02 <br />0.61 <br />! 0.02 '} <br />I 0.01 <br />d <br />0.01 - <br />0.01 _. - -- - - 74.00 <br />5.13 8.45 7.61 73.87 <br />- 7227 -- - -.. - <br />0.00 <br />0.00 <br />0.00 <br />0.00 <br />0 --.- <br />- 5.13 8.45 7.61 <br />87. <br />0.61 <br />� 0.02 <br />0.01 <br />0.01 <br />0.01 <br />_28.93 _ <br />0.19 <br />0.02 <br />uM1 <br />0.01 <br />0.01 - -- - <br />_- 5.13 _ 8.45 <br />134.95 _ ._ <br />0.19 <br />0.02 <br />0.01 <br />0.01 C <br />-- - - - --' <br />-- 5.13 8.45 <br />7.61 �I 50_35__ <br />157.00 <br />7.61 _156.37 <br />We are requesting the fee in the green block. The price under the green block <br />is the acutual cost to provide the vaccine. page 2 of 2 <br />