INSULIN PUMP CONSUMABLES ORDER FORM

National Diabetes Services Scheme (NDSS)
INSULIN PUMP CONSUMABLES
ORDER FORM
Version - January 2016
NDSS IPC Order Form
NDSS
Code
Product Description
Supplier
Code
Supplier
Catalogue No.
Pump
1
Connection
Price
Type2
Needle cannula
angle & type
No. Per box
per box
$
3
4
No.
Boxes
Infusion Sets
115
Soft Release O (6mm, 26G, 60cm)
Manage
S6051
Dana
Proprietary
sT
10 sets
16.20
116
Soft Release O (6mm, 26G, 80cm)
Manage
S6081
Dana
Proprietary
sT
10 sets
16.20
117
Soft Release O (9mm, 26G, 60cm)
Manage
S9051
Dana
Proprietary
sT
10 sets
16.20
118
Soft Release O (9mm, 26G, 80cm)
Manage
S9081
Dana
Proprietary
sT
10 sets
16.20
507
Cleo 90 (6mm, 28G, 61cm)
MSA
21-7220-24
Generic
Luer lock
aT
10 sets
16.20
508
Cleo 90 (6mm, 28G, 79cm)
MSA
21-7221-24
Generic
Luer lock
aT
10 sets
16.20
509
Cleo 90 (6mm, 28G, 107cm)
MSA
21-7222-24
Generic
Luer lock
aT
10 sets
16.20
510
Cleo 90 (9mm, 28G, 61cm)
MSA
21-7230-24
Generic
Luer lock
aT
10 sets
16.20
511
Cleo 90 (9mm, 28G, 79cm)
MSA
21-7231-24
Generic
Luer lock
aT
10 sets
16.20
512
Cleo 90 (9mm, 28G, 107cm)
MSA
21-7232-24
Generic
Luer lock
aT
10 sets
16.20
513
Accu-Chek FlexLink (8mm, 30cm)
Roche
4626427001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
514
Accu-Chek FlexLink (8mm, 60cm)
Roche
4626435001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
515
Accu-Chek FlexLink (8mm, 80cm)
Roche
4626478001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
516
Accu-Chek FlexLink (10mm, 30cm)
Roche
4626494001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
517
Accu-Chek FlexLink (10mm, 60cm)
Roche
4626516001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
518
Accu-Chek FlexLink (10mm, 80cm)
Roche
4626524001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
519
Accu-Chek FlexLink Cannula (8mm)
Roche
4626567001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 Cannula
11.30
520
Accu-Chek FlexLink Cannula (10mm)
Roche
4626575001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 Cannula
11.30
537
Inset 30 Infusion set (13mm, 110cm) grey
AMSL
100-396-03
Generic
Luer lock
aT
10 sets
16.20
538
Inset 30 Infusion Set (13mm, 60cm) blue
AMSL
100-396-01
Generic
Luer lock
aT
10 sets
16.20
539
Inset 30 Infusion set (13mm, 60cm) pink
AMSL
100-396-02
Generic
Luer lock
aT
10 sets
16.20
540
Inset 30 Infusion set (13mm, 60cm) grey
AMSL
100-396-00
Generic
Luer lock
aT
10 sets
16.20
541
Animas Comfort (17mm, 27G, 60cm)
AMSL
100-006-51
Generic
Luer lock
aT
10 sets
16.20
542
Animas Comfort (17mm, 27G, 60cm)
AMSL
100-006-03
Generic
Luer lock
aT
10 cannulae + 5 lines
13.50
543
Animas Comfort (17mm, 27G, 110cm)
AMSL
100-006-50
Generic
Luer lock
aT
10 sets
16.20
544
Animas Comfort (17mm, 27G, 110cm)
AMSL
100-006-02
Generic
Luer lock
aT
10 cannulae + 5 lines
13.50
545
Inset II - includes insertion device (6mm, 27G, 60cm) grey
AMSL
100-410-00
Generic
Luer lock
sT
10 sets
16.20
545.1 Inset II - includes insertion device (6mm, 27G, 60cm) blue
AMSL
100-410-01
Generic
Luer lock
sT
10 sets
16.20
545.2 Inset II - includes insertion device (6mm, 27G, 60cm) pink
AMSL
100-410-02
Generic
Luer lock
sT
10 sets
16.20
Inset II - includes insertion device (9mm, 27G, 60cm) grey
AMSL
100-411-00
Generic
Luer lock
sT
10 sets
16.20
546.1 Inset II - includes insertion device (9mm, 27G, 60cm) blue
AMSL
100-411-01
Generic
Luer lock
sT
10 sets
16.20
546.2 Inset II - includes insertion device (9mm, 27G, 60cm) pink
AMSL
100-411-02
Generic
Luer lock
sT
10 sets
16.20
546
547
Inset II - includes insertion device (6mm, 27G, 110cm) grey
AMSL
100-412-00
Generic
Luer lock
sT
10 sets
16.20
548
Inset II - includes insertion device (9mm, 27G, 110cm) grey
AMSL
100-413-00
Generic
Luer lock
sT
10 sets
16.20
549
Animas Comfort (60cm, 27G, 13mm)
AMSL
100-240-01
Generic
Luer lock
aT
10 sets
16.20
551
Animas Comfort (110cm, 27G, 13mm)
AMSL
100-240-03
Generic
Luer lock
aT
10 sets
16.20
552
Animas Comfort (60cm, 27G, 13mm)
AMSL
100-240-04
Generic
Luer lock
aT
10 cannulae + 5 lines
13.50
553
Animas Comfort (110cm, 27G, 13mm)
AMSL
100-240-05
Generic
Luer lock
aT
10 cannulae + 5 lines
13.50
561
Medtronic Paradigm Quickset (9mm, 25G, 110cm)
Medtronic
MMT-396
Paradigm
Paradigm only
sT
10 sets
16.20
562
Medtronic Paradigm Quickset (9mm, 25G, 60cm)
Medtronic
MMT-397
Paradigm
Paradigm only
sT
10 sets
16.20
563
Medtronic Paradigm Quickset (6mm, 25G, 110cm)
Medtronic
MMT-398
Paradigm
Paradigm only
sT
10 sets
16.20
564
Medtronic Paradigm Quickset (6mm, 25G, 60cm)
Medtronic
MMT-399
Paradigm
Paradigm only
sT
10 sets
16.20
568
Medtronic Paradigm Silhouette (17mm, 25G, 110cm)
Medtronic
MMT-377
Paradigm
Paradigm only
aT
10 sets
16.20
569
Medtronic Paradigm Silhouette (17mm, 25G, 60cm)
Medtronic
MMT-378
Paradigm
Paradigm only
aT
10 sets
16.20
576
Medtronic Quick Sets (9mm, 25G, 110cm)
Medtronic
MMT-390
507/507c/508
Luer lock
sT
10 sets
16.20
577
Medtronic Quick Sets (9mm, 25G, 60cm)
Medtronic
MMT-392
507/507c/508
Luer lock
sT
10 sets
16.20
578
Medtronic Quick Sets (6mm, 25G, 110cm)
Medtronic
MMT-391
507/507c/508
Luer lock
sT
10 sets
16.20
579
Medtronic Quick Sets (6mm, 25G, 60cm)
Medtronic
MMT-393
507/507c/508
Luer lock
sT
10 sets
16.20
582
Medtronic Silhouette (17mm, 25G, 110cm)
Medtronic
MMT-371
507/507c/508
Luer lock
aT
10 sets
16.20
583
Medtronic Silhouette (17mm, 25G, 60cm)
Medtronic
MMT-373
507/507c/508
Luer lock
aT
10 sets
16.20
588
Medtronic Paradigm Silhouette (13mm, 25G, 60cm)
Medtronic
MMT-381
Paradigm
Paradigm only
aT
10 sets
16.20
589
Medtronic Paradigm Silhouette (13mm, 25G, 110cm)
Medtronic
MMT-382
Paradigm
Paradigm only
aT
10 sets
16.20
590
Accu-Chek TenderLink Cannula (13mm)
Roche
5015260001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 cannula
11.30
591
Accu-Chek TenderLink Cannula (17mm)
Roche
5015251001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 cannula
11.30
592
Accu-Chek TenderLink 1 (13mm, 30cm)
Roche
4541596001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
593
Accu-Chek TenderLink 1 (13mm, 60cm)
Roche
4541600001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
594
Accu-Chek TenderLink 1 (13mm, 80cm)
Roche
4541618001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
595
Accu-Chek TenderLink 1 (17mm, 30cm)
Roche
4541634001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
Subtotal (A)
$
Amount
payable $
NDSS IPC Order Form continued
NDSS
Code
Product Description
Supplier
Code
Supplier
Catalogue No.
Pump1
Connection
Type2
Needle cannula
angle & type
No. Per box3
Price
No.
per box4
Boxes
$
596
Accu-Chek TenderLink 1 (17mm, 60cm)
Roche
4541642001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
597
Accu-Chek TenderLink 1 (17mm, 80cm)
Roche
4541669001
Spirit/Spirit Combo/Generic
Luer lock
aT
10 sets
16.20
603
Soft - Release ST (19mm, 26G, 70cm)
Manage
SR102
Dana
Dana only
aT
10 sets
16.20
611
Superline Easy Release II (7mm, 17G, 70cm)
Manage
SU401
Dana
Dana only
sm
10 sets
16.20
615
Accu-Chek Rapid-D Link Cannula (6mm, 10cm tail)
Roche
4541006001
Spirit/Spirit Combo/Generic
Luer lock
sm
25 cannulae
28.40
616
Accu-Chek Rapid-D Link Cannula (8mm, 10cm tail)
Roche
4541014001
Spirit/Spirit Combo/Generic
Luer lock
sm
25 cannulae
28.40
617
Accu-Chek Rapid-D Link Cannula (10mm, 10cm tail)
Roche
4541022001
Spirit/Spirit Combo/Generic
Luer lock
sm
25 cannulae
28.40
618
Accu-Chek Rapid-D Transfer Set (28G, 20cm)
Roche
4541057001
Spirit/Spirit Combo/Generic
Luer lock
sm
10 lines
4.90
619
Accu-Chek Rapid-D Transfer Set (28G, 50cm)
Roche
4541065001
Spirit/Spirit Combo/Generic
Luer lock
sm
10 lines
4.90
620
Accu-Chek Rapid-D Transfer Set (28G, 70cm)
Roche
4541073001
Spirit/Spirit Combo/Generic
Luer lock
sm
10 lines
4.90
640
Medtronic Paradigm Silhouette (13mm, 25G, 45cm)
Medtronic
MMT-368
Paradigm
Paradigm only
aT
10 sets
16.20
641
Medtronic Paradigm Silhouette (13mm, 25G, 80cm)
Medtronic
MMT-383
Paradigm
Paradigm only
aT
10 sets
16.20
642
Medtronic Paradigm Silhouette (17mm, 25G, 80cm)
Medtronic
MMT-384
Paradigm
Paradigm only
aT
10 sets
16.20
643
Medtronic Paradigm Mio (6mm, 27G, 45cm) pink
Medtronic
MMT-921
Paradigm
Paradigm only
sT
10 sets
16.20
643.1 Medtronic Paradigm Mio (6mm, 27G, 45cm) blue
Medtronic
MMT-941
Paradigm
Paradigm only
sT
10 sets
16.20
Medtronic Paradigm Mio (6mm, 27G, 60cm) pink
Medtronic
MMT-923
Paradigm
Paradigm only
sT
10 sets
16.20
644.1 Medtronic Paradigm Mio (6mm, 27G, 60cm) blue
Medtronic
MMT-943
Paradigm
Paradigm only
sT
10 sets
16.20
Medtronic Paradigm Mio (6mm, 27G, 80cm) pink
Medtronic
MMT-925
Paradigm
Paradigm only
sT
10 sets
16.20
645.1 Medtronic Paradigm Mio (6mm, 27G, 80cm) blue
Medtronic
MMT-945
Paradigm
Paradigm only
sT
10 sets
16.20
645.2 Medtronic Paradigm Mio (6mm, 27G, 80cm) clear
Medtronic
MMT-965
Paradigm
Paradigm only
sT
10 sets
16.20
644
645
646
Medtronic Paradigm Mio (9mm, 27G, 80cm) clear
Medtronic
MMT-975
Paradigm
Paradigm only
sT
10 sets
16.20
647
Medtronic Paradigm Sure - T (6mm, 29G, 60cm)
Medtronic
MMT-864
Paradigm
Paradigm only
sm
10 sets
16.20
648
Medtronic Paradigm Sure - T (8mm, 29G, 60cm)
Medtronic
MMT-874
Paradigm
Paradigm only
sm
10 sets
16.20
649
Medtronic Paradigm Sure - T (10mm, 29G, 60cm)
Medtronic
MMT-884
Paradigm
Paradigm only
sm
10 sets
16.20
650
Medtronic Paradigm Sure - T (6mm, 29G, 80cm)
Medtronic
MMT-866
Paradigm
Paradigm only
sm
10 sets
16.20
651
Medtronic Paradigm Sure - T (8mm, 29G, 80cm)
Medtronic
MMT-876
Paradigm
Paradigm only
sm
10 sets
16.20
652
Medtronic Paradigm Sure - T (10mm, 29G, 80cm)
Medtronic
MMT-886
Paradigm
Paradigm only
sm
10 sets
16.20
653
Medtronic Sure - T (6mm, 29G, 60cm)
Medtronic
MMT-863
507/507c/508
Luer lock
sm
10 sets
16.20
654
Medtronic Sure - T (8mm, 29G, 60cm)
Medtronic
MMT-873
507/507c/508
Luer lock
sm
10 sets
16.20
655
Medtronic Sure - T (10mm, 29G, 60cm)
Medtronic
MMT-883
507/507c/508
Luer lock
sm
10 sets
16.20
656
Medtronic Sure - T (6mm, 29G, 80cm)
Medtronic
MMT-865
507/507c/508
Luer lock
sm
10 sets
16.20
657
Medtronic Sure - T (8mm, 29G, 80cm)
Medtronic
MMT-875
507/597c/508
Luer lock
sm
10 sets
16.20
658
Medtronic Sure - T (10mm, 29G, 80cm)
Medtronic
MMT-885
507/507c/508
Luer lock
sm
10 sets
16.20
659
Medtronic Paradigm Quickset (6mm, 25G, 80cm)
Medtronic
MMT-387
Paradigm
Paradigm only
sT
10 sets
16.20
660
Medtronic Paradigm Quickset (9mm, 25G, 80cm)
Medtronic
MMT-386
Paradigm
Paradigm only
sT
10 sets
16.20
673
Contact Detach Infusion Set (6mm, 29G, 60cm)
AMSL
100-905-00
Generic
Luer lock
sm
10 sets
16.20
674
Contact Detach Infusion Set (6mm, 29G, 110cm)
AMSL
100-905-02
Generic
Luer lock
sm
10 sets
16.20
675
Contact Detach Infusion Set (8mm, 29G, 60cm)
AMSL
100-905-01
Generic
Luer lock
sm
10 sets
16.20
676
Contact Detach Infusion Set (8mm, 29G, 110cm)
AMSL
100-905-03
Generic
Luer lock
sm
10 sets
16.20
677
Accu-Chek FlexLink (6mm, 30cm)
Roche
6593844001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
678
Accu-Chek FlexLink (6mm, 60cm)
Roche
6593909001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
679
Accu-Chek FlexLink (6mm, 80cm)
Roche
6593917001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 sets
16.20
680
Accu-Chek Flexlink Cannula (6mm)
Roche
6593941001
Spirit/Spirit Combo/Generic
Luer lock
sT
10 cannula
11.30
Subtotal (B)
$
Amount
payable $
NDSS IPC Order Form continued
Pump Reservoirs/Cartridges
702
Deltec Insulin Reservoir, 3mL
MSA
704
21-1750-24
Cozmo
na
na
25
26.60
Minimed Reservoir, 3mL
Medtronic
MMT-103A
507/507 c/508
na
na
10
10.80
705
Medtronic Paradigm Insulin Reservoir 1.8mL
Medtronic
MMT-326A
515/522/554
na
na
10
10.80
706
Medtronic Paradigm Insulin Reservoir 3mL
Medtronic
MMT-332A
715/722/754
na
na
10
10.80
Manage
DAC00201
Dana only
na
na
10
10.80
709.1 Dana Reservoir 3mL
710
Animas IR1200/2020 Pump Cartridge 2mL
AMSL
AN100-124-01
IR1200/2020/Vibe
na
na
10
10.80
711
Universal Reservoir 1.8mL
MSA
1850-326A
Universal
na
na
10
10.80
712
Universal Reservoir 3.0mL
MSA
3070-332A
Universal
na
na
10
10.80
713
Accu-Chek Spirit Cartridge 3.15mL
Roche
5206073001
Spirit/Spirit Combo/Generic
na
na
25
26.60
714
Accu-Chek Spirit Cartridge 3.15mL
Roche
4949935001
Spirit/Spirit Combo/Generic
na
na
5
5.40
Subtotal (C)
$
Total Amount Payable
(A+B+C)
$
Office Use Only
1
This column indicates manufacturer recommended pump for use with listed consumable.
If a 'Lure lock' connection type is indicated, the product may be compatible with other pumps. Please note that the pump manufacturer may decline to provide support (or honour warranties) in the event that problems arise while utilising a pump
'sets' indicates equal number of cannulae and lines, e.g. '10 sets' = 10 cannulae + 10 lines.
4
Please note that there are no additional concessions on subsidised insulin pump consumables.
# Inset products include an additional co-payment of $20.00 per box to fund the integrated inserter.
Supplier codes:
AMSL - Australasian Medical & Scientific Limited
Medtronic - Medtronic Australasia
Manage - Managing Diabetes
Roche - Roche Diagnostics
2
3
Needle/cannula angle & type: straight, metal = sm
straight, Teflon = sT
angled, metal = am
angled, Teflon = aT
The National Diabetes Services Scheme (NDSS) is an initiative of the Australian Government administered by Diabetes Australia
OPS.FM.RG.016 v1601
NDSS ORDER FORM - UPDATED 01/01/2016