MARIVELES MENTAL HOSPITAL Mariveles, Bataan

33 Olanzapine 10mg Orodispersible(ODT) tabs 30,000 1,157,100.0038.57 34 Phenytoin Sodium 100mg caps 1,700 36,550.0021.50 35 Piperacillin+Tazobactam 4g...

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MARIVELES MENTAL HOSPITAL Mariveles, Bataan Name of Bidder/Distributor Address:

DRUGS AND MEDICINES for bid for the Twelve (12) Months Procurement 2019 NO.

ITEMS

UNIT

QTY.

1

Alprazolam 500mcg

tabs

500

2

Biperiden 2mg

tabs

75,000

3

Carbamazepine 200mg

tabs

10,000

4

Chlorpromazine 100mg

tabs

10,000

5

Chlorpromazine 200mg

tabs

51,500

6

Clonazepam 2mg

tabs

12,000

7

Clozapine 100mg

tabs

140,000

8

Diphenhydramine 50mg

caps

90,000

9

Divalproex Sodium 250mg

tabs

120,000

10 Divalproex Sodium 500mg

tabs

113,000

11 Donepezil 5mg

tabs

700

12 Epoetin Alfa 4000iu/0.4ml (IV,SC)

p.syr.

300

13 Escitalopram 10mg (as oxalate)

tabs

10,000

14 Fenofibrate 160mg

tabs

950

15 Fluconazole 150mg

caps

400

16 Fluoxetine 20mg

caps

1,000

17 Fluphenazine Decanoate 25mg/ml 10 ml

vials

100

18 Gabapentin 100mg

tabs

1,000

19 Haloperidol 5mg/ml

amps

600

20

Ipratropium+Salbutamol 500 mcg + 2.5 mg 2.5 ml

nebs

1,500

IV Fluids,Balanced Multiple Maintenance 21 Sol'n with 5% Dextrose for Adult 1L

bots

600

22 IV Fluids, 0.9% Sodium Chloride 1L

bots

1,200

23 Sterile Water 50ml

bots

500

bots

120

bots

900

26 IV Fluids, 5% Dextrose Water 1L

bots

160

27 IV Fluids, Lactated Ringer's Solution 1L

bots

600

28 Lactulose 3.3g/5ml (66%) syrup 120ml

bots

90

29 Lamotrigine 50mg

tabs

4,000

30 Montelukast 10mg

tabs

1,000

31 Multivitamins for Adult

tabs

30,000

32 Mupirocin 2% ointment 15g

tubes

240

33 Olanzapine 10mg Orodispersible(ODT)

tabs

30,000

34 Phenytoin Sodium 100mg

caps

1,700

35 Piperacillin+Tazobactam 4g+500mg

vials

200

IV Fluids, 5% Dextrose 0.9% Sodium 24 Chloride 1L IV Fluids, 5% Dextrose in Lactated Ringers 25 1L

BRAND

UNIT COST

AMOUNT

36 Potassium Chloride 2mEq/ml 20ml

vials

200

37 Potassium Chloride 600mg

tabs

1,800

38 Potassium Citrate 10mEq

tabs

1,300

39 Quetiapine 25mg (as Fumarate)

tabs

500

40 Quetiapine 100mg (as Fumarate)

tabs

1,500

41 Quetiapine 300mg (as Fumarate)

tabs

7,200

42 Risperidone 2mg

tabs

85,600

43 Risperidone 4mg

tabs

58,000

44 Sertraline 50mg

tabs

2,400

45 Trimetazidine 35mg

tabs

1,000

46 Ursodeoxycholic Acid 250mg

tabs

2,000

47 Vitamin B1 B6 B12

tabs

12,000

48 Zolpidem 10mg

tabs

300

nothing follows

MARIVELES MENTAL HOSPITAL Mariveles, Bataan Name of Bidder/Distributor Address:

DRUGS AND MEDICINES for bid for the Twelve (12) Months Procurement 2019 NO.

ITEMS

UNIT

QTY.

BRAND

UNIT COST

AMOUNT

1

Alprazolam 500mg

tabs

500

32.92

16,460.00

2

Biperiden 2mg

tabs

75,000

10.75

806,250.00

3

Carbamazepine 200mg

tabs

10,000

5.00

50,000.00

4

Chlorpromazine 100mg

tabs

10,000

6.54

65,400.00

5

Chlorpromazine 200mg

tabs

51,500

10.00

515,000.00

6

Clonazepam 2mg

tabs

12,000

12.69

152,280.00

7

Clozapine 100mg

tabs

140,000

11.78

1,649,200.00

8

Diphenhydramine 50mg

caps

90,000

2.00

180,000.00

9

Divalproex Sodium 250mg

tabs

120,000

27.77

3,332,400.00

10 Divalproex Sodium 500mg

tabs

113,000

11.50

1,299,500.00

11 Donepezil 5mg

tabs

700

93.00

65,100.00

12 Epoetin Alfa 4000iu/0.4ml (IV,SC)

p.syr.

300

717.00

215,100.00

13 Escitalopram 10mg (as oxalate)

tabs

10,000

21.75

217,500.00

14 Fenofibrate 160mg

tabs

950

32.31

30,694.50

15 Fluconazole 150mg

caps

400

56.00

22,400.00

16 Fluoxetine 20mg

caps

1,000

35.87

35,870.00

17 Fluphenazine Decanoate

vials

100

580.77

58,077.00

18 Gabapentin 100mg

tabs

1,000

22.88

22,880.00

19 Haloperidol 5mg/ml

amps

600

662.81

397,686.00

20 Ipratropium+Salbutamol

nebs

1,500

25.35

38,025.00

bots

600

84.62

50,772.00

22 IV Fluids, 0.9% Sodium Chloride 1L

bots

1,200

65.22

78,264.00

23 Sterile Water 50ml

bots

500

53.85

26,925.00

bots

120

63.18

7,581.60

bots

900

79.81

71,829.00

26 IV Fluids, 5% Dextrose Water 1L

bots

160

84.62

13,539.20

27 IV Fluids, Lactated Ringer's Solution 1L

bots

600

84.62

50,772.00

28 Lactulose 3.3g/5ml (66%) syrup 120ml

bots

90

215.38

19,384.20

29 Lamotrigine 50mg

tabs

4,000

20.77

83,080.00

30 Montelukast 10mg

tabs

1,000

24.85

24,850.00

31 Multivitamins for Adult

tabs

30,000

2.15

64,500.00

32 Mupirocin 2% ointment 15g

tubes

240

176.92

42,460.80

33 Olanzapine 10mg Orodispersible(ODT)

tabs

30,000

38.57

1,157,100.00

34 Phenytoin Sodium 100mg

caps

1,700

21.50

36,550.00

35 Piperacillin+Tazobactam 4g+500mg

vials

200

306.00

61,200.00

21

IV Fluids,Balanced Multiple Maintenance Sol'n with 5% Dextrose for Adult 1L

IV Fluids, 5% Dextrose 0.9% Sodium Chloride 1L IV Fluids, 5% Dextrose in Lactated Ringers 25 1L

24

36 Potassium Chloride 2mEq/ml 20ml

vials

200

59.14

11,828.00

37 Potassium Chloride 600mg

tabs

1,800

19.08

34,344.00

38 Potassium Citrate 10mEq

tabs

1,300

11.92

15,496.00

39 Quetiapine 25mg (as Fumarate)

tabs

500

40.00

20,000.00

40 Quetiapine 100mg (as Fumarate)

tabs

1,500

61.54

92,310.00

41 Quetiapine 300mg (as Fumarate)

tabs

7,200

73.08

526,176.00

42 Risperidone 2mg

tabs

85,600

20.00

1,712,000.00

43 Risperidone 4mg

tabs

58,000

41.07

2,382,060.00

44 Sertraline 50mg

tabs

2,400

38.42

92,208.00

45 Trimetazidine 35mg

tabs

1,000

13.60

13,600.00

46 Ursodeoxycholic Acid 250mg

tabs

2,000

48.56

97,120.00

47 Vitamin B1 B6 B12

tabs

12,000

2.88

34,560.00

48 Zolpidem 10mg

tabs

300

44.00

13,200.00

nothing follows

16,003,532.30

Department of Health Central Luzon Center for Health Development MARIVELES MENTAL HOSPITAL Mariveles, Bataan

CHECKLIST OF FIRST ENVELOPE (ELIGIBILITY AND TECHNICAL DOCUMENTS) DATE : PROJECT : Procurement of Drugs and Medicines 2019 BIDDER : The first envelope shall contain the technical component of the bid, including the eligibility requirements under Section 23.1 of IRR. Eligibility Documents a) Class "A" Documents Legal Documents i Registration certificate from SEC, Department of Trade and Industry (DTI) for sole proprietorship, or CDA for cooperatives, or any proof of such registration as stated in the Bidding Documents; ii Mayor's/Business permit issued by the city or municipality where the principal place of business of the prospective bidder is located, or the equivalent document for Exclusive Economic Zones or Areas. In cases of recently expired Mayor's/Business permits, it shall be accepted together with the official receipt as proof that the bidder has applied for renewal within the period prescribed by the concerned local government unit, provided that the renewed permit shall be submitted as a post-qualification requirement in accordance with Section 34.2 of the IRR; iii Tax Clearance per E.O 398, s. 2005 as finally reviewed and approved by the Bureau of Internal Revenue (BIR); Technical Documents i PhilGEPS Certificate of Registration and membership in accordance with Section 8.5.2 of the IRR; ii Statement of the prospective bidder of all its ongoing government and private contracts, including contracts awarded but not yet started, if any, whether similar or not similar in nature and complexity to the contracts to be bid; iii Statement of the bidders's Single Largest Completed Contract (SLCC) similar to the contract to be bid, except under conditions provided for in Sections 23.4.1.3 and 23.4.2.4 of this IRR, within the relevant period as provided in the Bidding Documents in the case of Goods; iv Valid joint venture agreement (JVA), in case the joint venture is already in existence. In the absence of JVA CASH/Manager's Check - 2% of ABC = PHP 320,070.65 v The bid security in the form of Surety Bond - 5% of ABC Bid Securing Declaration Letter of Credit

=

PHP 800,176.62

vi Additional Documentary Requirements a Valid and current License To Operate b Certificate of Product Registration c Copy of Foreign or Local Study or Certificate of Bio-Equivalence/Biosimilar study documenting the efficacy and safety profile of the drug; this is required from generic medicines that have not been used in the hospital d Copy of Certificate of Good Manufacturing Practice e Technical Specifications vii Sworn statement by the prospective bidder or its duly authorized representative in the form prescribed by the GPPB as to the following 1) Name, address, and designation of authorized representative; 2) The signatory is the duly authorized representative of the prospective bidder, and granted full power and authority to do, execute and perform any and all acts necessary and/or to represent the prospective bidder in the bidding, with the duly notarized Secretary's Certificate attesting to such fact, if the prospective bidder is a corporation, partnership, cooperative, or joint venture; 3) It is not "blacklisted" or barred from bidding by the GOP or any of its agencies, offices, corporations, or LGUs, including foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the GPPB;

PASS

FAIL

PASS

4) Each of the documents submitted in satisfaction of the bidding requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct; 5) It is authorizing the Head of the Procuring Entity or his duly authorized representative/s to verify all the documents submitted; 6) It complies with the disclosure provision under Section 47 of the Act in relation to other provisions of RA 3019; 7) It complies with the responsibilities of a propective or eligible bidder provided in the PBDs; 8) It complies with existing labor laws and standards, in the case of procurement services; 9) It did not give or pay, directly or indirectly, any commission, amount, fee, or any form of consideration, pecuniary or otherwise, to any person or official, personnel or representative of the government in relation to any procurement project or activity. viii BIR Registration Certification, which contains the Taxpayer's Identification Number; ix Latest income and business tax returns; x Bid documents to be attached inside original copy envelope, preferably all pages are signed. Financial Documents i Audited financial statements, showing, among others, the prospective bidder's total and current assets and liabilities stamped "received" by the BIR or its duly accredited and authorized instutions, for the preceding calendar year which should not be earlier than two (2) years from the date of submission; ii The prospective bidder's computation for its NET FINANCIAL CONTRACTING CAPACITY (NFCC). However, in the case of procurement of Goods, a bidder may submit a committed Line of Credit from a Universal or Commercial Bank, in lieu of its NFCC Computation.

Note: Any missing document in the above-mentioned checklist is a ground for outright rejection of the bid. The BAC requires the bidder to bring samples of medicines that have not been used by the hospital on Bid Opening. Remarks : ( ) ELIGIBLE ( ) INELIGIBLE Checked by: Zoraida F. Afable, MD Lea Jean M. Payong, MBA Merced Y. Arado, RPh Victoria S. Soan, MPS Relia I. Villegas, RN, MAN

FAIL

Department of Health Central Luzon Center for Health Development MARIVELES MENTAL HOSPITAL Mariveles, Bataan

CHECKLIST OF SECOND ENVELOPE (FINANCIAL DOCUMENTS) DATE BIDDER

: :

PROJECT : Procurement of Drugs and Medicines 2019

The second envelope shall contain the financial component of the bid. a) Duly signed Bid Prices in the Bill of Quantities b)

ELIGIBLE

Recurring maintenance costs, if applicable.

Note: Any missing document in the above-mentioned checklist is a ground for outright rejection of the bid.

Remarks : ( ) ELIGIBLE ( ) INELIGIBLE Checked by: Zoraida F. Afable, MD Lea Jean M. Payong, MBA Merced Y. Arado, RPh Victoria S. Soan, MPS Relia I. Villegas, RN, MAN

AL DOCUMENTS)

urement of Drugs and Medicines 2019

ht rejection of the bid.

INELIGIBLE

ORIGINAL TECHNICAL & ELIGIBILITY

ORIGINAL FINANCIAL

ORIGINAL BID

COPY NO. 1 TECHNICAL & ELIGIBILITY

COPY NO. 1 FINANCIAL

COPY NO. 1

MOTHER ENVELOPE

SEALING AND MARKING OF BIDS

COPY NO. 2 TECHNICAL & ELIGIBILITY

COPY NO. 2

COPY NO. 2 FINANCIAL

Department of Health Regional Office No. 3

MARIVELES MENTAL HOSPITAL

Mariveles, Bataan ITEM NO.

1

QUANTITY ABC

Strength

Alprazolam 500

TECHNICAL SPECIFICATIONS NAME OF MANUFACTURER BRAND

Php 16,460.00 PURCHASER'S SPECIFICATION 500mcg

Dosage Form

ITEM NO.

2

QUANTITY ABC

Tablet

Packaging Instructions

Biperiden

NAME OF MANUFACTURER BRAND

75,000 Php 806,250.00

PURCHASER'S SPECIFICATION Strength 2mg Dosage Form

ITEM NO.

3

QUANTITY ABC

Strength

Carbamazepine

NAME OF MANUFACTURER BRAND

PURCHASER'S SPECIFICATION 200mg

4

QUANTITY ABC

Strength

Packaging Instructions

Php 50,000.00

ITEM NO.

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

10,000

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Chlorpromazine

NAME OF MANUFACTURER BRAND

10,000 Php 65,400.00

PURCHASER'S SPECIFICATION 100mg

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION Packaging Instructions

Dosage Form

Tablet

ITEM NO.

5

QUANTITY ABC

Strength

51,500 Php 515,000.00

PURCHASER'S SPECIFICATION 200mg

Dosage Form

ITEM NO.

6

QUANTITY ABC

Strength

Chlorpromazine

Packaging Instructions

Clonazepam

NAME OF MANUFACTURER BRAND

Php 152,280.00 PURCHASER'S SPECIFICATION 2mg

ITEM NO.

7

QUANTITY ABC

Packaging Instructions

Clozapine

NAME OF MANUFACTURER BRAND

Php 1,649,200.00

PURCHASER'S SPECIFICATION Strength 100mg

ITEM NO.

8

QUANTITY ABC

Strength

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Diphenhydramine

NAME OF MANUFACTURER BRAND

90,000 Php 180,000.00

PURCHASER'S SPECIFICATION 50mg

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

140,000

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

12,000

Dosage Form

NAME OF MANUFACTURER BRAND

Capsule

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

ITEM NO.

9

QUANTITY ABC

Strength

120,000 Php 3,332,400.00

PURCHASER'S SPECIFICATION 250mg

Dosage Form

ITEM NO.

10

QUANTITY ABC

Strength

Divalproex Sodium

NAME OF MANUFACTURER BRAND

PURCHASER'S SPECIFICATION 500mg

11

QUANTITY ABC

Packaging Instructions

Donepezil

NAME OF MANUFACTURER BRAND

Php 65,100.00 PURCHASER'S SPECIFICATION 5mg

ITEM NO.

12

QUANTITY ABC

Packaging Instructions

Epoetin Alfa

NAME OF MANUFACTURER BRAND

Php 215,100.00

PURCHASER'S SPECIFICATION Strength 4000iu/0.4ml (IV,SC)

ITEM NO.

13

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

300

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

700

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

Php 1,299,500.00

ITEM NO.

NAME OF MANUFACTURER BRAND

tabs

113,000

Dosage Form

Strength

Divalproex Sodium

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Prefilled Syringe

Packaging Instructions

Escitalopram (as oxalate)

NAME OF

QUANTITY ABC

10,000 Php 217,500.00

PURCHASER'S SPECIFICATION Strength 10mg Dosage Form

ITEM NO.

14

ABC

Strength

Packaging Instructions

Fenofibrate

NAME OF MANUFACTURER BRAND

Php 30,694.50 PURCHASER'S SPECIFICATION 160mg

Dosage Form

ITEM NO.

15

QUANTITY ABC

Packaging Instructions

Fluconazole

NAME OF MANUFACTURER BRAND

Php 22,400.00

PURCHASER'S SPECIFICATION Strength 150mg

ITEM NO.

16

QUANTITY ABC

Strength

ITEM NO.

Packaging Instructions

Fluoxetine

NAME OF MANUFACTURER BRAND

Php 35,870.00 PURCHASER'S SPECIFICATION 20mg

17

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Capsule

1,000

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

400

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

950

QUANTITY

MANUFACTURER BRAND

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Capsule

Packaging Instructions

Fluphenazine Decanoate

NAME OF MANUFACTURER

QUANTITY ABC

Strength

100 Php 58,077.00

PURCHASER'S SPECIFICATION 25mg/ml 10ml

Dosage Form

ITEM NO.

18

QUANTITY ABC

Strength

19

ABC

NAME OF MANUFACTURER BRAND

Packaging Instructions

Haloperidol

NAME OF MANUFACTURER BRAND

Php 397,686.00 PURCHASER'S SPECIFICATION 5mg/ml

ITEM NO.

20

QUANTITY ABC

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Ampule

Packaging Instructions

Ipratropium+Salbutamol

NAME OF MANUFACTURER BRAND

1,500 Php 38,025.00

PURCHASER'S SPECIFICATION 500 mcg + 2.5 mg 2.5 ml

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

600

Dosage Form

Strength

Gabapentin

PURCHASER'S SPECIFICATION 100mg

QUANTITY

Strength

Packaging Instructions

Php 22,880.00

ITEM NO.

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Vial

1,000

Dosage Form

BRAND

Nebules

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

ITEM NO.

21

IV Fluids,Balanced Multiple Maintenance Sol'n with 5% Dextrose for Adult

QUANTITY ABC

600 Php 50,772.00

PURCHASER'S SPECIFICATION

NAME OF MANUFACTURER BRAND COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

22

QUANTITY ABC

1 Liter Bottle

Packaging Instructions

IV Fluids,0.9% Sodium Chloride

NAME OF MANUFACTURER BRAND

1,200 Php 78,264.00

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

23

QUANTITY ABC

1 Liter Bottle

Packaging Instructions

Sterile Water 50ml

NAME OF MANUFACTURER BRAND

500 Php 26,925.00

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

24

50ml Bottle

Packaging Instructions

IV Fluids,5% Dextrose 0.9% Sodium

NAME OF MANUFACTURER BRAND

Chloride

QUANTITY ABC

120 Php 7,581.60

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

1 Liter Bottle

Packaging Instructions

ITEM NO.

25

IV Fluids, 5% Dextrose in Lactated Ringers

QUANTITY ABC

900 Php 71,829.00

PURCHASER'S SPECIFICATION

NAME OF MANUFACTURER BRAND COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

26

QUANTITY ABC

1 Liter Bottle

Packaging Instructions

IV Fluids, 5% Dextrose Water

NAME OF MANUFACTURER BRAND

160 Php 13,539.20

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

27

QUANTITY ABC

1 Liter Bottle

Packaging Instructions

IV Fluids, Lactated Ringer's Solution

NAME OF MANUFACTURER BRAND

600 Php 50,772.00

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

28

QUANTITY ABC

1 Liter Bottle

Packaging Instructions

Lactulose

NAME OF MANUFACTURER BRAND

90 Php

PURCHASER'S SPECIFICATION Strength 3.3g/5ml (66%) Dosage Form

120ml syrup bottle

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

ITEM NO.

29

QUANTITY ABC

Strength

4,000 Php 83,080.00

PURCHASER'S SPECIFICATION 50mg

Dosage Form

ITEM NO.

30

QUANTITY ABC

Strength

Lamotrigine

Packaging Instructions

Montelukast

NAME OF MANUFACTURER BRAND

Php 24,850.00 PURCHASER'S SPECIFICATION 10mg

ITEM NO.

31

QUANTITY ABC

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

1,000

Dosage Form

NAME OF MANUFACTURER BRAND

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Multivitamins for Adults

NAME OF MANUFACTURER BRAND

30,000 Php 64,500.00

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO.

32

QUANTITY ABC

Tablet

Packaging Instructions

Mupirocin

NAME OF MANUFACTURER BRAND

240 Php 42,460.80

PURCHASER'S SPECIFICATION Strength 2% Dosage Form

ITEM NO.

33

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

15g ointment tube

Packaging Instructions

Olanzapine (Orodispersible)

NAME OF

QUANTITY ABC

30,000 Php 1,157,100.00

PURCHASER'S SPECIFICATION Strength 10mg Dosage Form

ITEM NO.

34

QUANTITY ABC

Strength

Packaging Instructions

Phenytoin Sodium

NAME OF MANUFACTURER BRAND

Php 36,550.00 PURCHASER'S SPECIFICATION 100mg

ITEM NO.

35

QUANTITY ABC

Packaging Instructions

Piperacillin+Tazobactam

NAME OF MANUFACTURER BRAND

Php 61,200.00

PURCHASER'S SPECIFICATION Strength 4g + 500mg

ITEM NO.

36

QUANTITY ABC

Strength

Potassium Chloride

NAME OF MANUFACTURER BRAND

PURCHASER'S SPECIFICATION 2 mEq/ml

QUANTITY ABC

Packaging Instructions

Php 11,828.00

ITEM NO.

37

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Vial

200

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Capsule

200

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

1,700

Dosage Form

MANUFACTURER BRAND

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

20ml Vial

Packaging Instructions

Potassium Chloride

NAME OF MANUFACTURER BRAND

1,800 Php 34,344.00

COUNTRY OF ORIGIN

Strength

PURCHASER'S SPECIFICATION 600mg

Dosage Form

ITEM NO.

38

QUANTITY ABC

Tablet

Packaging Instructions

Potassium Citrate

NAME OF MANUFACTURER BRAND

1,300 Php 15,496.00

PURCHASER'S SPECIFICATION Strength 10mEq Dosage Form

ITEM NO.

39

QUANTITY ABC

Strength

Quetiapine (as Fumarate)

NAME OF MANUFACTURER BRAND

PURCHASER'S SPECIFICATION 25mg

40

QUANTITY ABC

Strength

Packaging Instructions

Php 20,000.00

ITEM NO.

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Quetiapine (as Fumarate)

NAME OF MANUFACTURER BRAND

1,500 Php 92,310.00

PURCHASER'S SPECIFICATION 100mg

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

500

Dosage Form

SUPPLIER'S SPECIFICATION

Tablets

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

ITEM NO.

41

QUANTITY ABC

Strength

7,200 Php 526,176.00

PURCHASER'S SPECIFICATION 300mg

Dosage Form

ITEM NO.

42

QUANTITY ABC

Strength

Risperidone

NAME OF MANUFACTURER BRAND

PURCHASER'S SPECIFICATION 2mg

43

QUANTITY ABC

Packaging Instructions

Risperidone

NAME OF MANUFACTURER BRAND

Php 2,382,060.00 PURCHASER'S SPECIFICATION 4mg

ITEM NO. QUANTITY ABC

44

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Sertraline

NAME OF MANUFACTURER BRAND

2,400 Php 92,208.00

PURCHASER'S SPECIFICATION Strength 50mg Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

58,000

Dosage Form

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

Php 1,712,000.00

ITEM NO.

NAME OF MANUFACTURER BRAND

Tablet

85,600

Dosage Form

Strength

Quetiapine (as Fumarate)

Tablet

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

ITEM NO.

45

QUANTITY ABC

Strength

1,000 Php 13,600.00

PURCHASER'S SPECIFICATION 35mg

Dosage Form

ITEM NO.

46

QUANTITY ABC

Strength

Trimetazidine

Packaging Instructions

Ursodeoxycholic Acid

NAME OF MANUFACTURER BRAND

Php 97,120.00 PURCHASER'S SPECIFICATION 250mg

ITEM NO.

47

QUANTITY ABC

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

2,000

Dosage Form

NAME OF MANUFACTURER BRAND

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Tablet

Packaging Instructions

Vitamin B1 B6 B12

NAME OF MANUFACTURER BRAND

12,000 Php 34,560.00

PURCHASER'S SPECIFICATION

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Strength Dosage Form

ITEM NO. QUANTITY ABC

48

Tablet

Packaging Instructions

Zolpidem

NAME OF MANUFACTURER BRAND

300 Php 13,200.00

PURCHASER'S SPECIFICATION Strength 10mg Dosage Form

Tablet

COUNTRY OF ORIGIN SUPPLIER'S SPECIFICATION

Packaging Instructions

Upon delivery the following shall be complied: Shelf life: Drugs must be fresh commercial stock with a total shelf life of at least eighteen (18) months from the date of delivery. Labeling Instructions: For each box, bottle and corrugated carton the following should be legibly imprint: MANUFACTURE: BATCH/LOT NO: DATE OF MANUFACTURED: DATE OF EXPIRY:

End-User

Chair, Therapeutic Committee

Chairperson, BAC

Vice Chairperson, BAC

Member, BAC

Member, BAC

Member, BAC

NAME OF COMPANY

SIGNATURE OVER PRINTED NAME

ADDRESS

TELEPHONE / FAX NO.