Department of Health

NATIONAL CENTER FOR MENTAL HEALTH

Mandaluyong City

BIDS AND AWARDS COMMITTEE FOR GOODS

NEGOTIATED PROCUREMENT (TWO FAILED BIDDING)

SUPPLY AND DELIVERY OF DRUGS AND MEDICINES (Service Patients) 3 CY 2020

Bidder’s Name:
Date/Time of Submission of Bid:
Bidder’s Authorized Representative:

CHECKLIST OF REQUIRED DOCUMENTS

Technical Working Group: BAC Members:
1. Benjamin Vargas, MPA, LLB A. Alden C. Cuyos, MD, FPPA, IFAPA, MMHoA
2. Mary Anne del Rosario, RPh B. Victor Gerardo E. Pundavela, MD, FPOA, FPCS, MMHoA
3. Jayfferson Manalo, CPA C. Neil Michel Apollo S. Santos, MD, FPPA, MMHoA
4. Belma E. Cruz, Rph D. Jayson T. Canson, MD,DPBO, MMHoA
E. Clarita F. Lacerna, RPh
Instructions:
1. Check the submitted documents of each bidder against a checklist of required documents to ascertain if they are all
present, using a non-discretionary “pass/fail” criterion.
2. If a bidder submits the required document, it shall be rated “passed” for that particular requirement. In this regard,
bids that fail to include any requirement or are incomplete or patently insufficient shall be considered as “failed.”
Otherwise, the BAC shall rate the said first bid envelope as “passed.”
 “Passed”  “Failed” NA – Not Applicable
3. The TWG member shall write down the findings/remarks, if any, on the space below the list of a required document.

ELIGIBILITY AND TECHNICAL DOCUMENTS’ ENVELOPE

1 2 3 4 LIST OF REQU IREMENTS A B C D E

I. ELIGIBILITY REQUIREMENTS
CLASS “A” DOCUMENTS
A. LEGAL DOCUMENTS

 (1) REGISTRATION CERTIFICATE FROM PHILIPPINE GOVERNMENT    

ELECTRONIC PROCUREMENT SYSTEM (PHILGEPS) – Platinum
Membership; or
(2) BUSINESS REGISTRATION CERTIFICATE from the Securities and
Exchange Commission (SEC), Department of Trade and Industry (DTI) for
sole proprietorship, or Cooperative Development Authority (CDA) for
cooperatives, or any proof of such registration as stated in the BDS; and
(3) MAYOR’S PERMIT(valid and current) issued by the city or municipality
where the principal place of business of the prospective bidder is
located; and
(4) TAX CLEARANCE CERTIFICATE (valid and current) for Bidding
Purposes, per Executive Order No. 398, s. 2005, as finally reviewed
and approved by BIR.
1 2 3 4 LIST OF RE QUIR EMEN TS A B C D E

B. TECHNICAL DOCUMENTS
 1. Statement of ALL ITS ON-GOING GOVERNMENT AND PRIVATE    
CONTRACTS*,including contracts awarded but not yet started, if any,
whether similar or not similar in nature and complexity to the contract
to be bid, using the form prescribed in (Annex I);
This statement shall be supported with:
Notice of Award or Notice to Proceed or Contract issued by the owners.
*All spaces should be filled up with correct information.
 2. Statement of the Bidder’s SINGLE LARGEST COMPLETED CONTRACT    
(SLCC)* similar to the contract to be bid, in accordance with ITB
Clause 5.4 and using the form prescribed in (Annex II);
NOTE: Similar project refers to “Drugs and Medicines”, costing at least
twenty-five percent (25%) of the ABC

This statement shall be supported with:

(a) Notice of Award or Contract issued by the owners.
*All spaces should be filled up with correct information.
 3. BID SECURITY in any of the following form:    
3.1 Notarized Bid Securing Declaration, using the form prescribed in
(Annex III); or
3.2 Cash, Cashier’s/Manager’s Check, issued by a Universal or
Commercial Bank (not less than 2% of the ABC); or
3.3 Bank Draft/Guarantee or an irrevocable Letter of Credit issued
by a Universal or Commercial Bank, or by a foreign bank but shall
be accompanied by a confirmation from a Universal or
Commercial Bank(not less than 2% of the ABC); or
3.4 Surety Bond, callable upon demand [issued by a surety or insurance
company, with a certification from the Insurance Commission as
authorized to issue such instrument](not less than 5% of the ABC)
 (4.) Duly signed Schedule of Requirements (Annex IV)    

 (5) Conformity to TECHNICAL SPECIFICATIONS, using the prescribed    

form ( Annex V) of the Bidding Documents and showing compliance
to each item description provided for by NCMH;
(5.1) Current and Valid Certificate of Product Registration (CPR)
from FDA

(5.2) Current and Valid License to Operate (LTO) from FDA

(5.3) Current and Valid Certificate of Distributorship (if

applicable)

(5.4) Notarized LETTER OF ASSURANCE as to the availability of

stock and prompt delivery of goods.

(5.5) CERTIFICATE OF PERFORMANCE, For current supplier, it

shall be issued by the Chief of Material Management Section
(MMS) of NCMH for the current year. For non-current supplier,
certificate issued from other hospitals or agencies are acceptable.
1 2 3 4 LIST OF RE QUIR EMEN TS A B C D E

 (6) Notarized OMNIBUS SWORN STATEMENT in accordance with Section 25.3    
of the IRR of RA 9184, using the form prescribed in (Annex VI)

CLASS “B” DOCUMENTS: IF APPLICABLE 

 JOINT VENTURE AGREEMENT (JVA),in case the joint venture is already in   
existence; or
In the absence of a JVA, Duly Notarized Statements (i.e.,
Protocol/Undertaking of Agreement) from all the potential joint
venture partners should be included in the bid, stating: That, they will
enter into and abide by the provisions of the JVA in the event that the
bid is successful; and That, failure to enter into a joint venture in the
event of a contract award shall be ground for the forfeiture of the bid
security (Section 23.1(b) of the 2016 Revised IRR).
NOTES:
(a) The JVA or the Protocol must specify the company/partner and the name of the
office designated as the authorized representative of the joint venture.
(b) Each partner of the joint venture shall submit their respective Legal (I.A)
Eligibility Documents.
(c) The submission of technical and financial eligibility documents by any of the joint
venture partners constitutes compliance: Provided that, the partner responsible
to submit the NFCC shall likewise submit the Statement of all of its ongoing
contracts and latest Audited Financial Statements.
****IF NOT APPLICABLE INDICATE IN A SEPARATE SHEET WITH TABBING THAT JOINT VENTURE
AGREEMENT IS NOT APPLICABLE****

OTHER DOCUMENTARY REQUIREMENTS UNDER RA NO. 9184 (as

applicable)
 (1) [For foreign bidders claiming by reason of their country’s extension    
of reciprocal rights to Filipinos] Certification from the relevant
government office of their country stating that Filipinos are allowed
to participate in government procurement activities for the same
item or product.

 (2) Certification from the DTI if the bidder claims preference as a
Domestic Bidder or domestic Entity   

FINANCIAL DCOCUMENTS

 (1) AUDITED FINANCIAL STATEMENTS(For CY 2019 and 2018) showing    

among others the total and current assets and liabilities stamped
“received” by the BIR or its duly accredited and authorized institutions
for the preceding calendar year which should not be earlier than two
(2) years from date of bid submission. Attach a copy of the
corresponding INCOME TAX RETURNS for each AFS submitted
(BIR 1701 or 1702 – RT or the equivalent) filed and paid thru BIR’s
Electronic Filing and Payment System (eFPS).
*** Include as attachment to the ITR the eFPS page containing the
filing reference number and the page showing successful payment
(if applicable)***
1 2 3 4 LIST OF RE QUIR EMEN TS A B C D E

(2) Duly signed NET FINANCIAL CONTRACTING CAPACITY (NFCC)

COMPUTATION, in accordance with ITB Clause 5.5, or a
commitment from a Universal or Commercial Bank to extend a
Credit Line in favor of the prospective bidder if awarded the contract
to be bid.

OVER-ALL REMARK ON ELIGIBILITY DOCUMENTS:

 ELIGIBLE  INELIGIBLE

The above findings were reviewed and verified by: ___________________________________.

SIGNATURE OVER PRINTED NAME
 ANNEX: SAMPLE FORMS

Name of the Procuring Entity ____________________________________________________ Project Reference Number

Name of the Project

Location of the Project

List of all Ongoing Government and Private Contracts including Contracts Awarded but not yet started

Business Name :__________________________________

Business Address :__________________________________

a. Owner’s Name a. Date Awarded % Of Value of Outstanding

Name of Contract / Nature of Bidder’s Role
b. Address b. Date Started Accomplishment Works / Undelivered
Project Cost Work
c. Telephone No. Description % c. Date of Completion Planned Actual Portion
Government

Private

Note: This statement shall be supported with:

1. Notice of Award and / or Contract (Government and Private Contracts)
2. Sales Invoices (Private Contracts)

Submitted by :___________________________________
(Signature AbovePrinted Name)

Designation :___________________________________

Date :___________________________________
 ANNEX: SAMPLE FORMS

Name of the Procuring Entity Project Reference Number

Name of the Project
Location of the Project

Statement of Single Largest Completed Contract which is similar in nature for the past 2 years

Business Name :__________________________________

Business Address :__________________________________

a. Owner’s Name Bidder’s Role a. Amount of Award a. Date Awarded

Name of Contract b. Address Nature of Work b. Amount at Completion b. Contract Effectivity
Description %
c. Telephone No. c. Duration c. Date Completed
Government

Private

Note: This statement shall be supported with:

1. Notice of Award and/or Contract (Government and Private Contracts)
2. Sales Invoice (Private Contracts)

Submitted by :_________________________________
(Signature Above Printed Name)

Designation :_________________________________

Date :_________________________________
 REPUBLIC OF THE PHILIPPINES
Department of Health
NATIONAL CENTER FOR MENTAL HEALTH
Nueve de Febrero Street, Mandaluyong City, Philippines

BIDS AND AWARDS COMMITTEE

Telephone No. 531-9001 loc. 242 Telefax No. 5318318 E-mail: [email protected] Website: www.ncmh.gov.ph

Section VI
Schedule of Requirements
The delivery schedule expressed as weeks/months stipulates hereafter a delivery date which is the date
of delivery to the project site.

Delivered,
ITEM
DESCRIPTION QTY TOTAL Weeks/Months
NO.
1 Tobramycin + Dexamethasone Eye 100 46,908.00 One time delivery
Ointment 0.3% + 0.1 %, 3.5g tube (December 2020)
2 Ertapenem (as Sodium salt) 1 g / vial 1,000 3,739,490.00 One time delivery
(December 2020)
3 Nitrofurantoin 100 mg 2,000 135,860.00 One time delivery
(December 2020)
4 Aluminum Hydroxide + Magnesium 200 12,710.00 One time delivery
Hydroxide 225mg Aluminum Hydroxide + (December 2020)
200 mg Magnesium Hydroxide per 5 ml
suspension 60 ml
5 Dobutamine 2mg / ml, 250 ml D5W pre- 200 195,052.00 One time delivery
mixed (December 2020)
6 Morphine (as sulfate) 10 mg / ml, 1 ml 500 64,625.00 One time delivery
ampule (December 2020)
7 Lidocaine (as Hydrochloride) 10%, 50 ml 120 288,000.00 One time delivery
spray (December 2020)
8 Phenobarbital 120mg / ml, 1 ml 400 235,096.00 One time delivery
(December 2020)
9 Prednisolone Eye Drops 1%, 5 ml bottle 50 8,350.00 One time delivery
(December 2020)
10 Fluoxetine 20 mg 3,000 16,140.00 One time delivery
(December 2020)
11 Ferrous Sulfate 325 mg 780,000 1,950,000.00 One time delivery
(December 2020)

Note:
Delivery of medicines should be 18
months to 24 months expiry.

NCMH- Drugs and Medicines

Section VI-Schedule of Requirements Page 1
 REPUBLIC OF THE PHILIPPINES
Department of Health
NATIONAL CENTER FOR MENTAL HEALTH
Nueve de Febrero Street, Mandaluyong City, Philippines
BIDS AND AWARDS COMMITTEE
Telephone No. 531-9001 loc. 242 Telefax No. 5318318 E-mail: [email protected] Website: www.ncmh.gov.ph

SECTION VII

Technical Specifications

INSTRUCTION: Bidders must state here either “Comply” or “Not Comply” against each of the individual parameters of
each Specification stating the corresponding performance parameter of the equipment offered. Statements of “Comply” or
“Not Comply” must be supported by evidence in a Bidders Bid and cross-referenced to that evidence. Evidence shall be in the
form of manufacturer’s un-amended sales literature, unconditional statements of specification and compliance issued by the
manufacturer, samples, independent test data etc., as appropriate. A statement that is not supported by evidence or is
subsequently found to be contradicted by the evidence presented will render the Bid under evaluation liable for rejection. A
statement either in the Bidders statement of compliance or the supporting evidence that is found to be false either during Bid
evaluation, post-qualification or the execution of the Contract may be regarded as fraudulent and render the Bidder or supplier
liable for prosecution subject to the provisions of ITB Clause 3.1(a) (ii) and/or GCC Clause 2.1(a)(ii).
STATEMENT OF
ITEM SPECIFICATION
COMPLIANCE
Tobramycin + Dexamethasone Eye Ointment 0.3% + 0.1 %, 3.5g
1
tube
2 Ertapenem (as Sodium salt) 1 g / vial
3 Nitrofurantoin 100 mg
Aluminum Hydroxide + Magnesium Hydroxide 225mg Aluminum
4 Hydroxide + 200 mg Magnesium Hydroxide per 5 ml suspension
60 ml
5 Dobutamine 2mg / ml, 250 ml D5W pre-mixed
6 Morphine (as sulfate) 10 mg / ml, 1 ml ampule
7 Lidocaine (as Hydrochloride) 10%, 50 ml spray
8 Phenobarbital 120mg / ml, 1 ml
9 Prednisolone Eye Drops 1%, 5 ml bottle
10 Fluoxetine 20 mg
11 Ferrous Sulfate 325 mg

NCMH- ITB – Drugs and Medicines (Service Patients) CY2021

Section VII Technical Specifications Page 1
 Omnibus Sworn Statement (Revised)
[shall be submitted with the Bid]
_____________________________________________________________________________________

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF __________ ) S.S.

AFFIDAVIT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at [Address of Affiant],
after having been duly sworn in accordance with law, do hereby depose and state that:
1. [Select one, delete other:]

[If a sole proprietorship:] I am the sole proprietor or authorized representative of [Name

of Bidder] with office address at [address of Bidder];

[If a partnership, corporation, cooperative, or joint venture:] I am duly authorized and

designated representative of [Name of Bidder] with office address at [address of Bidder];

2. [Select one, delete other:]

[If a sole proprietorship:] As the owner and sole proprietor, or authorized representative
of [Name of Bidder], I have full power and authority to do, execute and perform any and
all acts necessary to participate, submit the bid, and to sign and execute the ensuing
contract for [Name of the Project] of the [Name of the Procuring Entity], as shown in the
attached duly notarized Special Power of Attorney;

[If a partnership, corporation, cooperative, or joint venture:] I am granted full power and
authority to do execute and perform any and all acts necessary to participate, submit the
bid, and to sign and execute the ensuing contract for [Name of the Project] of the [Name
of the Procuring Entity], as shown in the attached [state title of attached document
showing proof of authorization (e.g., duly notarized Secretary’s Certificate,
Board/Partnership Resolution, or Special Power of Attorney, whichever is applicable;)];

3. [Name of Bidder] is not “blacklisted”, or barred from bidding by the Government of the
Philippines or any of its agencies, offices, corporations, or Local Government Units,
foreign government/foreign or international financing institutions whose blacklisting
rules have been recognized by the Government Procurement Policy Board, by itself or by
relation, membership, association, affiliation, or controlling interest with another
blacklisted person or entity as defined and provided for in the Uniform Guidelines on
Blacklisting:
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. [Name of Bidder] is authorizing the Head of the Procuring Entity or its duly authorized
representative(s) to verify all the documents submitted;

6. [Select one, delete the rest:]

[If a sole proprietorship:] The owner or sole proprietor is not related to the Head of the
Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical
Working Group, and the BAC Secretariat, the head of the Project Management Office or
the end-user unit, and the project consultants by consanguinity or affinity up to the third
civil degree;

[If a partnership or cooperative:] None of the officers and members of [Name of Bidder]
is related to the Head of the Procuring Entity, members of the Bids and Awards
Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the
Project Management Office or the end-user unit, and the project consultants by
consanguinity or affinity up to the third civil degree;

[If a corporation or joint venture:] None of the officers, directors, and controlling
stockholders of [Name of Bidder] is related to the Head of the Procuring Entity, members
of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC
Secretariat, the head of the Project Management Office or the end-user unit, and the
project consultants by consanguinity or affinity up to the third civil degree;

7. [Name of Bidder] complies with existing labor laws and standards; and

8. [Name of Bidder] is aware of and has undertaken the responsibilities as a Bidder in

compliance with the Philippine Bidding Documents, which includes:

a. Carefully examining all of the Bidding Documents;

b. Acknowledging all conditions, local or otherwise, affecting the implementation of the
Contract;
c. Making an estimate of the facilities available and needed for the contract to be bid,
of any; and
d. Inquiring or securing Supplemental/Bid Bulletin(s) issued for the [Name of the
Project].

9. [Name of Bidder] 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.
 10. In case advance payment was made or given, failure to perform or deliver any of the
obligations and undertakings in the contract shall be sufficient grounds to constitute
criminal liability for Swindling (Estafa) or the commission of fraud with unfaithfulness
or abuse of confidence through misappropriating or converting any payment received
by a person or entity under an obligation involving the duty to deliver certain goods or
services, to the prejudice of the public and the government of the Philippines pursuant
to Article 315 of Act No. 3815 s. 1930, as amended, or the Revised Penal Code.

IN WITNESS WHEREOF, I have hereunto set my hands this _____ day of ________, 20____ at
___________, Philippines.

[Insert NAME OF BIDDER OR ITS AUTHORIZED

REPRESENTATIVE]
[Insert signatory’s legal capacity]
Affiant
[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]
 Bid Securing Declaration Form
[shall be submitted with the Bid if bidder opts to provide this form of bid security]
__________________________________________________________________________________

REPUBLIC OF THE PHILIPPINES)

CITY OF _____________________) S.S.

BID SECURING DECLARATION

Project Identification No.: [Insert number]

To: [Insert name and address of the Procuring Entity]

I/We, the undersigned, declare that:

1. I/We understand that, according to your conditions, bids must be supported by a Bid Security,
which may be in the form of a Bid Securing Declaration.

2. I/We accept that: (a) I/we will be automatically disqualified from bidding for any procurement
contract with any procuring entity for a period of two (2) years upon receipt of your Blacklisting
Order; and, (b) I/we will pay the applicable fine provided under Section 6 of the Guidelines on
the Use of Bid Securing Declaration, within fifteen (15) days from receipt of the written demand
by the procuring entity for the commission of acts resulting to the enforcement of the bid
securing declaration under Sections 23.1 (b), 34.2, 40.1 and 69.1, except 69.1 (f), of the IRR of RA
No. 9184; without prejudice to other legal action the government may undertake.
Vvvvvvvvvvvvvvvvvvvvvvv
3. I/We understand that this Bid Securing Declaration shall cease to be valid on the following
circumstances:

a. Upon expiration of the bid validity period, or any extension thereof pursuant to your
request;
b. I am/we are declared ineligible or post-disqualified upon receipt of your notice to such
effect, and (i) I/we failed to timely file a request for reconsideration or (ii) I/we filed a waiver
to avail of said right; and
c. I am/we are declared the bidder with the Lowest Calculated Responsive Bid, and I/we have
furnished the performance security and signed the Contract.

IN WITNESS WHEREOF, I/We have hereunto set my/our hand/s this _____ day of [month] [year]
at [place of execution].

[Insert NAME OF BIDDER OR ITS AUTHORIZED

REPRESENTATIVE
[Insert signatory’s legal capacity]
Affiant

[Jurat]
[Format shall be based on the latest Rules on Notarial Practice]

Bid Securing Declaration Form - Goods

Page 1 of 1
 APPENDIX “1”

Bid Form for the Procurement of Goods

[shall be submitted with the Bid]

BID FORM
Date: ________________
Project Identification No.: _________________

To: [name and address of Procuring Entity]

Having examined the Philippine Bidding Documents (PBDs) including the

Supplemental or Bid Bulletin Number [insert numbers], the receipt of which is hereby duly
acknowledged, we, the undersigned, offer to [supply/deliver/perform] [description of the
Goods] in conformity the said PBDs for the sum of [total Bid amount in words and figures] or
the total calculated bid price, as evaluated and corrected for computational errors, and
other bid modifications in accordance with the Price Schedules attached herewith and made
part of this Bid. The total bid price includes the cost of all taxes, such as, but not limited to:
[specify the applicable taxes, e.g. (i) value added tax (VAT), (ii) income tax, (iii) local taxes,
and (iv) other fiscal levies and duties], which are itemized herein or in the Price Schedules,

If our Bid is accepted, we undertake:

a. To deliver the goods in accordance with the delivery schedule specified in the
Schedule of Requirements of the Philippine Bidding Documents (PBDs);

b. To provide a performance security in the form, amounts, and within the times
prescribed in the PBDs;

c. To abide by the Bid Validity Period specified in the PBDs and it shall remain
binding upon us at any time before the expiration of that period.

[Insert this paragraph if Foreign-Assisted Project with the Development Partner:

Commissions or gratuities, if any, paid or to be paid by us to agents relating to this
Bid, and to contract execution if we are awarded the contract, are listed below:

Name and address Amount and Purpose of

of agent Currency Commission or gratuity

____________________________________
____________________________________
____________________________________
(if none, state “None”)]

Bid Form - Goods

Page 1 of 2
 Until a formal Contract is prepared and executed, this Bid, together with your
written acceptance thereof and your Notice of Award, shall be binding upon us.

We understand that you are not bound to accept the Lowest Calculated Bid or any
Bid you may receive.

We certify/confirm that we comply with the eligibility requirements pursuant to the

PBDs.

The undersigned is authorized to submit the bid on behalf of [name of the bidder] as
evidenced by the attached [state the written authority].

We acknowledge that failure to sign each and every page of this Bid Form, including
the attached Schedule of Prices, shall be a ground for the rejection of our bid.

Name: _____________________________________________________________________
Legal Capacity: ______________________________________________________________
Signature: __________________________________________________________________
Duly authorized to sign the Bid for and behalf of: ___________________________________
Date: ____________________

Bid Form - Goods

Page 2 of 2
 Price Schedule for Goods Offered from Within the Philippines
[shall be submitted with the Bid if bidder is offering goods from within the Philippines]
_____________________________________________________________________________________________________

For Goods Offered from Within the Philippines

Name of Bidder ___________________________________ Project ID No.___________ Page ____of____

1 2 3 4 5 6 7 8 9 10
Item Description Country of Quantity Unit Transportation Sales and Cost of Total Price, Total Price
Origin Price and all other other taxes Incidental per unit (col delivered
EXW per costs payable if Services, if 5+6+7+8) Final
item incidental to Contract is applicable, Destination
delivery, per awarded, per per item (col 9) x (col
item item 4)

Name: ______________________________________________________________________
Legal Capacity: _______________________________________________________________
Signature: ___________________________________________________________________
Duly authorized to sign the Bid for and behalf of: ____________________________________
 LIST OF ITEMS FOR NEGOTIATED PROCUREMENT (TWO FAILED BIDDING)3 CY 2020
DRUGS AND MEDICINES (SERVICE PATIENT)

NO. ITEM DESCRIPTION ITEM CODE QTY. UNIT OF UNIT PRICE TOTAL PRICE
MEASURE
1 3FBDMSP2020-01 Tobramycin + Dexamethasone 100 tube 469.08 46,908.00
Eye Ointment 0.3% + 0.1 %, 3.5g
tube
2 3FBDMSP2020-02 Ertapenem (as Sodium salt) 1 g / 1,000 vial 3,739.49 3,739,490.00
vial
3 3FBDMSP2020-03 Nitrofurantoin 100 mg 2,000 capsule 67.93 135,860.00
4 3FBDMSP2020-04 Aluminum Hydroxide + 200 bottle 63.55 12,710.00
Magnesium Hydroxide 225mg
Aluminum Hydroxide + 200 mg
Magnesium Hydroxide per 5 ml
suspension 60 ml
5 3FBDMSP2020-05 Dobutamine 2mg / ml, 250 ml 200 ampule 975.26 195,052.00
D5W pre-mixed
6 3FBDMSP2020-06 Morphine (as sulfate) 10 mg / ml, 500 ampule 129.25 64,625.00
1 ml ampule
7 3FBDMSP2020-07 Lidocaine (as Hydrochloride) 120 bottle 2,400.00 288,000.00
10%, 50 ml spray
8 3FBDMSP2020-08 Phenobarbital 120mg / ml, 1 ml 400 ampule 587.74 235,096.00
9 3FBDMSP2020-09 Prednisolone Eye Drops 1%, 5 ml 50 bottle 167.00 8,350.00
bottle
10 3FBDMSP2020-10 Fluoxetine 20 mg 3,000 capsule 5.38 16,140.00
11 3FBDMSP2020-11 Ferrous Sulfate 325 mg 780,000 tablet 2.50 1,950,000.00
6,692,231.00
Submitted by:

BELMA ESGUERRA CRUZ, RPh

End-user, BAC for Drugs and Medicines- Service Patient CY 2020

Recommending Approval:

ALDEN C. CUYOS, MD, FPPA, IFAPA, MMHoA

Chairperson BAC for Drugs and Medicines- Service Patient CY 2020

Approved by:

NOEL V. REYES, MD, FPPA

OIC-Medical Center Chief II