project reference no. g-2020-466 (lot 1)
TRANSCRIPT
Project Reference No. G-2020-466 (Lot 1)
1
Republic of the Philippines
CITY OF SANTA ROSA Province of Laguna
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.
Item No. Description Quantity Unit Delivery Schedule
1 Acetylcysteine 200mg powder for oral Solution 30s
25 BOX Within thirty (30)
calendar days upon
receipt by the Bidder of
the Notice to Proceed
(NTP)
2 Acetylcysteine 600mg Powder for oral solution 10's
50 BOX
3 Aciclovir 800mg tablet 20's 5 BOX
4 Amikacin (as Sulfate) 125mg/ml, 2ml ampoule 50 AMP
5 Amlodipine (as Besilate) 10mg Tablet, 100s 5 BOX
6 Amlodipine (as Besilate) 5mg Tablet, 100s 5 BOX
7 Amoxicillin (as Trihydrate) 500mg Capsule, 100's 30 BOX
8 Ampicillin (as Sodium) + Sulbactam (as Sodium) 750mg Powder for Injection Vial
100 VIAL
9 Ampicillin (as Sodium) 1g Powder for Injection Vial
50 VIAL
10 Ascorbic Acid (as Sodium Ascorbate) + Zinc (as Sulfate) 500mg / 10mg Capsule 100's
25 BOX
11 Ascorbic Acid 500mg. tab. 100s 20 BOX
12 Atorvastatin (as Calcium) 10mg tablet 100's 5 BOX
13 Atorvastatin (as Calcium) 20mg tablet 50's 5 BOX
14 Atorvastatin (as Calcium) 80mg tablet 100's 3 BOX
15 Azithromycin (as Dihydrate) 500mg Powder for Injection vial
75 VIAL
16 Azithromycin (as Dihydrate) 500mg Tablet 3's 150 BOX
17 Bacillus Calmette Guerin (BCG) Vaccine - 250mcg Vial
165 VIAL
18 Betahistine 16mg Tablet 100s 1 BOX
19 Betahistine HCI 24mg Tablet, 100's 1 BOX
20 Bisacodyl 5mg Tablet 100s 1 BOX
21 Budesonide 250mcg/ml, 2ml (500mcg/2ml) suspension for Nebulization 35's
20 BOX
22 Butorphanol Tartrate 2mg/ml injection, 1ml 150 VIAL
23 Calcium Carbonate 500 mcg Tablet 100s 2 BOX
24 Carboprost (as Trometamol) 250mcg/ml Solution for Injection Ampoule
150 AMP
25 Carvedilol 25mg Tablet 100s 1 BOX
26 Cefixime 100 mg/5ml granules for suspension 60ml
5 BOTTLE
27 Cefixime 200mg Capsule 30's 25 BOX
28 Cefotaxime (as Sodium) 500mg powder for Injection Vial
15 VIAL
29 Ceftriaxone (as Sodium) 1g Powder for Injection Vial
3,250 VIAL
30 Cefuroxime Axetil 500mg Tablet 30's 300 BOX
Project Reference No. G-2020-466 (Lot 1)
2
Item No. Description Quantity Unit Delivery Schedule
31 Celecoxib 200mg capsule 50's 10 BOX
32 Celecoxib 400 mg Capsule 100s 2 BOX
33 Cinnarizine 25mg tablet 100's 5 BOX
34 Ciprofloxacin (as Hydrochloride) 500mg Tablet 100's
10 BOX
35 Ciprofloxacin (as Lactate) 2mg/ml Solution for Injection Ampoule
100 BOTTLE
36 Clarithromycin 500mg Tablet 30s 20 BOX
37 Clindamycin (as Hydrochloride) 150mg Capsule 100's
2 BOX
38 Clindamycin (as Hydrochloride) 300mg Capsule 100's
3 BOX
39 Clindamycin (as Phosphate) 150mg/ml 2ml Solution for Injection Ampoule
100 AMP
40 Clonidine Hydrochloride 75mcg Tablet 100's 3 BOX
41 Clopidogrel (as Bisulfate) 75mg Tablet 100's 5 BOX
42 Co-Amoxiclav 500mg/125mg Tablet 12's 200 BOX
43 Dexamethasone (as Sodium Phosphate) 4mg/ml 2ml Solution for Injection Ampoule
50 AMP
44 Digoxin 250 mcg Tablet 100s 5 BOX
45 Enalapril Maleate 10mg Tablet 100s 1 BOX
46 Enoxaparin Sodium 4000 i.u., 0.4ml Solution for Injection
150 PIECE
47 Enoxaparin Sodium 6000iu/0.6ml Solution for Injection
150 PIECE
48 Recombinant Human Erythropoietin 4000 i.u/ml solution for injection
100 PIECE
49 Fenofibrate 160mg tablet 30's 2 BOX
50 Folic Acid 5mg Capsule 100's 5 BOX
51 Furosemide 10mg/ml, 2ml (20mg/2ml) Solution for Injection Ampoule
3,250 AMP
52 Furosemide 20 mg Tablet 100s 2 BOX
53 Furosemide 40 mg Tablet 100s 2 BOX
54 Gentamycin Sulfate 40mg/ml 2ml (80ml/2ml) Solution for Injection Ampoule
100 AMP
55 Gliclazide 30mg Tablet 30s 5 BOX
56 Gliclazide 60mg Tablet 30s 5 BOX
57 Hepatitis B Vaccine 10mcg/0.5ml Vial 500 VIAL
58 Human Albumin 20%, 50ml 25 BOTTLE
59 Human Albumin 25% 50ml vial 5 VIAL
60 Hydroxyethyl Starch (200/0.5) + Sodium Chloride 500 ml
10 BOTTLE
61 Hyoscine-N-Butylbromide 20mg/mL, 1 mL Solution for Injection Ampule
150 AMP
62 Irbesartan 150mg tablet 100's 2 BOX
63 Irbesartan 300mg tablet 100's 2 BOX
64 Isosorbide Dinitrate 1mg/ml , 10ml Solution for IV Infusion
25 AMP
65 Isosorbide Mononitrate 30mg tablet 100's 2 BOX
66 Ketorolac Trometamol 30mg/ml, 1ml Solution for Injection Ampule
300 AMP
67 Lactulose 3.35g/5ml Syrup, 120ml 25 BOTTLE
Project Reference No. G-2020-466 (Lot 1)
3
Item No. Description Quantity Unit Delivery Schedule
68 Levocetirizine Hydrochloride 5mg tablet 100's 5 BOX
69 Levofloxacin 500mg/100ml Solution for IV Infusion
15 VIAL
70 Linagliptin 5mg Tablet 30's 5 BOX
71 Losartan Potassium 100mg Tablet 100's 5 BOX
72 Losartan Potassium 50mg Tablet 100's 10 BOX
73 Magnesium Sulfate 250mg/ml, 20 ml Solution for Injection
30 VIAL
74 Mefenamic Acid 500mg Capsule 100s 40 BOX
75 Meropenem (as Trihydrate) 1g Powder for Injection
25 PIECE
76 Methylprednisolone 4mg tab. 100's 5 BOX
77 Metoprolol Tartrate 50mg Tablet 100's 2 BOX
78 Metronidazole (as Benzoate) 125mg/5ml Suspension 60ml
10 BOTTLE
79 Metronidazole 500 mg Tablet 100s 5 BOX
80 Montelukast (as Sodium) 10mg Chewable Tablet 100s
3 BOX
81 Montelukast (as Sodium) 5mg Chewable Tablet 100s
3 BOX
82 Montelukast Sodium + Levocetirizine Hydrochloride 10mg/5mg tablet 30's
8 BOX
83 Mupirocin 20mg/g (2%) Ointment 15 TUBE
84 Nicardipine Hydrochloride 1mg/ml, 10ml (10mg/10ml) Solution for Injection, Ampule
300 AMP
85 Norepinephrine (as Bitartrate) 1mg/ml, 2ml Solution for Infusion ampoule
100 AMP
86 Norepinephrine (as Bitartrate) 1mg/ml, 4ml Solution for Infusion ampoule
100 AMP
87 Omeprazole 40mg Capsule 100s 5 BOX
88 Omeprazole 40mg Powder for Injection Vial 3,250 VIAL
89 Paracetamol 1g/100ml Solution for Intravenous Infusion
150 PIECE
90 Piperacillin (as Sodium) + Tazobactam (as Sodium) 2.25g Powder for IV Injection
250 VIAL
91 Piperacillin (as Sodium) + Tazobactam (as Sodium) 4.5g Powder for IV Injection
250 VIAL
92 Potassium Chloride 600mg Tablet 100s 15 BOX
93 Potassium Citrate 1080mg tablet 30's 5 BOX
94 Prednisone 20mg Tablet 100's 2 BOX
95 Rebamipide 100mg Tablet 30's 5 BOX
96 Rosuvastatin (as Calcium) 20mg Tablet 50's 5 BOX
97 Simvastatin 10mg tablet tablet 30's 5 BOX
98 Simvastatin 20mg tablet 30's 5 BOX
99 Sitagliptin Phosphate 100mg Tablet 28's 3 BOX
100 Sodium Bicarbonate 650mg tablet 100's 10 BOX
101 Sodium Bicarbonate 84mg/ml Solution for Injection, 20ml Ampoule
50 AMP
102 Spironolactone 25mg Tablet 100's 5 BOX
103 Spironolactone 50mg tablet 100's 10 BOX
104 Sulodexide 250 LSU Softgel Capsule 50's 8 BOX
105 Sulodexide 300 LSU/ml, 2ml (600 LSU/2ml) 25 AMP
Project Reference No. G-2020-466 (Lot 1)
4
Item No. Description Quantity Unit Delivery Schedule
Solution for Injection
106 Sultamicillin Tosylate 750mg Tablet 50's 5 BOX
107 Terbutaline Sulfate 500mg/ml 1ml Solution for Inejection
5 AMP
108 Tetanus Immunoglobulin, Human 250 i.u/ml 300 VIAL
109 Tramadol Hydrochloride + Paracetamol 37.5mg/325mg tablet 100's
5 BOX
110 Tramadol Hydrochloride 50mg/ml, 2ml Solution for Injection Ampoule
300 AMP
111 Tranexamic Acid 100mg/ml, 5ml (500mg/5ml) Solution for Injection
300 AMP
112 Tranexamic Acid 500 mg Capsule 100s 10 BOX
113 Trimetazidine Hydrochloride 35mg Tablet 20s 10 BOX
114 Vitamin B1 + B6 + B12 100mg + 5mg + 50mcg Tablet 100s
10 BOX
115 Vitamin B1 + B6 + B12 Solution for Injection Ampoule
50 AMP
116 Zinc (as Sulfate Monolydrate) 10mg/ml Syrup 15ml Lot 1 – Supply and Delivery of Medicine
Supplies for the use of Santa Rosa Community
Hospital, City of Santa Rosa, Laguna
===== nothing follows =====
15 BOTTLE
I hereby certify to comply and deliver all the above requirements.
Name: ___________________________________________________________________
Legal capacity: ____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Date: ___________________
Project Reference No. G-2020-466 (Lot 1)
1
Republic of the Philippines
CITY OF SANTA ROSA Province of Laguna
Technical Specifications
Bidders must state in the Bidder’s Statement of Compliance column 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 Bidder’s 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 Bidder's 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 applicable laws and issuances.
Item
No. Quantity Unit Purchaser’s Specifications
Bidder’s Statement
of Compliance
1 25 BOX Acetylcysteine 200mg powder for oral Solution 30s
2 50 BOX Acetylcysteine 600mg Powder for oral solution 10's
3 5 BOX Aciclovir 800mg tablet 20's
4 50 AMP Amikacin (as Sulfate) 125mg/ml, 2ml ampoule
5 5 BOX Amlodipine (as Besilate) 10mg Tablet, 100s
6 5 BOX Amlodipine (as Besilate) 5mg Tablet, 100s
7 30 BOX Amoxicillin (as Trihydrate) 500mg Capsule, 100's
8 100 VIAL Ampicillin (as Sodium) + Sulbactam (as Sodium) 750mg Powder for Injection Vial
9 50 VIAL Ampicillin (as Sodium) 1g Powder for Injection Vial
10 25 BOX Ascorbic Acid (as Sodium Ascorbate) + Zinc (as Sulfate) 500mg / 10mg Capsule 100's
11 20 BOX Ascorbic Acid 500mg. tab. 100s
12 5 BOX Atorvastatin (as Calcium) 10mg tablet 100's
13 5 BOX Atorvastatin (as Calcium) 20mg tablet 50's
14 3 BOX Atorvastatin (as Calcium) 80mg tablet 100's
15 75 VIAL Azithromycin (as Dihydrate) 500mg Powder for Injection vial
16 150 BOX Azithromycin (as Dihydrate) 500mg Tablet 3's
17 165 VIAL Bacillus Calmette Guerin (BCG) Vaccine - 250mcg Vial
18 1 BOX Betahistine 16mg Tablet 100s
19 1 BOX Betahistine HCI 24mg Tablet, 100's
20 1 BOX Bisacodyl 5mg Tablet 100s
21 20 BOX Budesonide 250mcg/ml, 2ml (500mcg/2ml) suspension for Nebulization 35's
22 150 VIAL Butorphanol Tartrate 2mg/ml injection, 1ml
23 2 BOX Calcium Carbonate 500 mcg Tablet 100s
24 150 AMP Carboprost (as Trometamol) 250mcg/ml Solution for Injection Ampoule
Project Reference No. G-2020-466 (Lot 1)
2
Item
No. Quantity Unit Purchaser’s Specifications
Bidder’s Statement
of Compliance
25 1 BOX Carvedilol 25mg Tablet 100s
26 5 BOTTLE Cefixime 100 mg/5ml granules for suspension 60ml
27 25 BOX Cefixime 200mg Capsule 30's
28 15 VIAL Cefotaxime (as Sodium) 500mg powder for Injection Vial
29 3,250 VIAL Ceftriaxone (as Sodium) 1g Powder for Injection Vial
30 300 BOX Cefuroxime Axetil 500mg Tablet 30's
31 10 BOX Celecoxib 200mg capsule 50's
32 2 BOX Celecoxib 400 mg Capsule 100s
33 5 BOX Cinnarizine 25mg tablet 100's
34 10 BOX Ciprofloxacin (as Hydrochloride) 500mg Tablet 100's
35 100 BOTTLE Ciprofloxacin (as Lactate) 2mg/ml Solution for Injection Ampoule
36 20 BOX Clarithromycin 500mg Tablet 30s
37 2 BOX Clindamycin (as Hydrochloride) 150mg Capsule 100's
38 3 BOX Clindamycin (as Hydrochloride) 300mg Capsule 100's
39 100 AMP Clindamycin (as Phosphate) 150mg/ml 2ml Solution for Injection Ampoule
40 3 BOX Clonidine Hydrochloride 75mcg Tablet 100's
41 5 BOX Clopidogrel (as Bisulfate) 75mg Tablet 100's
42 200 BOX Co-Amoxiclav 500mg/125mg Tablet 12's
43 50 AMP Dexamethasone (as Sodium Phosphate) 4mg/ml 2ml Solution for Injection Ampoule
44 5 BOX Digoxin 250 mcg Tablet 100s
45 1 BOX Enalapril Maleate 10mg Tablet 100s
46 150 PIECE Enoxaparin Sodium 4000 i.u., 0.4ml Solution for Injection
47 150 PIECE Enoxaparin Sodium 6000iu/0.6ml Solution for Injection
48 100 PIECE Recombinant Human Erythropoietin 4000 i.u/ml solution for injection
49 2 BOX Fenofibrate 160mg tablet 30's
50 5 BOX Folic Acid 5mg Capsule 100's
51 3,250 AMP Furosemide 10mg/ml, 2ml (20mg/2ml) Solution for Injection Ampoule
52 2 BOX Furosemide 20 mg Tablet 100s
53 2 BOX Furosemide 40 mg Tablet 100s
54 100 AMP Gentamycin Sulfate 40mg/ml 2ml (80ml/2ml) Solution for Injection Ampoule
55 5 BOX Gliclazide 30mg Tablet 30s
56 5 BOX Gliclazide 60mg Tablet 30s
57 500 VIAL Hepatitis B Vaccine 10mcg/0.5ml Vial
58 25 BOTTLE Human Albumin 20%, 50ml
59 5 VIAL Human Albumin 25% 50ml vial
60 10 BOTTLE Hydroxyethyl Starch (200/0.5) + Sodium Chloride 500 ml
61 150 AMP Hyoscine-N-Butylbromide 20mg/mL, 1 mL
Project Reference No. G-2020-466 (Lot 1)
3
Item
No. Quantity Unit Purchaser’s Specifications
Bidder’s Statement
of Compliance
Solution for Injection Ampule
62 2 BOX Irbesartan 150mg tablet 100's
63 2 BOX Irbesartan 300mg tablet 100's
64 25 AMP Isosorbide Dinitrate 1mg/ml , 10ml Solution for IV Infusion
65 2 BOX Isosorbide Mononitrate 30mg tablet 100's
66 300 AMP Ketorolac Trometamol 30mg/ml, 1ml Solution for Injection Ampule
67 25 BOTTLE Lactulose 3.35g/5ml Syrup, 120ml
68 5 BOX Levocetirizine Hydrochloride 5mg tablet 100's
69 15 VIAL Levofloxacin 500mg/100ml Solution for IV Infusion
70 5 BOX Linagliptin 5mg Tablet 30's
71 5 BOX Losartan Potassium 100mg Tablet 100's
72 10 BOX Losartan Potassium 50mg Tablet 100's
73 30 VIAL Magnesium Sulfate 250mg/ml, 20 ml Solution for Injection
74 40 BOX Mefenamic Acid 500mg Capsule 100s
75 25 PIECE Meropenem (as Trihydrate) 1g Powder for Injection
76 5 BOX Methylprednisolone 4mg tab. 100's
77 2 BOX Metoprolol Tartrate 50mg Tablet 100's
78 10 BOTTLE Metronidazole (as Benzoate) 125mg/5ml Suspension 60ml
79 5 BOX Metronidazole 500 mg Tablet 100s
80 3 BOX Montelukast (as Sodium) 10mg Chewable Tablet 100s
81 3 BOX Montelukast (as Sodium) 5mg Chewable Tablet 100s
82 8 BOX Montelukast Sodium + Levocetirizine Hydrochloride 10mg/5mg tablet 30's
83 15 TUBE Mupirocin 20mg/g (2%) Ointment
84 300 AMP Nicardipine Hydrochloride 1mg/ml, 10ml (10mg/10ml) Solution for Injection, Ampule
85 100 AMP Norepinephrine (as Bitartrate) 1mg/ml, 2ml Solution for Infusion ampoule
86 100 AMP Norepinephrine (as Bitartrate) 1mg/ml, 4ml Solution for Infusion ampoule
87 5 BOX Omeprazole 40mg Capsule 100s
88 3,250 VIAL Omeprazole 40mg Powder for Injection Vial
89 150 PIECE Paracetamol 1g/100ml Solution for Intravenous Infusion
90 250 VIAL Piperacillin (as Sodium) + Tazobactam (as Sodium) 2.25g Powder for IV Injection
91 250 VIAL Piperacillin (as Sodium) + Tazobactam (as Sodium) 4.5g Powder for IV Injection
92 15 BOX Potassium Chloride 600mg Tablet 100s
93 5 BOX Potassium Citrate 1080mg tablet 30's
94 2 BOX Prednisone 20mg Tablet 100's
95 5 BOX Rebamipide 100mg Tablet 30's
96 5 BOX Rosuvastatin (as Calcium) 20mg Tablet 50's
97 5 BOX Simvastatin 10mg tablet tablet 30's
Project Reference No. G-2020-466 (Lot 1)
4
Item
No. Quantity Unit Purchaser’s Specifications
Bidder’s Statement
of Compliance
98 5 BOX Simvastatin 20mg tablet 30's
99 3 BOX Sitagliptin Phosphate 100mg Tablet 28's
100 10 BOX Sodium Bicarbonate 650mg tablet 100's
101 50 AMP Sodium Bicarbonate 84mg/ml Solution for Injection, 20ml Ampoule
102 5 BOX Spironolactone 25mg Tablet 100's
103 10 BOX Spironolactone 50mg tablet 100's
104 8 BOX Sulodexide 250 LSU Softgel Capsule 50's
105 25 AMP Sulodexide 300 LSU/ml, 2ml (600 LSU/2ml) Solution for Injection
106 5 BOX Sultamicillin Tosylate 750mg Tablet 50's
107 5 AMP Terbutaline Sulfate 500mg/ml 1ml Solution for Inejection
108 300 VIAL Tetanus Immunoglobulin, Human 250 i.u/ml
109 5 BOX Tramadol Hydrochloride + Paracetamol 37.5mg/325mg tablet 100's
110 300 AMP Tramadol Hydrochloride 50mg/ml, 2ml Solution for Injection Ampoule
111 300 AMP Tranexamic Acid 100mg/ml, 5ml (500mg/5ml) Solution for Injection
112 10 BOX Tranexamic Acid 500 mg Capsule 100s
113 10 BOX Trimetazidine Hydrochloride 35mg Tablet 20s
114 10 BOX Vitamin B1 + B6 + B12 100mg + 5mg + 50mcg Tablet 100s
115 50 AMP Vitamin B1 + B6 + B12 Solution for Injection Ampoule
116 15 BOTTLE Zinc (as Sulfate Monolydrate) 10mg/ml Syrup 15ml Lot 1 – Supply and Delivery of Medicine
Supplies for the use of Santa Rosa Community
Hospital, City of Santa Rosa, Laguna
Special Instruction:
Upon delivery the medicines’ expiry must be at least one (1) year from the
date of delivery.
Additional technical documents/requirements that must be submitted/complied
with in accordance with Technical Component Envelope requirement (h) of
Section VII (Checklist of Technical and Financial Documents):
Manpower Requirements
I hereby certify to comply and deliver all the above requirements.
Name: ___________________________________________________________________
Legal capacity: ____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Date: ___________________
Project Reference No. G-2020-466 (Lot 1)
1
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 Invitation to Bid Number: 2020-086 Procurement Project Lot 1 – Supply and Delivery of Medicine Supplies for the use of Project ID Number: G-2020-466
Santa Rosa Community Hospital, City of Santa Rosa, Laguna
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
1 Acetylcysteine 200mg powder for oral Solution 30s
25 BOX
2 Acetylcysteine 600mg Powder for oral solution 10's
50 BOX
3 Aciclovir 800mg tablet 20's 5 BOX
4 Amikacin (as Sulfate) 125mg/ml, 2ml ampoule 50 AMP
5 Amlodipine (as Besilate) 10mg Tablet, 100s 5 BOX
6 Amlodipine (as Besilate) 5mg Tablet, 100s 5 BOX
7 Amoxicillin (as Trihydrate) 500mg Capsule, 100's 30 BOX
8 Ampicillin (as Sodium) + Sulbactam (as Sodium) 750mg Powder for Injection Vial
100 VIAL
9 Ampicillin (as Sodium) 1g Powder for Injection Vial
50 VIAL
10 Ascorbic Acid (as Sodium Ascorbate) + Zinc (as Sulfate) 500mg / 10mg Capsule 100's
25 BOX
11 Ascorbic Acid 500mg. tab. 100s 20 BOX
12 Atorvastatin (as Calcium) 10mg tablet 100's 5 BOX
13 Atorvastatin (as Calcium) 20mg tablet 50's 5 BOX
14 Atorvastatin (as Calcium) 80mg tablet 100's 3 BOX
15 Azithromycin (as Dihydrate) 500mg Powder for Injection vial
75 VIAL
16 Azithromycin (as Dihydrate) 500mg Tablet 3's 150 BOX
17 Bacillus Calmette Guerin (BCG) Vaccine - 250mcg 165 VIAL
Project Reference No. G-2020-466 (Lot 1)
2
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
Vial
18 Betahistine 16mg Tablet 100s 1 BOX
19 Betahistine HCI 24mg Tablet, 100's 1 BOX
20 Bisacodyl 5mg Tablet 100s 1 BOX
21 Budesonide 250mcg/ml, 2ml (500mcg/2ml) suspension for Nebulization 35's
20 BOX
22 Butorphanol Tartrate 2mg/ml injection, 1ml 150 VIAL
23 Calcium Carbonate 500 mcg Tablet 100s 2 BOX
24 Carboprost (as Trometamol) 250mcg/ml Solution for Injection Ampoule
150 AMP
25 Carvedilol 25mg Tablet 100s 1 BOX
26 Cefixime 100 mg/5ml granules for suspension 60ml
5 BOTTLE
27 Cefixime 200mg Capsule 30's 25 BOX
28 Cefotaxime (as Sodium) 500mg powder for Injection Vial
15 VIAL
29 Ceftriaxone (as Sodium) 1g Powder for Injection Vial
3,250 VIAL
30 Cefuroxime Axetil 500mg Tablet 30's 300 BOX
31 Celecoxib 200mg capsule 50's 10 BOX
32 Celecoxib 400 mg Capsule 100s 2 BOX
33 Cinnarizine 25mg tablet 100's 5 BOX
34 Ciprofloxacin (as Hydrochloride) 500mg Tablet 100's
10 BOX
35 Ciprofloxacin (as Lactate) 2mg/ml Solution for Injection Ampoule
100 BOTTLE
36 Clarithromycin 500mg Tablet 30s 20 BOX
37 Clindamycin (as Hydrochloride) 150mg Capsule 100's
2 BOX
38 Clindamycin (as Hydrochloride) 300mg Capsule 100's
3 BOX
39 Clindamycin (as Phosphate) 150mg/ml 2ml 100 AMP
Project Reference No. G-2020-466 (Lot 1)
3
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
Solution for Injection Ampoule
40 Clonidine Hydrochloride 75mcg Tablet 100's 3 BOX
41 Clopidogrel (as Bisulfate) 75mg Tablet 100's 5 BOX
42 Co-Amoxiclav 500mg/125mg Tablet 12's 200 BOX
43 Dexamethasone (as Sodium Phosphate) 4mg/ml 2ml Solution for Injection Ampoule
50 AMP
44 Digoxin 250 mcg Tablet 100s 5 BOX
45 Enalapril Maleate 10mg Tablet 100s 1 BOX
46 Enoxaparin Sodium 4000 i.u., 0.4ml Solution for Injection
150 PIECE
47 Enoxaparin Sodium 6000iu/0.6ml Solution for Injection
150 PIECE
48 Recombinant Human Erythropoietin 4000 i.u/ml solution for injection
100 PIECE
49 Fenofibrate 160mg tablet 30's 2 BOX
50 Folic Acid 5mg Capsule 100's 5 BOX
51 Furosemide 10mg/ml, 2ml (20mg/2ml) Solution for Injection Ampoule
3,250 AMP
52 Furosemide 20 mg Tablet 100s 2 BOX
53 Furosemide 40 mg Tablet 100s 2 BOX
54 Gentamycin Sulfate 40mg/ml 2ml (80ml/2ml) Solution for Injection Ampoule
100 AMP
55 Gliclazide 30mg Tablet 30s 5 BOX
56 Gliclazide 60mg Tablet 30s 5 BOX
57 Hepatitis B Vaccine 10mcg/0.5ml Vial 500 VIAL
58 Human Albumin 20%, 50ml 25 BOTTLE
59 Human Albumin 25% 50ml vial 5 VIAL
60 Hydroxyethyl Starch (200/0.5) + Sodium Chloride 500 ml
10 BOTTLE
61 Hyoscine-N-Butylbromide 20mg/mL, 1 mL Solution for Injection Ampule
150 AMP
62 Irbesartan 150mg tablet 100's 2 BOX
Project Reference No. G-2020-466 (Lot 1)
4
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
63 Irbesartan 300mg tablet 100's 2 BOX
64 Isosorbide Dinitrate 1mg/ml , 10ml Solution for IV Infusion
25 AMP
65 Isosorbide Mononitrate 30mg tablet 100's 2 BOX
66 Ketorolac Trometamol 30mg/ml, 1ml Solution for Injection Ampule
300 AMP
67 Lactulose 3.35g/5ml Syrup, 120ml 25 BOTTLE
68 Levocetirizine Hydrochloride 5mg tablet 100's 5 BOX
69 Levofloxacin 500mg/100ml Solution for IV Infusion
15 VIAL
70 Linagliptin 5mg Tablet 30's 5 BOX
71 Losartan Potassium 100mg Tablet 100's 5 BOX
72 Losartan Potassium 50mg Tablet 100's 10 BOX
73 Magnesium Sulfate 250mg/ml, 20 ml Solution for Injection
30 VIAL
74 Mefenamic Acid 500mg Capsule 100s 40 BOX
75 Meropenem (as Trihydrate) 1g Powder for Injection
25 PIECE
76 Methylprednisolone 4mg tab. 100's 5 BOX
77 Metoprolol Tartrate 50mg Tablet 100's 2 BOX
78 Metronidazole (as Benzoate) 125mg/5ml Suspension 60ml
10 BOTTLE
79 Metronidazole 500 mg Tablet 100s 5 BOX
80 Montelukast (as Sodium) 10mg Chewable Tablet 100s
3 BOX
81 Montelukast (as Sodium) 5mg Chewable Tablet 100s
3 BOX
82 Montelukast Sodium + Levocetirizine Hydrochloride 10mg/5mg tablet 30's
8 BOX
83 Mupirocin 20mg/g (2%) Ointment 15 TUBE
84 Nicardipine Hydrochloride 1mg/ml, 10ml (10mg/10ml) Solution for Injection, Ampule
300 AMP
Project Reference No. G-2020-466 (Lot 1)
5
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
85 Norepinephrine (as Bitartrate) 1mg/ml, 2ml Solution for Infusion ampoule
100 AMP
86 Norepinephrine (as Bitartrate) 1mg/ml, 4ml Solution for Infusion ampoule
100 AMP
87 Omeprazole 40mg Capsule 100s 5 BOX
88 Omeprazole 40mg Powder for Injection Vial 3,250 VIAL
89 Paracetamol 1g/100ml Solution for Intravenous Infusion
150 PIECE
90 Piperacillin (as Sodium) + Tazobactam (as Sodium) 2.25g Powder for IV Injection
250 VIAL
91 Piperacillin (as Sodium) + Tazobactam (as Sodium) 4.5g Powder for IV Injection
250 VIAL
92 Potassium Chloride 600mg Tablet 100s 15 BOX
93 Potassium Citrate 1080mg tablet 30's 5 BOX
94 Prednisone 20mg Tablet 100's 2 BOX
95 Rebamipide 100mg Tablet 30's 5 BOX
96 Rosuvastatin (as Calcium) 20mg Tablet 50's 5 BOX
97 Simvastatin 10mg tablet tablet 30's 5 BOX
98 Simvastatin 20mg tablet 30's 5 BOX
99 Sitagliptin Phosphate 100mg Tablet 28's 3 BOX
100 Sodium Bicarbonate 650mg tablet 100's 10 BOX
101 Sodium Bicarbonate 84mg/ml Solution for Injection, 20ml Ampoule
50 AMP
102 Spironolactone 25mg Tablet 100's 5 BOX
103 Spironolactone 50mg tablet 100's 10 BOX
104 Sulodexide 250 LSU Softgel Capsule 50's 8 BOX
105 Sulodexide 300 LSU/ml, 2ml (600 LSU/2ml) Solution for Injection
25 AMP
106 Sultamicillin Tosylate 750mg Tablet 50's 5 BOX
107 Terbutaline Sulfate 500mg/ml 1ml Solution for Inejection
5 AMP
108 Tetanus Immunoglobulin, Human 250 i.u/ml 300 VIAL
Project Reference No. G-2020-466 (Lot 1)
6
1 2 3 4a 4b 5 6 7 8 9 10
Item No.
Description Country of origin
Qty UOM Unit price
EXW per item
Transportation and all other
costs incidental to delivery, per
item
Sales and other taxes payable if
Contract is awarded, per
item
Cost of Incidental
Services, if applicable,
per item
Total Price, per unit
(col 5+6+7+8)
Total Price delivered
Final Destination (col 9) x (col
4a)
109 Tramadol Hydrochloride + Paracetamol 37.5mg/325mg tablet 100's
5 BOX
110 Tramadol Hydrochloride 50mg/ml, 2ml Solution for Injection Ampoule
300 AMP
111 Tranexamic Acid 100mg/ml, 5ml (500mg/5ml) Solution for Injection
300 AMP
112 Tranexamic Acid 500 mg Capsule 100s 10 BOX
113 Trimetazidine Hydrochloride 35mg Tablet 20s 10 BOX
114 Vitamin B1 + B6 + B12 100mg + 5mg + 50mcg Tablet 100s
10 BOX
115 Vitamin B1 + B6 + B12 Solution for Injection Ampoule
50 AMP
116 Zinc (as Sulfate Monolydrate) 10mg/ml Syrup 15ml Lot 1 – Supply and Delivery of Medicine Supplies
for the use of Santa Rosa Community Hospital,
City of Santa Rosa, Laguna
===== nothing follows =====
15 BOTTLE
Total Amount of Bid in Figures : PhP _________________________
Total Amount of Bid in Words : _____________________________________________________________________________________________________________________________________
Name: ___________________________________________________________________
Legal capacity: _____________________________________________________________
Signature: ________________________________________________________________
Duly authorized to sign the Bid for and behalf of: __________________________________
Date: ___________________