CHECKLIST OF REQUIREMENTS FOR DRUGSTORE/HOSPITAL PHARMACY/RETAIL OUTLET FOR NON-PRESCRIPTION DRUGS. A. THE FOLLOWING MUST BE SUBMITTED UPON FILING OF APPLICATION TO FDA = Accomplished Petition Form and Joint Affidavit of Undertaking duly notarized (no erasures) - ANNEX “A” = Tentative List of Products using Generic and Brand Names = Generic White Label bearing the exact registered business name & address = Rubber stamp of outlet bearing the exact registered business name & address = Picture of signboard bearing the exact registered business name = Copies of Pharmacist Board Certificate, valid PRC ID, valid PTR 1(2x2) ID Picture, Duties and Responsibilities of the Pharmacist and Certificate of Attendance of Owner/Pharmacist to an FDA sponsored/accredited Seminar on Licensing of Drug Establishments and Outlets (A.O. #56 s. 1989) and Seminar on EDPMS (NCPAM) Contact Person for EDPMS : DENDEN — 711-2589 / 711-9501 743-8301 = IfSingle Proprietorship, Certificate of Business Name Registration with the Department of Trade and Industry (DTD) ¥ Barangay Business Permit or Mayor’s Permit bearing the complete registered business name and address of the outlet = If Cooperative, registration with Cooperative Development Authority (CDA) = If Corporation or Partnership, Registration with Securities and Exchange Commission (SEC) and Articles of Incorporation ¥ Ifthe Corporate Name is different from the Business Name, secure Business Name registration with Department of Trade and Industry (DTD) V Ifthe Corporate Address is different from the Business Address, secure either Barangay Business Permit or Mayor's Permit reflecting the exact registered business name and addressY If Franchisee, submit copy of Franchise Agreement indicating the complete address of the outlet = Contract of Lease for the space occupied if not owned, or any proof of ownership if owned (e.g. Tax declaration) or notarized Certificate of Occupaney = Floor area not less than 15 square meters * Location Plan (Sketch with landmark) and Floor Plan with dimensions (square meters) * Licensing Fee based on AO#50 s. 2001 Opening/Initial (1-year validity): P 1,000.00 B. THE FOLLOWING MUST BE PRESENTED DURING INSPECTION: = Reference Material Y Philippine National Drug Formulary (latest edition) ¥ R.A. 3720— Food, Drugs and Devices and Cosmetics Act — ANNEX “B” VY R.A. 6675 — Generics Act of 1988 and Relevant Implementing Rules and Regulations — ANNEX “C” ¥ R.A, 5921 — Pharmacy Law as amended and Relevant Implementing Rules and Regulations — ANNEX “D” VY R.A. 8203 — Special Law on Counterfeit Drugs ~ ANNEX “E” VY R.A, 9502 ~The Universally Accessible Cheaper and Quality Medicines Act of 2008 - ANNEX “F” ¥ E.0.#821 — Prescribing the Maximum Drug Retail Prices for Selected Drugs and Medicines that Address Diseases that Account for the4 Leading Causes of Morbidity and Mortality (MDRP) ~ ANNEX “G” ¥ Advisory Council for Price Regulation# 2009-001 — Government-Mediated Access Price (GMAP) - ANNEX “H” ¥ R.A. 9711 — The Food and Drug Administration Act of 2009 — ANNEX “I” Y A.0.456 s. 1989 — Licensing of Drug Establishments and Outlets — ANNEX “J”= Any one of the following reference books (latest edition) Y United States Pharmacopoeia/National Formulary (USP/NF) ¥ Remington: The Science and Practice of Pharmacy Y Goodman & Gilman’s: The Pharmacological Basis of ‘Therapeutics = Record Books (Prescription Book, Senior Citizen’s, Persons with Disability) = Menu Cards (Generics, MDRP, GMAP) — ANNEX “K” = Dispensing Apparatus (tablet counter, spatula, graduated cylinder) = Dispensing Flow Chart ~ ANNEX “L” = Room thermometer / Temperature Monitoring Chart * Standard Operating Procedures (SOPs): v Handling of Product Complaint ¥ Handling of Product Recall Y Good Procurement Practice Y Handling of Adverse Drug Reactions/Events ¥ Good Dispensing Practice ¥ Good Storage Practice ¥ Good Housekeeping (including Pest Control and Garbage Disposal) ¥ Cold Chain Management Requirements (if applicable) = Organizational Chart Note: 1, Bring original documents for verification during inspection 2. Prepare two (2) sets of application: > Yellow folder for drugstore > Violet folder for RONPD with ear tagsRepublic of the Philippines Department of Health FOOD AND DRUG ADMINISTRATION IN THE MATTER OF PETITION OF: ‘ame af Owner) ‘TOOPEN A DRUG ESTABLISUMENT PARTICULARLY AS & 1 Retan Draestore 1D ospitat Pharmacy 1B Retsil Out for Non-Prescription Drogs 1B roe oi (Co importer E} Exporter ©) Wholesaler) PETITION ‘COMES now the undersigued petitioner nto the Food and Drag Adaiuistration, Department of Health Manila respectfully alleges; IRST— That the petitioner so egal age, mareedsingle, Filipino ci (Conary SECOND —That the petitioner desires to opens drug etablshaent particularly as te be located at _ be known as zl ‘Comper Adres) “Enact Bases Name) THIRD — That the petitioner has the athorty fies apliation asthe sole ProprctoriOwner TD attornessutact Cl) rumorted Representative; FOURTH -That said establishment all be open for bushes rom __A.M.f0_ P.M. and shall e under the peroaal nnd immediate supervision at sa duly registred pharmacist with Certieat of Repsteation No, issued o FIFTH That {she onner of i extablinhenent with postal address a : SIXTH That the petitioner hereby gress to change the business name ofthe estalishinent in the even that tere is similar or same w registered with the Food and Drug Administration ste lter chat ts mibeadig: SEVENTH — That te amount of Capital invested for sid establishments Php EIGHTH That the pet stand the establishment registered pharmacist shall ign a jolt affidavit of undertaking WHERFORE, 1 compliance wit petitioner respectuly prays th the requirements cues and regal she be grant Heens a operat a drug establishment after inspect sof the Food aud Drug Administration ‘Mania, Ptipines 20 “PRINTED NANIETSIGNATURE OF OWNER Res. Cert No VERIFICATION Petitioner after having sworm in accordance with Iw, hereby states hat 1. Helse is the petitioner in the above eatited petition 2. The peiioner has caused the preparation ofthe sad petition amd has read nid hows the contents thereof amd J. The allegations are true and eorzect to hater owa knowtedge, Civic Drwe, Fitnvast Corporate City Alabang, Gy of Muntinlupa 1781 Philippines 8084280 (tunkie) / 8425606 information) / 8078275 (consumer hotine) / 8070791 (dxector} ‘wien bad gov ph bad@bfad gov phRepublic of the Philippines FRA,’ Department of Health fad ol es peer FOOD AND DRUG ADMINISTRATION JOINT AFFIDAVIT OF UNDERTAKING ee PRE Regiteation No: PRC Regier Naar af Pharmacirin-Charg@) Issued on prenos ‘(Maiden or Married Nam, i different fron above) egal ne singlelmarried and a reidet of (Complete ares) owner of. a __tocated at ‘ame of Eab ihre) of egal age and resident ‘Compare Adres Tonplee tdtressy ater having been sworn in acordance with a, hereby deeare: aware ofthe provisions of the Pharmacy Lam, the Foods, Drugs and Deviees and Coumeties Act the Generis Act of fret Drugs Uaiversally Accessible Cheaper and Quality Medizin Act of 2008, The Food and Drug, and regulations: I be wader the IMMEDIATE AND. “That me are aware ofthe specific requeements thatthe operation of ’ PERSONAL SUPERVISION of the Pharmacist In-Charge, he ess hours being rom. AM.t0 PMs ‘That we agre to change the business mame i there i aready av 1 name solar t ou business name ret ‘That we shall display our appr License to Operate ia a conspicuous plat in our establishment “That ve shall oify FDA in cae any shang inthe circumstances af ovr application for a License to Operate, including but not limited to chnage of location, change of pharmacstin-eharge, and change drag products; “Thot the pharmacst-in-charge will wot in any way be connected with 7 drug oF similar establsheentoatet; nd ‘That the owner and the pharmactt: lertake tobe joatly und soldat lable for any violation committed relating tthe operation of a drag estabtshven WITNESS wa REOF, we hereuato as our sgn OWNER eg. CeetNos Tasted on Civic Drive, Fimvest Corporate City Alabang. Cay of Nuniniupa 1781 Phipps (2094390 (runkine) / 8425606 (information) / 8076275 (consumer hotine) 8070751 (aroctor) worn bfad govph/bfad@btad gov phGENERICS MENU CARD _ (Name of Drugstore) ee (Address) = IBUPROFEN PREPARATIONS Oral: 200 mg tablet Il] | (UH Sa Generics Makapipili na, Makatitipid pa ang bawat gamot ay Sa botika, hanapin ang listahan may generic name. ng produkto. na may | generic name katulad ng ® Tiyaking may generic name nasa inyong reseta. ang reseta ng doktor. © Piliin at bilhin ang produkto na abot kaya ng bulsa.GENERICS MENU CARD ‘(Name of Drugstore) 7 (Aadress) RIFAMPICIN UNIT UNIT PREPARATIONS, PRICE PREPARATIONS: PRICI 150 mg tablet Oral: 450mg capsule Oral: 300 mg tablet Oral: 600 mg capsule Oral: 450 mg tablet Oral: 100 mg /5 mL, 30 mL syrup. Oral: 600 mg tablet Oral: 100:mg/5 ml., 60 mL syrup Oral: 150 mg capsule Oral: 100mg/5 ml, 30 mL suspension Oral: 360 mg capsute Oral: 100 mg/5 mL, 60 mL suspensionGENERICS MENU CARD (ame oF Drugstore) Oe ee | (Address) | SALBUTAMOL UNIT UNIT PREPARATIONS PRICE PREPARATIONS. PRICE Oraik: 2 ng tablet (as sulfate) Nebulis 1.25mg/mL, 2 mL nebule (as sulfate) L (Oral! 2.mg/5 mL, 60 mL syrup (as sulfate) Nebuliser: Smg/mL resp. soln. (as sulfate) Inhaler: |100 meg//inhalation (ss sulfate) 1nj:500 meg/mL, 1 mL ampul (as sulfate) tT Sa Generics Makapipili na, Makatitipid pa @ang bawat gamot ay © Sa botika, hanapin ang listahan may generic name. ng produkto na may generic name katulad ng @Tiyaking may generic name nasa inyong reseta. $ ang reseta ng doktor. © Piliin at bilhin ang produkto na abot kaya ng bulsa.GENERICS MENU CARD PREPARATIONS. Oral (as potassium salt) Game of Brugstare) ee (Address) PHENOXYMETHYLPENICILLIN (penicillin V) UNIT. UNIT PRICE, PREPARATIONS PRICE Oral: 125 mg/S mt, lenin for suspension, 30 mL (as potassium salt) | (Oral: 500 mg tablet (a3 potassium salt) Oral: 250 capsule (as potassium salt) (I| Oral: 125 mg/S:ml.gsanules/powder for suspension, 60 ml. (as potassium salt) Oral: 500 mg capsule (es potassium salt) Oral: 32mg/mL,30 mL drops (as potassium salt) Oral: 125 mg/5 mL granules /powder for syrup, 30 mL (as potassium salt) NE TN III Oral: 250 mg/5 mL granules/powder for syrup, 30 mL (as potassium salt) Oral: 250.mg/5 mL granules /poider for syrup, 60 mL. {as potassium salt) Oral: 250 mg/5 ml. granules /powder for suspension, 30 mL as potassium salt) Oral: 125 mg/5 mL granules/powder fot syrup, 60 mL. (as potassium salt) | ‘Oral: 250 mg/5 mL granules /powder for suspension, 60 mt (@s potassium salt)GENERICS MENU CARD (Narne of Drugstore) SS (Address) PYRAZINAMIDE PREPARATIONS PRICE Oral: 500mg tablet . KUMUNSULTA SA INYONG DOKTOR BAGO MAG-ANTIBIOTIC Para sa mabisang paggamit ng antibiotic, sundin ang prescription ng doktor.ENERICS MENU CARD ee ==—iNerie of Drigsiore) SS ee REPARATIONS Oral: 300mg or 325 mg tablet == fadeiress) PARACETAMOL UNIT PRICE PREPARATIONS ‘Oral: 250 mg/5 mL, 60 mL syrup (eicohol-frée preferred) UNIT PRICE Oral: 500mg tablet a SS — Oral: 120 mg/5 mL or 125 mg/5 mL {60 ml suspension {alcohol-free preferred) Oral: 100 mg/mL, 15 mL. drops (alcohol-free) SS SSS Se SS Oral: 120 mg/5 mL or 125 mg/5 mL 320 mb suspension (alcohol-free preferred) ———— Oral: 125 mg/S mL or 125 mg/5mL 60 mL syrup (elcohol-free preferred) EEE oa a eS ee an SS SSS ‘Oral: 250 mg/SmL, 30 mL suspension (alcohol-free preferred) ee Oralt 120mg/5 mL or 125 mg/5 mL. 120 mi syrup (alcohol-free preferred) eS SSS Oral: 250 mL, 5 mL, 60 mL suspension (alcohol-free preferred) SSS SS il Oral: 250 mg/5 mL, 30 mL syrup {alcohol-free prefered) Sa Generics... Makapipili na Makatitipid pa!GENERICS MENU CARD SF (ame of Drugstore) eS ed (Address) a ERYTHROMYCIN UNIT UNIT {EPARATIONS: PRICE PREPARATIONS, PRICE ‘eat: 250 mg capsule (as base) Oral: 200 mg/5 mL granules/powder for suspension, 60 mL. {as ethyl succinate) ‘Oral: 500 mg capsule (as base) SSS Oral: 400 mg/5 mL granules/powder {for suspension, 30 mL, (as ethyl succinate) SSS SSS lc ee ee eT Oral: 400mg/5 mL granules/powder for suspension, 60 ml. (@s ethyl succinate) Oral: 500 mg film tablet (es stearate) SS LN) EN TT Oral: 200 mg/5 mL granules/ powder for suspension, 30 mL, (as ethyl succinate) Cumunsulta sa inyong Doktor vago mag-antibio Para sa mabisang paggamit ng antibiotic, sundin ang prescription ng doktor.GENERICS MENU CAF. __. (Name of Drugstore) ee cea (aceiress) PREPARATIONS Orel: 250 mg capsule Sa UNIT. i PRIC! PREPARATIONS (Oral: 250 mg/5 mL granules /powder for suspension, 30 mL UNIT. PRICE Oral: 500 mg capsule ee Se ———— Oral: 125mg/S granules/powder for suspension, 60.mL Oral; 100 mg/ml granules /powsier for drops, 10 mL eS ae SS ———S ———— Oral: 250:mg/5 mL granules/powder for suspension, 60 mL. NT Oral: 125 mg/5 mL granules/powder for suspension, 20 mL (IN Kumunsulta sa inyong doktor bago mag-antibiotic Para sa mabisang paggamit ng antibiotic sundin ang prescription ng doktor.GENERICS MENU CARD (lame of Drugstore) ‘(Aderess) ISONIAZID PREPARATIONS: Oral: 100 mg tablet ea ee SSS ae Se Oral: 200 mg tablet SSS — a Cral: 400 mg tablet SSS SSS Oral: 100 mg/S mL,60 mL syrup Sa Generics Makapipili na, Makatitipid pa © Ang bawat gamot ay may generic name. © Tiyaking may generic name ang rasata ng doktor. © Sa botika, hanapin ang listahan rig produkto na may generic name katulad ng nasa inyong reseta. ® Pillin at bilhin ang produkto na abot kaya ng bulsa.MAXIMUM DRUG RETAIL PRICES (MDRP) Dosage Strength & Form ‘Rela Generic Name Braod Name Selling Price Phy T Aime Cag 1S Ti ma wb Gromer & all sl form) ‘Simg tablet _ 7285 Tong wa ED 2, Atorvastati TO mg film coated tablet 34.45, ; Time Him comeT abe wa = 0 wig Wim soled wt 0H Wing Hin come wait 0a Tedimladiping beatae Saag 10g ble : aa ‘Atorvastatin calcium Sng +20 me wba eas I Smig +40 mg tablet waz Sing 60mg ab ow Tomy 1g wo sm Tag Wg ae Tas Tag Fao aT Ts . 1 | 10 mg + 80 mg tablet [9179 t7 Aitiromyem & aisle Boing wile TEs 7] form 200 glint power Tor ae “| suspension 15 ma, Too mma/SmaL pewder Tor eam ‘uaspension 22.5 mL FOO mg ablet sis al'me vial For injection Wis Fewanles 60 5 Gyarabine THO mg/L. amipaleMAl 340.00 avisc) TO mg/ml amipalevel 50050 (QVISC) $m. oF 500 rg vel =| TOO mg/ml ampulenval TROD (VISC) 10 mL. | vial 20 mgjmi 5 mL ampulehviad Tso) | ‘or Injetion © Doxorubicin © allie TO me powder vial for a5 fom Injection LC ‘SH ang powder vial Tor DET InjectionGOVERNMENT MEDIATED ACCESS PRICES | (GMAP) ‘Actual | Generic Name Dosage Strength & Form Brand Name mar | Sebing Price — Php Thp | 1 Teimisartan omg abet Miearaie 15.75 BO mg bier [Micardis 50) 2 Tamisartan mg + 12.5 mg wie Wicardis Poa 25.00, Hydrochlorothinzide G0mg + 12.5 mg tablet Micardis Plus 44.50) Sr irbesartan —_T0mgubiet ‘Aprovel 7A38 300 mg tabiet ‘Aprovel 70.00 = 7 imbesartan + 150mg + 12.5 mg lee Go-Apioval 25.13 Hydrochlorothinzide 300mg + 12.5 mg tablet GosAprovel T1350 E Clopidogrel 775 mg cuaied tablet Plavix 61.75 6. Gileeidle img Modified Release GbIeL Dismicron NR 975, 0 mg tablet Diamieron 975 7 Piperaeiin + Tazabactam Tp 250 mg val Tasocia 730.20 ip 500mg vial “Tazocin 1270.05 5 Cipronoxscin 500 nig tablet Ciprobay a9 00mg tablet Extended Release Ciprobuy XI 4.02 Tgubie ‘Ciproba 72.55 250 mg tablet ‘Ciprobay 3237 Tayi. TV infusion 100 mL ‘Ciprcbay 342.00 100 mg IV Infusion 50 mal Gipeoba Ta. GOO ma TV Tafusion 200 ma ‘Giprobay 1603.55 9. Metronidazole 125 mg/S mk. suspension 60m Fagyt 65.50 . ‘500 mg tablet ‘Sanofi-Aventis via 175. Winthrop Siding IV haan 100 FiagyL 10. Co-Amoxiclav (Amoxiailin > 625 mg tablet Tegbectn Clavutanie Act) 475 mg tablet ‘Augmentin Tg biel ‘Auginentin Tor jeaon ‘Augmentin 1:2 vial for njeotion ‘Augmentin D0 mg +28.5 mg/S ral. susponsion ‘ugmentin 7am 125 mg #31.25mgi5 mL suspension | Augmentin ‘60 mL 250 mg + 62.5 mel5 w- suspension “Rugmentin TT om. FDO mg FST mys mi, suspension “Kuga Tas 0m ‘OO mg TST mgs mL suspension “Ragesila 76155 33 mL = Ti. Bleomyein iS cag VaTampule for yeaion Blenowane 520.00 12. Carboplatin Toma 15 mal vial or 150 mg for Paraplatin 1803.00 injection 1S. Cisplatin 30mg powder vial (cr injection Platinal 7125.00, 14. Cyclophosphamide Sa 1730 Endoxan 175.00 300 mig vial Tor injection Plainol 324.50 T gor 1000 mg vil for injection Qualimed 577.50 15. Etoposide __ ‘Qualimed [__565.00, 15. Mereaptopurine if Pur-nethol | — 39.50, 17, Methotrexate sodium ZS mg ablet ‘Qualimed 11,00 TOmg/2 ea. vial for iajeatTon slimes 306.00, TS. Mesa (Adjust eaphy) 400 ig Injection [—“Tronitexen 166.67 _ 19. Fentanyl (as citrate) 30 meg! mL Injection Womb | Janssen 377.50 i meg/miL. Injection ZL. 132.00 2.6 jenclamide Simg ubles 3 8.00Ti. Citfeatine “Sop rag inieerion Takeda Pharmaceuticals TOOO mg Injection Takes Pharmaceuticals DE. Thiamizole (Wetnimazole) Sing ablet Pharma Link Asio 6x0 Pacific 2 Glucometamine + T50mg?30mg+ 20mg capsale | Pharma Link Asia 1280 Glucodinmnine + Nicotinamide Pacific Ascorbate Tes mat S0mRT TS eT Pharma Link Ala TaD 3 ml syrup 60 mL. Pacific T37S mg + 50 mg * 25 mel Pharma Link Asa 385.40 Sl syrup 120 mi. Pacific 2, Sotalol 160 mg. tablet [_ BrisoT Myers Squibb 25. Losartan (as potassium '50/mg tablet Chiral 26. Cetivizine (as dihydrochioride)_| 10 ma-tablet = Chiral [27 Diclofenac (as sodium) ‘30 mg tablet Chiral (78. Cefalexin (es monohydrate) 50D mg copsule Chiral 29. Clarithromycin 230 mg iablet Chiral 500mg abet Chiral 30, Miconazole AS g tube cream Chiral 31, Toluaftate 19415 g tule cream Chiral 32. Multivitamins sig chal 35. Belamiethasone 15 gtube oiotnent Chiral 34. Simvastatin = 10-mg ubiet | cit 20mg tablet Chiral ome biel Chiral 35, Trimetazidine HT 20 mg tablet Chiral 76. Megesterol Acciate 16D mg ble Biol Myers Saab 37. Kosfamide Ti val for injection Qualimed 2 vial for injection] Qualitned 3, Mitomycin TO mg vial fr injection Qualimed 39: Ertotinib 150 mg tablet Roche 40. Tamoxifen 70 mg able Aira Zena 41. Oseltnmivir 75 mg capsule Roche #2. Hemodialysis Acid "| Ald Concentrate 01-1113) Solucid AC Concentrate ‘Acid Concenrate O11 OL) Solucid AC “eid Concentrate 01,02,05,10, 11 | AC(@. Braun Avitum) | — 308.00 1) Acid Concentrate SL) 3510646 (B. Braun | 4000 ‘Aviturn) ‘Acid Conceniate(SL) 3610652, Braun | 420.00 ‘Avitun) ‘eid Concentrate (ST) 3610653 (B. Braun | 440.00 ita ‘Acid Concentrate (5 L) 3610645 (B. Braun 440.00 ‘Avitum) ‘Reid Concentrate (SL) 3510654 (B. Braun | 44000 ‘avilum) “Reid Concentrate (SL) 3610655 (B. Braun | 440.00 Avitum) ‘Acid Concentrate (5 L) 3610650 (B. Braun 440,00 it) “Reid Concentrate (SL) 7610646 (B. Braun | 440.00 Avitum) ‘eid Concentrate (OL) 3610638 B. Braun} 840.00 ‘Avitum) 7. Hemodialysis Aca ‘Acid Concentinle 22(5 0) Biasol AC-22 FED Concentrate with Potass 44. Hemodialysis Acid ‘Acid Concentrate 20 (5 L) Biasol AC-20 276.00 Concentrate without Potassium 45. Hemodialysi lL 3610952 B. Braun 600.00 Concentrate ‘Avitunt wBonste Cons. 1-02 (5 L) Soluearb BC a0Siembons Cone 07-22 (TOL) Gh ac FEA Bicarbonate Cone. oT (IL) B01 (B. Braun | 588.00 ‘vitum 5. Liquid Biearbonate Jk aT 276.00 Concentrate 5%4 Consenirale (SL) Solucarh Be 03-39% | 488.00 | $s Concenirate (OL) Solucarb BC 01-5 528.00 >| 3% Concentrate (10 L) G10937 @. Braun | 840.00 ‘Avitamn) $.4% Concentrate (5 L) “| Sohucarb BC 03-8.4% 484.00 “5.4% Concentrate (OL) ‘BC G-8.4%(B. Braun | 308.00 ‘Avitum BAv pee GOL) ‘Salucarb BC 03-8.4% 24.00 7 Peritoneal Dinivsis Solution TL EMEDOZT (@. Braun | $0.00 with 15% Dextrose Avitum FB, Peritoneal Dialysis Solution TE ENEDOZ (. Braun | 90.00 swith 425% Dextrose Avitum 49; Sodium Bicarbonate Bag (poe Buro-Med 256.00 Fa0 ¢ (ouch) ENEDO2T CB. Broun | 182.00 ‘situ — PHBE. Braun Avtar) | — 450.00, 30, Sodtam Bicarbonate with Buro-Med, 26.00 Sodium Chloride . HAS g (pouch) EREDOrS CB. Brau | 182.00 ‘Avitum) Si. Duval without Potassium CRRT hain SO Bir (B Brun | 2800.00 [52 CACHE Dinivzar Medel 110 53. CAsfIP Dialyzer Model 130 a3 Sa. CAcHIP Dialyzer Model 150 Baxter Phils 702435 55. CA-HP Dialyzer Model 170, Baxter Phils TTT 36, CA-HP Dialyzer Model 210 Bader Phils 1207.00 57. Ezelimibe Toma able Eero 33.75 38. Bretimibe ¥ Simvastatin Oma 10 mg tablet Vyiorin 35.62 10mg + 20 mg tablet Vytorin 70:50 imag + AU mg tale Vyorin 101.00 35. Lomartan potassium 50 mg tablet Cozaar 21.50 100 mig tablet Cozaae 25:50 0: Lasarian potassium > 30mg + 12.5 mg OIE Tiyzaar 23.75 Hydrocblorothiazide 100 mg-# 12.5 mg tablet yaar 31.8 TOO mg +25 mg tablet | Byzsar DS S88 Gi, Felodipine Metoprotot Sing 50 mg tablet ‘Logimax 31.00 2: Datasteride 300 meg capsule ‘Avodart 50.00) 63. Paroxetine HCL 0 rag table, Seroxst 65.78 ‘64, Clozapine 25 mg tablet Leponee 23.75 65. Lapatinib ditosylate 750 mg abet Tyke 564.00 66. Gosereln acetate 3.6 mga) Zoiadex 5159.00 z| _ 70.8 mg in) Zoladex LA 19953.00 1 67. L-Asparaginase 79,000 1.U. Inj ‘Leunase. 2670.00. 68. Salbatamot Fd re roacap + rotahaler de Veron Rotapack | — 100.00 69. Warfarin sodium z Tmg mblet Coumadin 27.40, Cc 2.5 mg able ‘Coumadin 430 Sig tablet Coumadin 47.40 To Nadroparin calcium 3,800 1.0 el. np Fesuaparine 5410.00 77, Betaxolol HCL TS %6 x5 el. eye drops Beptic 470.60 72. Ciprofloxacin HCI O.3ex Sieve drops Giloxan 296.64 | 73. Clovudiae 30 mg tablet Revowir 30.00 74. Levefloxacia. a 500 mg tablet Winthrop 3.00 | 75. Meloxicam 75mg eablet Wintlrp 13350 15 mg tablet Wintirop 22.50GENERIC DISPENSING FLOWCHART PRESCRIPTION DRUGS (Rx) Label bears the Rx symbol | OVER THE COUNTER DRUGS Label does not bear the Rx symbol Prescription is required Prescription is not required Evaluate the prescription | Prescription is incorrect Prescription is correct Fill and file the prescription Erroneous/volative Inform the buyer of all available prescription products that have the same | generic name and dosage form, and their corresponding prices. Fill the prescription Keep the prescription SSS Dispense the product chosen by the buyer. -s| Impossible prescription Danet dispense or fil | Fully-filled prescription Retain prescription and file for 2 years Partially-filled prescription Indicate the number dispensed in the prescription and return it to the patient