For Retail / Manufacturing Industry

ANNEX A
FREMONT RENAL CARE AND MEDICAL CLINIC
MERCHANDISE/ RAW MATERIALS / GOODS IN PROCESS / FINISHED GOODS INVENTORY
As of December 31, 2020

LOCATION (Note 1) INVENTORY UNIT OF MEASUREMENT

VALUATION TOTAL
PRODUCT / INVENTORY METHOD UNIT PRICE QUANTITY IN
ITEM DESCRIPTION (In weight or volume) WEIGHT / TOTAL COST
CODE ADDRESS CODE REMARKS STOCKS
(Note 2) e.g., kilos, grams, liters, VOLUME
etc.)
1001 0.3% D5 NSS 500cc 124.00 3.00 PC 372.00
1004 AF 13 3,890.00 8.00 PC 31,120.00
1006 Alcohol 500ml bottles 47.75 33.00 PC 1,575.75
1007 Aluminum Hydroxide (Maalox) 9.00 2.00 PC 18.00
1008 Aspirin 80mg tab 1.75 4.00 PC 7.00
1009 Atropine Sulfate 1mg/ml amp 15.00 8.00 PC 120.00
1010 Blood transfusion set 80.00 10.00 PC 800.00
1011 Bloodline - Fresenius 150.00 2,200.00 PC 330,000.00
1012 Bloodline- Bioteq 150.00 1,848.00 PC 277,200.00
1013 Calcium Gluconate 10% solution (10 ml) 120.00 3.00 PC 360.00
1014 Captopril 25mg 16.00 18.00 PC 288.00
1015 Cardiac Leads 9.00 150.00 PC 1,350.00
1016 Celecoxib 200mg 77.00 4.00 PC 308.00
1017 Chlorine Strips 900.00 1.00 PC 900.00
1018 Chlorphenamine (Antamin) 10mg amp 65.00 8.00 PC 520.00
1021 Clonidine 150 mcg (Catapress) 66.50 20.00 PC 1,330.00
1022 Clonidine 75 mcg 43.75 8.00 PC 350.00
1023 Cordarone 50mg/ml 376.60 2.00 PC 753.20
1024 Cotton balls 300's per pack 49.75 1.00 PC 49.75
1025 D5LR 1L 79.00 2.00 PC 158.00
1026 D5NM 1L 80.00 2.00 PC 160.00
1027 D5W 500ml 69.00 2.00 PC 138.00
1028 Dextrose 50%/50ml vial 53.00 27.00 PC 1,431.00
1029 Dialysate Part "A" 199.49 105.00 PC 20,946.45
1030 Dialysate Pre-mix Part "B" 250.00 1,220.00 PC 305,000.00
1031 Dialyzer Dia20 (hiflux-dialife) 900.00 7.00 PC 6,300.00
1032 Dialyzer F7 1,150.00 73.00 PC 83,950.00
1033 Dialyzer F8 1,280.00 79.00 PC 101,120.00
1034 Diasafe 5,212.00 9.00 PC 46,908.00
1035 Diazepam 5mg amp 105.25 2.00 PC 210.50
1036 Digoxin (Lanoxin) 250 mcg/ml 195.00 4.00 PC 780.00
1037 Digoxin (Lanoxin) 250 mcg/tab 84.00 5.00 PC 420.00
1038 Diltiazem HCl 60mg/tab 52.70 6.00 PC 316.20
1039 Diphenhydramine 25mg/cap 39.55 20.00 PC 791.00
1040 Diphenhydramine HCl 50mg/ml 145.00 20.00 PC 2,900.00
1041 Dobutamine Hydrochloride 250mg in 20ml 450.00 2.00 PC 900.00
1043 Dopamine 200mg/250ml 765.00 2.00 PC 1,530.00
1044 Dopamine 400mg/250ml 765.00 2.00 PC 1,530.00
1045 ECG Thermal Paper 1.9 in x 98.4 feet 350.00 2.00 PC 700.00
1050 Elastic Bandage 210.00 2.00 PC 420.00
1051 Epinephrine HCl 1mg/ml amp 55.00 20.00 PC 1,100.00
1052 Epoetin Alfa (Epovax) 4,000 "u" 580.00 51.00 PC 29,580.00
1055 ET tube 130.00 2.00 PC 260.00
1057 Fistula Needles G. 16 20.00 472.00 PC 9,440.00
1058 Fistula Needles G.17 20.00 788.00 PC 15,760.00
1060 Foley catheter Fr 18 48.00 2.00 PC 96.00
1061 Furosemide 10mg/ml 15.00 4.00 PC 60.00
1062 Gloves, m 350.00 28.00 PC 9,800.00
1063 Heparin 1000iu 75.00 29.00 PC 2,175.00
1064 Heparin 5000iu 195.00 375.00 PC 73,125.00
1065 Heplock 40.00 2.00 PC 80.00
1066 HGT Lancet 2.50 25.00 PC 62.50
1067 HGT Monitoring Strips 25.20 25.00 PC 630.00
1068 Hydralazine Hcl 30mg/ml 240.00 2.00 PC 480.00
1069 Hydrocortisone sodium 46.50 8.00 PC 372.00
1073 Hydrogen Peroxide 500ml bottle 87.00 1.00 PC 87.00
1074 Hyoscine N-butylbromide 20mg/ml 215.25 2.00 PC 430.50
1076 Ipratopium + Salbutamol 500mcg/2.5mg 31.65 4.00 PC 126.60
1077 Isosorbide dinitrate 5mg/tab 22.10 2.00 PC 44.20
1078 Isosorbide mononitrate 10mg/tab 83.00 2.00 PC 166.00
1079 IV Butterfly Cannula G21 140.00 2.00 PC 280.00
1080 IV Butterfly Cannula G21 140.00 2.00 PC 280.00
1081 IV Cannula G.26 140.00 2.00 PC 280.00
1082 IV Cannula G.21 140.00 2.00 PC 280.00
1083 IV Cannula G24 140.00 2.00 PC 280.00
1084 KY Jelly 42.00 4.00 PC 168.00
1085 Lanoxin 250mcg/tab 64.00 6.00 PC 384.00
1087 Leukoplast 350.00 1.00 PC 350.00
1088 Lidocaine Hydrochloride bottle 60.20 2.00 PC 120.40
1090 Macroset 4.50 2.00 PC 9.00
1091 Magnesium Sulfate amp 70.50 2.00 PC 141.00
1092 Mask 150.00 54.00 PC 8,100.00
1093 Mefenamic Acid 12.00 4.00 PC 48.00
1094 Metoclopramide hcl 5mg/ml (2ml) 20.00 10.00 PC 200.00
1096 Micropore 1 inch 29.17 49.00 PC 1,429.33
1097 Microset 45.00 1.00 PC 45.00
1098 Nebulizing Kit 110.00 10.00 PC 1,100.00
1099 Nicardipine Hcl 1mg/ml in 2ml amp 192.00 4.00 PC 768.00
1102 Nitrile Gloves 360.00 226.00 PC 81,360.00
1103 Nitroglycerin Transdermal Patch 147.00 3.00 PC 441.00
1104 Norepinephrine 1mg/ml in 2ml amp 550.00 4.00 PC 2,200.00
1105 Omeprazole 40mg cap 51.45 2.00 PC 102.90
1106 Omeprazole 40mg/vial 110.00 10.00 PC 1,100.00
1107 Oral Airway 175.00 2.00 PC 350.00
1108 Oxygen Mask 90.00 14.00 PC 1,260.00
1109 Oxygen Nasal Cannula 75.00 10.00 PC 750.00
1110 Paracetamol 5.25 10.00 PC 52.50
1111 Paracetamol 2ml Ampl 25.00 10.00 PC 250.00
1112 Paracetamol+Tramadol 75.60 2.00 PC 151.20
1113 Peracetic Acid Test Strip 1,300.00 1.00 PC 1,300.00
1114 Phenobarbital 90mg/cap 107.00 4.00 PC 428.00
1115 Plain LR 1L 70.00 2.00 PC 140.00
1116 Plain NSS 1L 49.00 2,040.00 PC 99,960.00
1117 Plain Nss 500ml 69.00 2.00 PC 138.00
1118 Potassium Chloride 2meqs/20ml 59.00 6.00 PC 354.00
1120 Povidone Iodine 1gal 650.00 1.00 PC 650.00
1121 Purple Top 4.50 400.00 PC 1,800.00
1122 Racecadotril 100mg/cap 48.00 3.00 PC 144.00
1123 Ranitidine Hcl 25mg/ml 30.00 4.00 PC 120.00
1124 Red Top 4.50 300.00 PC 1,350.00
1125 Renalin 10 L 17,339.00 1.00 PC 17,339.00
1127 Rolled Gauze 900.00 1.00 PC 900.00
1128 Salbutamol 2.5ml nebule 8.50 4.00 PC 34.00
1129 Sodium Bicarbonate 8.4% (1meq/ml) 50ml vial 277.00 4.00 PC 1,108.00
1132 Sterile Gauze 36.00 2.00 PC 72.00
1133 Sterile Gloves 45.00 4.00 PC 180.00
 1134 Sterile Water 50cc 231.00 4.00 PC 924.00
1135 Stomach Tube 149.00 1.00 PC 149.00
1136 Suction Catheter 180.00 3.00 PC 540.00
1137 Syringe 10cc 2.80 720.00 PC 2,016.00
1138 Syringe 1-cc (TB syringe) 1.70 1,727.00 PC 2,935.90
1139 Syringe 50cc 48.00 3.00 PC 144.00
1140 Syringe 5-cc 2.00 2,056.00 PC 4,112.00
1141 Terbutaline sulfate 5mg/2ml 55.00 2.00 PC 110.00
1142 Tramadol 50mg/tab 10.00 4.00 PC 40.00
1143 Tramadol Hcl 50mg/2ml 30.00 3.00 PC 90.00
1144 Tranexamic Acid 100mg/ml 104.00 2.00 PC 208.00
We
1146 decla Tranexamic Acid 500mg/cap 9.00 2.00 PC 18.00
1148 re, Verapamil 2.5mg/ml 2ml vial 282.00 4.00 PC 1,128.00
unde
1149 r the Verapamil 40mg/tab 72.00 3.00 PC 216.00
1150 pena Wooden Tongue Depressor 205.00 2.00 PC 410.00
1151 lties Alcohol 1gal 360.00 3.00 PC 1,080.00
of
1152 perju Alcohol container 1,300.00 2.00 PC 2,600.00
ry,
that
this 1,612,923.88
sche
dule
a Include all goods whether taxpayer has title thereto or not, provided these goods are actually situated in location/address at the Head Office or Branch or Facilities (with or without
has sales activity of the taxpayer). Facilities shall include but not limited to place of production, showroom, warehouse, storage place, leased property, etc. Include also goods out on
been consignment, though not physically present are nonetheless owned by the taxpayer.
mad
e in
good
b Use the following codes:
faith,
verifi CH Goods on consignment held by the Indicate the name of the consignor in the Remarks column
ed taxpayer
by P Indicate the name of related party/owner in the Remarks column
us, Parked goods or goods owned by related
and parties
to O Goods owned by the taxpayer
the
best CO Goods out on consignment held in the Indicate the name of the entity in the Remarks column
of hands of entity other than taxpayer
our
know
Note 2 legde Indicate
and Costing
belie Method
applied,
f, is e.g.,
true Standar
and d
corre Costing, JOFEL C. HILAGA
ct FIFO,
purs Weighte Name and Signature of Authorized
uant d Representative
to Average,
the Specific
Identific
provi ation,
sions etc.
of
the
TIN : 907-747-806