Department of Health
Center for Health Development - I
Monitoring Tool for Medicines under the Maximum Retail Price
Name of Facility: DIVINE MERCY FOUNDATION OF URDANETA HOSPITAL (ST. ANNE PHARMACY)
Classification: ✘ Hospital
Drugst
ore
Address: #25 High School Drive, San Vicente West, City of Urdaneta, PANGASINAN
Monitored through:
Actual Telephone
Visit Interview ✘ Email
For actual visit, please put a check if there is an IEC material posted in a conspicuous area
Yes No
Date monitored:
No. Generic name Dosage Form/Strength Brand name MRP
1 Levamlodipine 2.5 mg tablet* 11.84
Indapamide + 2.5 mg + 10 mg film-
2 30.51
Perindopril coated tablet*
3 Metolazone 5 mg tablet 25.89
4 Parecoxib 40 mg ampule 478.01
5 Triflusal 300 mg capsule 45.57
6 Palonosetron 50 mcg/mL, 5 mL vial 3,666.00
7 Desmopressin 0.1 mg tablet* 70.78
8 Fosinopril 10 mg tablet 20.87
9 Fosinopril 20 mg tablet 25.56
10 Exemestane 25 mg tablet* 326.75
11 Alteplase 50 mg, 50 mL vial 38,186.81
12 Everolimus 10 mg tablet 3,628.09
0.5 mg prolonged-release
13 Tacrolimus 67.19
capsule
14 Beractant 25 mg/mL, 8 mL vial 19,600.27
15 Quinapril 5 mg tablet 15.01
16 Apixaban 2.5 mg film-coated tablet 91.17
17 Apixaban 5 mg film-coated tablet 90.98
10.8 mg pre-filled syringe
18 Goreselin 19,725.85
(SC)
19 Calcitonin (Salmon) 100 IU/mL, 1 mL ampule 466.79
20 Nimodipine 10 mg, 50ml vial* 1,886.29
21
22
23
24
Monitored by: Respondent:
MA. SOCORRO R. MENDOZA, R
ERWIN G. FLORES CHIEF PHARMACIS
Administrative Assistant III Name and Designation of person inte
DOH-PD-MOP-06 Form 1 Rev
nt - I
ximum Retail Price
SPITAL (ST. ANNE PHARMACY)
cuous area
Time monitored:
Actual Price Remarks
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MA. SOCORRO R. MENDOZA, RPh.
CHIEF PHARMACIS
Name and Designation of person interviewed
DOH-PD-MOP-06 Form 1 Rev. 0
