SUPPLIER ACCREDITATION CHECKLIST

IMPORTANT SUBMISSION GUIDELINES:

Please compile in a Long Black Clear Book

Submission deadline would be on or before: _____________________________

APPLICATION FOR (tick appropriate box): □ IN-PATIENT PHARMACY □ OUT-PATIENT / CHRYS SPECIALTY PHARMACY □ BOTH
PRIMARY REQUIREMENTS

Supplier Accreditation Form

General Documentary Requirements

Company Profile and History
Organizational Chart
Key Personnel and Management Profile
Location Map of Head Office and Warehouse Facilities
List of Top Ten Customers/Clients (indicating addresses, contact person and numbers)
Latest Audited Financial Statement (2 years) or Income Tax Returns duly received by the BIR
Photocopy of Official Receipt and Sales Invoice bearing Tax Identification Number (TIN)
Returns Policy

Permits and Licenses

License to Operate
BIR Certificate of Registration (BIR Form 2303)
SEC Certificate of Registration (for Corporation) DTI Registration (for Proprietorship and/or Partnership)
Mayor’s Permit / Business License
Sanitary Permit
Certificate of Distributorship and/or Sub-distributorship
Quality Certificates (ISO, cGMP, etc., if applicable)
S4 Licence (for wholesaler of dangerous drugs)

SECONDARY REQUIREMENTS

Drugs and Medicines

Certificate of Product Registration (CPR)
Certificate of Pharmaceutical Product (for imported drugs/compassionate drugs, if applicable)
Certificate of Product Analysis and/or Drug Study (for raw materials)
Materials Safety Data Sheet (MSDS)
Evaluation report of drugs for formulary (product monograph) – Product Details
Product Lists with corresponding price (include comparative SRP or market price if not included in MPHHI-RFQ)

Medical Supplies and Devices

Certificate of Product Registration (CPR)
Quality Systems Certificate of Approval on Manufacturing, or compliance certificate with ISO 9000 series or ISO 13485; for imported medical device, the
Certificate shall be duly authenticated by the territorial Philippine Consulate
Device description and/or device manual (including intended use, warnings, precautions, potential adverse effects, etc)
Product Lists with corresponding price (include comparative SRP or market price if not included in MPHHI-RFQ)

Other Consumables / Products / Services (Non-Medical)

Certificate of Product Registration (CPR)
Product description (including intended use, warnings, precautions, potential adverse effects, etc)
Product Lists with corresponding price (include comparative SRP or market price if not included in MPHHI-RFQ)