| 1 | 12160000 | 12162200 | 12162201 | Ácido ascórbico | CITRATO DE CALCIO 1500/ VITAMINA D3 400 UI X 30 TB | Unidad | 10 | 865.38 | 0.00 | 0.00 | 0.00 | 8,653.80 |
| 2 | 51140000 | 51141500 | 51141507 | Fenitoína | FEMITOINA SODICA | Unidad | 10 | 3,306.29 | 0.00 | 0.00 | 0.00 | 33,062.90 |
| 3 | 51150000 | 51151700 | 51151738 | Fumarato de formoterol | FORMOTEROL FUMARATO / DIHIDRATO BUDESONIDA X 60 TB | Unidad | 50 | 1,999.65 | 0.00 | 0.00 | 0.00 | 99,982.50 |
| 4 | 51120000 | 51121700 | 51121704 | Lisinopril | AMLODIPINA 5 MG/ LISINOPRIL 10 MG X 30 TB | Unidad | 15 | 1,153.85 | 0.00 | 0.00 | 0.00 | 17,307.75 |
| 5 | 51120000 | 51121700 | 51121704 | Lisinopril | AMLODIPINA 10 MG/ LISINOPRIL 20 MG X 30 TB | Unidad | 15 | 1,153.85 | 0.00 | 0.00 | 0.00 | 17,307.75 |
| 6 | 51180000 | 51181600 | 51181608 | Levotiroxina | ESOMEPRAZOL 40 MG/ BICARBONATO DE SODIO 1100 MG X 30 TB | Unidad | 10 | 2,480.76 | 0.00 | 0.00 | 0.00 | 24,807.60 |
| 7 | 51180000 | 51181600 | 51181608 | Levotiroxina | LEVOTIROXINA 25MG X 50 TB | Unidad | 5 | 1,005.00 | 0.00 | 0.00 | 0.00 | 5,025.00 |
| 8 | 51120000 | 51121700 | 51121753 | Irbesartán | IBERSARTAN 150 MG X 30 TB | Unidad | 10 | 1,039.50 | 0.00 | 0.00 | 0.00 | 10,395.00 |
| 9 | 51100000 | 51101500 | 51101548 | Fosfomicina trometamol | FOSFOMICINA TROMETAMOL 3G X 1 SOBRE | Unidad | 5 | 1,345.50 | 0.00 | 0.00 | 0.00 | 6,727.50 |
| 10 | 51120000 | 51121700 | 51121726 | Indapamida | INDAPAMIDE 1.5 MG/ INDAPAMIDA 1.5 MG X 30 TB | Unidad | 5 | 3,027.05 | 0.00 | 0.00 | 0.00 | 15,135.25 |
| 11 | 51100000 | 51102200 | 51102212 | Ácido acetohidroxámico | ACIDO ACEXAMICO-NEOMICIDA 40 GR | Unidad | 5 | 997.50 | 0.00 | 0.00 | 0.00 | 4,987.50 |
| 12 | 51180000 | 51182400 | 51182408 | Fosfato sódico de celulosa | CARBOXIMETILCELULOSA SODICA 0.5% GLICERINA 1% Y POLISOBARTO 80 0,5% | Unidad | 10 | 900.00 | 0.00 | 0.00 | 0.00 | 9,000.00 |
| 13 | 51180000 | 51182400 | 51182408 | Fosfato sódico de celulosa | CARBOXIMETILCELULOSA SODICA 0.5% 15 ML | Unidad | 10 | 750.00 | 0.00 | 0.00 | 0.00 | 7,500.00 |
| 14 | 51170000 | 51171900 | 51171909 | Omeprazol | OMEPRAZOL 20 MG/LEVOFLOXACINA 750 MG /AMOXICILINA 1G | Unidad | 5 | 5,653.85 | 0.00 | 0.00 | 0.00 | 28,269.25 |
| 15 | 51120000 | 51121600 | 51121611 | Trimetazidina | DICLORHIDRATO DE TRIMETAZIDINA 80 MG X30 | Unidad | 10 | 4,309.50 | 0.00 | 0.00 | 0.00 | 43,095.00 |
| 16 | 51150000 | 51151800 | 51151817 | Hidrocloruro de tamsulosina | TRIMETAZIDINA DICLORHIDRATO 35 MG X 30 TB | Unidad | 10 | 2,449.50 | 0.00 | 0.00 | 0.00 | 24,495.00 |
| 17 | 51120000 | 51121700 | 51121733 | Valsartán | VILDAGLIPTINA 50 MG X 30 TB | Unidad | 30 | 1,534.62 | 0.00 | 0.00 | 0.00 | 46,038.60 |