SIX SIGMA BLACK BELT FINAL PROJECT This work is to fulfill the Final Project requirement for the Aveta Certified Six Sigma Black Belt Program
Submitted by Eduardo Lopez
Six Sigma Black Belt Final Project Contenido Process Setting Description................................................................................................................. 3 Problem Description............................................................................................................................ 3 DEFINE PHASE ..................................................................................................................................... 4 Project Charter ................................................................................................................................ 4 Project WBS & Schedule.................................................................................................................. 5 Project Budget ................................................................................................................................. 5 Process Map: See Excel file ............................................................................................................. 5 Determine variables to measure ..................................................................................................... 5 Developing Success Metrics ............................................................................................................ 6 Critical to Cost: ............................................................................................................................ 6 Inventory Carrying Cost ............................................................................................................... 6 Critical to Schedule...................................................................................................................... 6 Critical to Quality......................................................................................................................... 7 Determining Scope SKUs to Analyze ............................................................................................... 7 MEASURE PHASE ................................................................................................................................. 8 Initial Data Gathering ...................................................................................................................... 8 SKU Demand Data ....................................................................................................................... 8 Delivery Times ............................................................................................................................. 8 Inventory Carrying Cost ............................................................................................................... 9 Customer Response to a Stock-out ................................................................................................. 9 ANALYZE PHASE................................................................................................................................. 11 Evaluating Causes of Stock-Outs ................................................................................................... 11 Creating a Stock-Out Cost Model .................................................................................................. 11 Creating a Safety Stock Recommendation Model ........................................................................ 11 Estimating Total Costs of Safety Stock Heuristic ........................................................................... 12 Value Stream Map ......................................................................................................................... 13 IMPROVE PHASE ................................................................................................................................ 14 Evaluating Improvement Alternatives .......................................................................................... 14 Lean manufacturing Concepts ...................................................................................................... 15 Japanese 5-S .................................................................................................................................. 16 Quadratic Loss Function ................................................................................................................ 16 Versión 1.0
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Six Sigma Black Belt Final Project CONTROL PHASE ............................................................................................................................... 17 Appendix I – WBS and Schedule........................................................................................................ 18 Appendix II – AHP Matrix .................................................................................................................. 19 Appendix III – Ishikawa Diagram ....................................................................................................... 20 Appendix IV – Reordering Process Flowchart ................................................................................... 21 Appendix V – Value Stream Map ...................................................................................................... 22 Appendix VI – Sales and Stock-out Flowchart ................................................................................... 23 Appendix VII – Safety Stock Calculation for Top 20 SKUs ................................................................. 24
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Six Sigma Black Belt Final Project Process Setting Description Tecnomed is second the largest wholesale distributor of pharmaceuticals and hospital supplies in Santa Cruz, Bolivia. Its customer base is wide, covering most of the country’s eastern states. It’s comprised mostly of public hospitals, private clinics, drugstore chains, as well as other independently owned retailers. Tecnomed trades 170 different SKUs, 60 of which comprise most of the volume of sales. The company has a very diverse supply chain. Some of the products are sourced from locally-based importers. Other products are sourced in neighboring countries. Yet another set of products is sourced directly from manufacturers overseas. The sales operations include 800 line telemarketing sales as well as orders raised by an in-house sales force. The company also works in direct B2B sales via electronic link with its largest customers.
Problem Description Managing over one hundred SKUs, as well as having a geographically diverse supply chain create many challenges in inventory management. The company has experienced in several instances stock outs. Unexpected shortages of stock as well as having a backlog in order fulfillment are more than merely a nuisance. The market in which Tecnomed operates is highly competitive. Oftentimes a customer may not be willing to wait for the order to be fulfilled longer than 24 hours. Management may at times choose to incur extra expense to expedite shipments of stock-out items. In other instances the sales force may be obliged to grant a customer a significant discount as a way to prevent the loss of sale due to stock-out. In either scenario the company incurs in unexpected liability. The current inventory management system that the company uses has a minimum stock level alert. This is however a static/determinist quantity, which is seldom if ever updated. To date, the company has not performed a detailed study of the stochastic nature of demand and transport times. The Black Belt Project will address the area of stock-outs and will aim to minimize its impact on company’s finances as well as in customer satisfaction.
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Six Sigma Black Belt Final Project DEFINE PHASE Project Charter Project Name: Optimizing Safety Stock Levels to Minimize Stock-out Cost Sponsoring Organization: Tecnomed Project Sponsor: Dra. Marina Alarcon Project Black Belt: Eduardo Lopez Project Green Belt: N/A Principal Stakeholders: Tecnomed Operations Management High Level Business and Problem Survey Project Goals: Determine common causes of stock-outs. Formulate and implement steps to minimize occurrence of stock-outs and minimize impact to our operations Process Problem: The cost of incurring a stock-out is significant, both in economic terms as well as customer satisfaction. Demand is not constant and has great variability, but so does replenishment lead times. Safety stocks are currently set according to best guess estimation. The company needs a heuristic to determine optimal safety stock levels. Optimal levels minimize the total cost, by balancing the cost of carrying inventory against the cost of stock-outs. Scope of the Project: The project will analyze SKUs covering 80% of sales volume Process Importance: Inventory is the single largest asset and expense for the company. Managing the investment in inventory in such a way that optimizes availability while minimizes carrying costs is of strategic importance to both, the financial aspect and the commercial strategy of the company. Authorized Resources: In order to accomplish the project the company has authorized 20-person hours of time allocated to the project, as well as the use of all IT and data resources of the company. Versión 1.0
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Six Sigma Black Belt Final Project We will have access to operations personnel but it will be restricted to the later part of the afternoon, so as to not interrupt the busier time of operations.
Project WBS & Schedule Please see Appendix I
Project Budget Given that this is an analytically-driven project, the principal resource involved is time allocation of members of the Six Sigma team. To a lesser extent, time availability for interviewing of operators and logisticians is also a resource. We don’t expect our recommendations to include considerable capital expenditures. Rather, we expect our recommendations to include changes in purchasing and logistics heuristics, procedures and practices. Therefore, we do not try to quantify a monetary budget. The time allocation of the people resources involved is detailed in the WBS/Schedule chart.
Process Map: See Excel file Please see Appendix IV for a detailed depiction of the Reorder Process. Please refer to Appendix VI for a diagram of the Sales and Stock-Out process.
Determine variables to measure In order to accurately estimate what variables to take into consideration we made use of the Analytical Hierarchy Process methodology. We requested the management team to provide a set of factors to be used in our interviews with clients. By means of random sampling, we selected a set of 10 customers for interviewing. Following the methodology, we requested that they provide weights for each pair-wise comparison for the given factors. For a detailed overview of the calculations and matrix involved please refer to Appendix II. The result of the analysis yielded the following priorities:
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Six Sigma Black Belt Final Project Factor Price Speed of Delivery Packaging Quality Customer Service
Weight 54% 26% 13% 7%
We discussed these findings with our management contact. Based on her personal and anecdotal experience, she agrees that this prioritization is correct. The industry and markets in which the company operates have several sophisticated competitors. The customer is highly price-sensitive but also expects quick delivery times. Package quality is not a major differentiator given that governmental regulations norm strictly the design of packaging. Customer service practices are very important to the client. However, customer practices have become relatively standardized in this industry. Therefore all main competitors have similar customer service practices and levels in the industry.
Developing Success Metrics Based on these results of customer opinions, we determine our success metrics as follows: Critical to Cost: Cost of Stock-out is of the highest concern to us, as it impacts the company’s bottom line and eventually has an impact on price. There are three ways in which a stock-out generates an incremental liability to the company:
Incremental cost of expediting freight, if management sees fi t to request overnight delivery of shortage items. Cost of losing a sale due to stock-out.- We define the cost of a lost sale as the average gross margin for that stock-out item. Cost of offering a discount in exchange for waiting.- In some occasions customer service will offer to discount 15% of the price of an item not to lose a sale. This happens only by management approval and it’s used in instances with certain clients or markets.
Inventory Carrying Cost.- Carrying inventory involves a hard cost. Not only does inventory signifies a capital expenditure (and therefore interest expense) but also warehousing, handling and insurance costs. We include this cost into our consideration because recommendations on increased buffer or safety stock do imply an incremental inventory carrying expense that has to be justified by reductions in stock-out costs. Critical to Schedule:
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Six Sigma Black Belt Final Project Supplier Delivery Time.- The most critical variable in the replenishment cycle is the time that it takes between the decision to reorder stock and the reception on warehouse of the same. We will measure this variable in days, and estimate it to be stochastic, normally distributed. Critical to Quality One of the key measurements in customer service is percent availability of stock. This measure is complementary related to the stock-out percent rate.
Determining Scope SKUs to Analyze As previously stated, the company has on catalog an array of 170 different SKUs. In order to have a well-defined and manageable scope, we have chosen to focus on a subset of the full catalog. We used Pareto Analysis to identify 20 SKUs which account for 76% of all sales volume demand. We believe that optimizing these SKUs will have the most significant impact on the variables defined as critical. The table below lists all selected SKUs. SKU (D)ALBENDAZOL 400 MG X 100 COMPRIMIDOS V-5 MULTIVITAMINAS X 140 UNID S. NARANJA V-5 MULTIVITAMINAS X 140 UNID S.FRUTILLA GLIBENCLAMIDA 5 MG X 100 COMPRIMIDOS CREMA CURATIVA DR. SELBY 5 GR. CREMA CURATIVA DR. SELBY X 20 GR. KETOCONAZOL CREMA AL 2% X 30 GR SALBUTAMOL INHALADOR COMPLEJO B X 10 AMP CIPROFLOXACINA 200 MG X 1 FCO AMP METOCLOPRAMIDA 10 MG X 10 AMPOLLAS CREMA CURATIVA DR. SELBY 40 GR. (D)OMEPRAZOL 40 MG + SOLVENTE METRONIDAZOL 500 MG INYECTABLE UP.VITAMINA K 10 MG/1ML X 1 AMP AGUA CON LIDOCAÍNA AL 1% X 5 ML X 1 Amp METAMIZOL INY 1G 2ML X 1 AMP VITAMINA C 1 GR. X 1 AMPOLLA UP.DEXAMETASONA 4 MG X 1 AMP AGUA DESTILADA 5 ML X 1 AMP
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Six Sigma Black Belt Final Project MEASURE PHASE Initial Data Gathering SKU Demand Data: We sample 52 contiguous weeks of demand data for the 20 SKUs selected. We consider that taking a year into account will help in factoring in any and all seasonality effects. We excluded returned transactions and a few instances in which the stock left the warehouse on consignment. The data is currently stored in a MS SQL Server database. Computing mean and standard deviation was fairly straightforward making use of standard SQL syntax. The resulting data is summarized below:
SKU-Daily Demand (D)ALBENDAZOL 400 MG X 100 COMPRIMIDOS V-5 MULTIVITAMINAS X 140 UNID S. NARANJA V-5 MULTIVITAMINAS X 140 UNID S.FRUTILLA GLIBENCLAMIDA 5 MG X 100 COMPRIMIDOS CREMA CURATIVA DR. SELBY 5 GR. CREMA CURATIVA DR. SELBY X 20 GR. KETOCONAZOL CREMA AL 2% X 30 GR SALBUTAMOL INHALADOR COMPLEJO B X 10 AMP CIPROFLOXACINA 200 MG X 1 FCO AMP METOCLOPRAMIDA 10 MG X 10 AMPOLLAS CREMA CURATIVA DR. SELBY 40 GR. (D)OMEPRAZOL 40 MG + SOLVENTE METRONIDAZOL 500 MG INYECTABLE UP.VITAMINA K 10 MG/1ML X 1 AMP AGUA CON LIDOCAÍNA AL 1% X 5 ML X 1 Amp METAMIZOL INY 1G 2ML X 1 AMP VITAMINA C 1 GR. X 1 AMPOLLA UP.DEXAMETASONA 4 MG X 1 AMP AGUA DESTILADA 5 ML X 1 AMP
Mean StdDev 2.36 2.70 2.89 4.90 5.53 1.88 14.06 13.18 15.98 2.87 17.90 5.19 18.29 21.22 29.08 5.89 34.50 4.14 39.16 39.24 40.31 4.56 46.53 1.70 66.19 14.90 84.63 18.71 189.06 35.98 250.00 31.54 360.40 33.23 575.00 147.81 606.67 55.22 966.67 129.43
Delivery Times We took a sample of delivery times occurred over the span of 20 weeks. The process of data gathering was manually done due to the fact that the company does not keep automated records for this variable currently. We determined duration from purchasing request and delivery form dates. The sample rendered a fairly normally distributed variable.
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Six Sigma Black Belt Final Project
Inventory Carrying Cost The company’s accounting department does maintain an estimated inventory carrying cost. It takes into account warehousing, labor, insurance and interest expenses allocated using SKU cost as basis. The calculation is updated on an annual basis. While by Accounting’s own admission this calculation is an estimate, we make use of it given that management is used to it and validating this indicator is out of scope for our project. The number that the company uses is 6% of retail value.
Customer Response to a Stock-out The course of action after a customer is notified of a stock-out on an ordered item results in different costs to the company. While Tecnomed does not keep detailed track of the outcome of each stock-out, we estimated percentages based on order data and judgment from Sales personnel. The implied cost of each occurrence is calculated straightforwardly. Some customers chose to wait until the order is fulfilled. The incremental costs to the company are negligible in this case. Some customers are offered 15% discount as a customer service devise. This discount is considered a cost to the company. When a customer choses to cancel its order we consider a loss of the order’s gross margin as the cost of stock-out. In reality we understand that there’s a hidden or not accounted-for stock-out cost: the loss of customer good will. Losing face could result in fewer or less frequent orders in the future. It could also result in losing a customer completely. Accurately estimating this cost is difficult. We consider that analysis to be out of scope for the current project. We also consider advisable to remain focused on the most tangible and less ambiguous measurements in order to be able to provide reliable and generally accepted hard dollar savings estimates.
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Six Sigma Black Belt Final Project Customer Scenario Will Wait Discount to Wait Will Not Wait
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Probability 55% 10% 35%
Cost 0% 15% 40%
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Six Sigma Black Belt Final Project ANALYZE PHASE Evaluating Causes of Stock-Outs In order to better understand the causes of Stock-Outs we not only mapped the Sales and Reordering process but we also did an Ishikawa or Fishbone diagram. See Appendix IV.
Creating a Stock-Out Cost Model While the company can readily account of the cost of particular stock-out instance, it lacks a documented model for calculating the total cost of stock-outs. Given that the AHP rendered and Price, and therefore implicitly costs, are of most import to the customer, we take the first step to implement a stock-out cost model:
Where:
And:
In basic terms, this model states that the stock-out cost for a given SKU is an expected value. It’s derived from multiplying the probability of a stock-out times the weighted average cost of a stockout. The probability of a stock-out is the same as the probability of demand exceeding certain value (our determined safety stock). This is readily calculated given that we have previously determined mean and standard deviation for each SKU studied. Using the probabilities and costs for each case of a stock-out, we can readily determine the weighted average cost of a stock-out. We determine this to be 16% of retail price.
Creating a Safety Stock Recommendation Model In our estimation, safety stock should be equal to the demand that may occur during the replenishment cycle time. While some inventory models readily assume that demand as well as lead times is deterministic, we know that in practice, such as in this particular case, both are Versión 1.0
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Six Sigma Black Belt Final Project stochastic in nature. Therefore, safety stock is considered the product of two normally distributed independent variables, whose mean and standard deviations are known. We recognize that there’s a possibility that Demand and Lead times may be positively correlated. For instance, during high demand period multiple customers may place orders with Tecnomed’s supplier. This may result in both, high demand and high lead times. The opposite scenario is certainly plausible. However given the limitations on data availability, we were unable to establish many demand-lead time paired data points, in order to run a reliable Pearson Correlation Coefficient. One of our recommendations will be to start keeping detailed records of these variables in order to make better inferences on the nature of these variables. For purposes of this project, our base heuristic will be defined as follows:
Where: D = Mean Daily Demand SKU L = Mean Replenishment Lead Time in Days Z = Service level we want to achieve And:
This is the standard formula for variance for the product of two independent variables.
Estimating Total Costs of Safety Stock Heuristic The more safety stock the company carries, the less the chance of a stock-out. Therefore, both quantities are inversely related. Total cost of implementing our recommended heuristic takes into account both of these costs. The inversely correlated nature of these two quantities in general terms results in a concave function, in which its lower point offers an optimal tradeoff between each type of cost. We also consider this calculated function to be closely related to Taguchi’s Quality Deployment Function.
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Six Sigma Black Belt Final Project STOCK-OUT COST
DECREASES
CARRYING COST
AS
INCREASES
We therefore define the total cost function as follows:
Where:
This takes into account the cost of carrying stock in excess of the expected demand And:
We have previously introduced this equation.
Value Stream Map We have also studied the re-ordering process and mapped out not only the flow of activities but where the process incurs in waiting, inventory in transit, and transport. Graphically noting these will allow us to determine improvement opportunities. See Appendix V.
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Six Sigma Black Belt Final Project IMPROVE PHASE In order to better understand the behavior of the cost function we modeled under different conditions in Lead Times and Services Levels. We show in the table below results for Albendazole 400mg, the top 1 SKU.
Base Case uses Lead Time 5.13 Days and Standard Deviation 2.11 Days Low Lead Time simulates a 2 Day Lead Time with Standard Deviation 2.11 Days Low Lead Variation simulates a 5.13 Day Lead Time but with a Standard Deviation 1 Day
Based on the preceding model, we derive the following conclusions:
The cost of offering service levels greater than 90% quickly rises and outweighs the cost suffering stock-outs. Getting a more reliable carrier (i.e. less variability) does not make a decisive impact on total costs. Demand variability (i.e. demand’s standard deviation) and consequently Safety Stock requirements, has greater impact on total costs. All things being equal, getting a supplier located geographically closer, such that Lead Times are reduced, does have a significant impact on total costs.
Evaluating Improvement Alternatives Making use of the Pugh Matrix methodology we list our brainstormed possible improvement paths, and compare them. Versión 1.0
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Six Sigma Black Belt Final Project
Criteria Do Nothing Increase SS to 80% Increase SS to 90% Increase SS to 99% Find Local Supplier Find Reliable Carrier
Cost Base S + S S
Customer Satif base + + + + S
Based on our comparative analysis, we recommend the following managerial on operative adjustments to the company’s business processes:
Set reorder points to no greater than a 90% service level. Continue offering discounts to those customers who otherwise may not wait. Analyze if better service times can be negotiated with the supplier, or if the company can find suppliers closer to its warehouse.
Furthermore we suggest topics for further study:
Determine if customers are equally sensitive to stock-outs in all SKUs or if there’s a differentiation. This could allow setting lower service levels to less sensitive SKUs. Determine the causes that drive demand variability and if the company can do anything to smooth demand or better predict it.
We include a table estimating Safety Stock for all 20 SKUs in our study on the Appendix section. During our analysis we have done detailed flowcharts and Value Stream Mapping on the company’s replenishment business processes. We also referred to commonly process improvement methodologies such as Lean Manufacturing and Japanese 5-S methodologies. We detail additional findings and recommendations below.
Lean manufacturing Concepts
Transport.- Analyze the current order lot sizing policy to include not only quantity discounts but also total replenishment costs (transport frequency vs. warehousing costs) Inventory.- During our analysis we detected several slow moving items. Analyze if the profit contribution of these is such that they should still be carried, or if they could be phased out. Motion.- In cleaning the data, we detected several instances of returned inventory, both from the end customer to Tecnomed, and from Tecnomed to its supplier. Investigate the causes of these.
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Six Sigma Black Belt Final Project
Waiting.- Currently a purchase order has to wait for Finance approval. While not often, at times this may introduce further delay in placing an order. Analyze the possibility of automating reordering at least for certain products. Overproduction.- As we have previously noted, too much safety stock increases inventory cost considerably. Do not exceed 90% service levels unless warranted by financial analysis. Over processing.- Consider what can be done to lessen the instances in which a sales order is placed for an already depleted item. Knowledge of inventory levels has to be more efficiently and effectively communicated to Sales.
Japanese 5-S
Sorting.- We have previously noted that out of the 170 SKUs, 20 are responsible for over 70% of sales volume. Therefore, it’s warranted to differentiate the level of attention to inventory levels according to their criticality and volume. Straightening.- We witnessed that the inventory keeping system does suffer from some inaccuracies. As the arithmetic in the engine has been proven as accurate, we believe the source of errors is in the data entry process. We recommend that the company investigate the causes of inventory data mis-keys. Shine.-Inventory keeping errors made in the past have a compound effect in SKU count. Make a priority cleaning up inventory system data. Standardize.- Setting up consistent service levels and reorder points helps better communicate managerial performance expectations for the replenishment process. Sustaining.- Documenting and training the relevant operators will ensure that the changes will persist through time. Furthermore we recommend that service level data be included in the company’s Balanced Scorecard Report.
Quadratic Loss Function As we have stated previously we consider the Total Cost Function to be very similar in nature to Taguchi’s Quadratic Loss Function. The closer the actual service level is to the optimal level (and by implication safety stock) the more optimal the results for both the customer and the company.
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Six Sigma Black Belt Final Project CONTROL PHASE In order to bring the reorder process under control and keep it there we not only need to make changes to the reordering policy and formally document it. The company must also start keeping relevant data to the critical variables and report on it periodically. The use of SPC is recommended as well as including these measures in the company’s Balanced Scorecard Report. The company is in the process of getting ISO 9001 certified. The service level policy should be included in the formal policy required by the norm. Continuous Improvement efforts, as required by the norm should be directed in part to monitor and improve not only stock-outs but its underlying causes, such as IT systems and organizational communication processes.
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Six Sigma Black Belt Final Project Appendix I – WBS and Schedule
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Six Sigma Black Belt Final Project Appendix II – AHP Matrix ANALYTICAL HIERARCHY PROCESS MATRIX
Price Speed of Delivery Packaging Quality Customer Service Sum
Price 1,00 0,17 0,20 0,25 1,62
Delivery Speed 6,00 1,00 0,17 0,25 7,42
Packaging Qual. 5,00 6,00 1,00 0,25 12,25
Cust. Service 4,00 4,00 4,00 1,00 13,00
Price Speed of Delivery Packaging Quality Customer Service
0,62 0,10 0,12 0,15
0,81 0,13 0,02 0,03
0,41 0,49 0,08 0,02
0,31 0,31 0,31 0,08
Factor Price Speed of Delivery Packaging Quality Customer Service
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Weight 54% 26% 13% 7%
Weight 54% 26% 13% 7%
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Six Sigma Black Belt Final Project Appendix III – Ishikawa Diagram
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Six Sigma Black Belt Final Project Appendix IV – Reordering Process Flowchart
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Six Sigma Black Belt Final Project Appendix V – Value Stream Map
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Six Sigma Black Belt Final Project Appendix VI – Sales and Stock-out Flowchart
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Six Sigma Black Belt Final Project
Appendix VII – Safety Stock Calculation for Top 20 SKUs
29 35
18
18
16
14
6
3
2
39
6 4
21
5
3
13
2
5
3
202
196
145 173
91
89
80
70
28
14
12
2,165
1,625
1,534
846 1,190
335
320
255
198
31
8
6
4
4
4
4
4 4
4
4
4
4
4
4
4
25
25
25
25
25
25 25
25
25
25
25
25
25
25
1,295
350
222
3
21
1,540
35 17
450
27
8
174
4
24
7
303,125
191,509
40,635
25,052
9,711
7,755
45,325
4,632 5,728
12,745
2,099
1,342
5,225
225
638
207
778
551
438
202
158
99
88
213
68 76
113
46
37
72
15
25
14
18
17
16
15
14
13
12
11
10
8 9
7
6
5
4
3
2
1
28,283
28,846
15,254
10,214
7,633
3,302
2,433
1,443
1,195
2,385
709 875
913
377
273
380
77
72
30
43,400
25,249
25,971
13,452
8,964
6,687
2,879
2,102
1,210
994
2,189
564 702
822
288
193
309
49
58
18
Safety Stock
39 5
233
4,381
4
25
995
605,889
1,421
19
48,233
Reorder Point
40 2
331
7,162
4
25
1,105
2,018,156
1,310
20
Z(90%)
47 15
423
35,745
4
25
21,847
1,714,809
2,140
Std. Dev (DL)
66
19
945
62,500
4
25
3,050
4,579,050
Var(DL)
85
36
1,250
129,888
4
25
16,752
Var(D)
189
32
1,802
330,625
4
25
Var(L) E(L)^2
250
33
2,875
368,044
4
E(D)^2
360
148
3,033
934,444
DxL
575
55
4,833
StdDev
VITAMINA C 1 GR. X 1 AMPOLLA
607
129
Mean
UP.DEXAMETASONA 4 MG X 1 AMP
967
SKU-Daily Demand (D)ALBENDAZOL 400 MG X 100 COMPRIMIDOS V-5 MULTIVITAMINAS X 140 UNID S. NARANJA V-5 MULTIVITAMINAS X 140 UNID S.FRUTILLA GLIBENCLAMIDA 5 MG X 100 COMPRIMIDOS CREMA CURATIVA DR. SELBY 5 GR. CREMA CURATIVA DR. SELBY X 20 GR. KETOCONAZOL CREMA AL 2% X 30 GR SALBUTAMOL INHALADOR COMPLEJO B X 10 AMP CIPROFLOXACINA 200 MG X 1 FCO AMP METOCLOPRAMIDA 10 MG X 10 AMPOLLAS CREMA CURATIVA DR. SELBY 40 GR. (D)OMEPRAZOL 40 MG + SOLVENTE METRONIDAZOL 500 MG INYECTABLE UP.VITAMINA K 10 MG/1ML X 1 AMP AGUA CON LIDOCAÍNA AL 1% X 5 ML X 1 Amp METAMIZOL INY 1G 2ML X 1 AMP
AGUA DESTILADA 5 ML X 1 AMP
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