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Making Quality Healthcare Affordable

Antiretroviral Medicines Request Form

Please fill in the fields below to provide us with additional information to be able to process your request. Fields marked with * are obligatory.

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Are you’re a customer of IDA Foundation? *

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Organisation Name*

Customer number*

Contact person for this request

Mr/Mrs*

First Name

Last name*

E-mail address*

Phone number*

Fax number

Destination country*

Please fill in the desired quantity of units and click on Submit button to send the request to IDA HIV/AIDS Group:

Quantity	IDA Code	Product Description	Unit
	310401	abacavir 60 mg	60	tabs
	312800	abacavir 300 mg	60	tabs
	312900	abacavir 20 mg/ml oral solution, 240 ml	1	bottle
	312200	didanosine 25 mg, buffered	60	tabs
	312600	didanosine 50 mg, buffered	60	tabs
	312300	didanosine 100 mg, buffered	60	tabs
	319900	didanosine 200 mg, enteric coated	30	caps
	311900	didanosine 250 mg, enteric coated	30	tabs
	312700	didanosine 400 mg, enteric coated	30	tabs
	312000	didanosine 2 g, powder for oral solution	1	bottle
	319000	emtricitabine 200 mg	30	caps
	310700	lamivudine 150 mg	60	tabs
	314000	lamivudine 10 mg/ml, oral solution, 240 ml	1	bottle
	315100	lamivudine 150 mg + stavudine 30 mg	60	tabs
	310600	lamivudine 150 mg + zidovudine 300 mg	60	tabs
	311606	stavudine 15 mg	60	caps
	311306	stavudine 20 mg	60	caps
	311406	stavudine 30 mg	60	caps
	314400	stavudine 1 mg/ml pwd for oral solution, 200 ml	1	bottle
	313007	tenofovir disoproxil fumarate 300 mg	30	tabs
	310100	zidovudine 100 mg	100	caps
	310201	zidovudine 300 mg	60	tabs
	310300	zidovudine 10 mg/ml solution for IV infusion, 20 ml	5	vials
	314201	zidovudine 10 mg/ml oral solution, 240 ml	1	bottle
	313607	efavirenz 50 mg	30	caps
	313707	efavirenz 100mg	30	caps
	311800	efavirenz 200 mg	90	caps
	313507	efavirenz 600 mg	30	tabs
	313900	efavirenz 30 mg/ml oral solution, 180 ml	1	bottle
	310900	nevirapine 200 mg	60	tabs
	314600	nevirapine 10 mg/ml oral suspension, 240 ml	1	bottle
	316600	atazanavir 150 mg	60	caps
	316701	atazanavir 200 mg	60	caps
	317700	darunavir 300 mg	120	tabs
	317200	fosamprenavir 700 mg	60	tabs
	310500	indinavir 400 mg	180	caps
	317100	lopinavir 100 mg + ritonavir 25 mg	60	tabs
	317000	lopinavir 200 mg + ritonavir 50 mg	120	tabs
	314104	lopinavir 80 mg/ml + >ritonavir 20 mg/ml oral solution (**)	5	btls
	311700	nelfinavir 250 mg	270	tabs
	311102	ritonavir 100 mg (***)	84	caps
	318801	ritonavir 100 mg (heat stable)	84	tabs
	314300	ritonavir 80 mg/ml oral solution, 240 ml	1	bottle
	313200	saquinavir 200 mg	270	caps
	313300	saquinavir 500 mg	120	tabs
	313100	tenofovir 300 mg + emtricitabine 200 mg	30	tabs
	317500	tipranavir 250 mg	120	tabs
	313400	efavirenz 600mg + emtricitabine 200mg + tenofovir 300mg	60	vials
	315601	lamivudine 30mg + stavudine 6mg + nevirapine 50mg	60	tabs
	315701	lamivudine 60mg + stavudine 12mg + nevirapine 100mg	60	tabs
	315501	lamivudine 150mg + stavudine 30mg + nevirapine 200mg	60	tabs
	315800	lamivudine 150mg + zidovudine 300mg + nevirapine 200mg	60	tabs
	315300	lamivudine 150mg + zidovudine 300mg & abacavir 300mg, co-blister	60+60	tabs
	316100	lamivudine 150mg + zidovudine 300mg & efavirenz 600mg, co-blister	60+30	tabs
	314900	lamivudine 300mg + tenofir df 300mg	30	tabs
	318000	enfuvirtide 90mg powder for injection + solvent	60	vials

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We specialise

Making Quality Healthcare Affordable

Antiretroviral Medicines Request Form