CODE OF PRACTICE FOR THE PHARMACEUTICAL INDUSTRY 2014 Annex I- Disclosure Template June 2014 Healthcare Profesionals (HCPs): city of principal practice Country of Principal Principal Practice DNI / CIF Full Name Donations Contribution to educational and scientific meetings (Art. 18.3.1.b & 18.3.2.a) Fees for service (Art. 18.3.1.c & 18.3.2.b) Pratice Address XXX1234XX Healthcare Organisations (HCOs): city where registered TOTAL Related expenses Sponsorship agreed in the (Mandatory) (Mandatory) (Optional) (Optional) (Mandatory) agreements with Registration Travel & fee for service or (Art. 18.3.1.a) HCOs / third parties Fees Fees Accomodation consultancy contract, appointed by HCOs including travel & (Art. 18.1) (Art. 18.3) (Art. 18.3) (Art. 18.3) (Art. 18.3) to manage an Event accomodation INDIVIDUAL NAMED DISCLOSURE: one line per HCP (i.e. all Transfers of Value during a year for an individual HCP will be summed up. Itemisation should be available for the individual HCP or public authorities´consultation only as appropriate. HOSP. HM QUIRURGICO ABA GARROTE MARIA MODELO A CORUÑA SPAIN N/A N/A 100,00 EUR 823,35 EUR 923,35 EUR CARMEN C. VIRREY OSORIO, 30, 15011 HOSP. UNIVERSITARIO ABDELFATAH INSULAR GRAN LAS PALMAS DE GRAN MOHAMED SUCAINA SPAIN CANARIA N/A N/A 65,97 EUR 65,97 EUR CANARIA MOHAMED AV. MARITIMA DEL SUR, SN, 35016 HOSP. UNIVERSITARIO ABRALDES PUERTA DEL MAR BECHIARELLI ALFREDO CADIZ SPAIN XXX4858XX N/A N/A 750,00 EUR 750,00 EUR AV. ANA DE VIYA, 21, JOSE 11009 HOSP. CLINICO UNIVERSITARIO VIRGEN ABRISQUETA CARRION EL PALMAR (EL SPAIN DE LA ARRIXACA XXX0459XX N/A N/A 1.060,00 EUR 1.643,04 EUR 450,00 EUR 3.153,04 EUR JESUS PALMAR) CTRA. MADRID CARTAGENA, SN, 30120 HOSP. GENERAL UNIVERSITARIO DE ELDA VIRGEN DE LA ABUOMAR ADEL ELDA SPAIN N/A N/A 560,00 EUR 2.009,27 EUR 2.569,27 EUR SALUD CTRA. ELDA A SAX, KM 3, 03600 HOSP. UNIVERSITARI ACEITUNO MUTUA TERRASSA QUINTANILLA TERRASSA SPAIN N/A N/A 200,00 EUR 413,78 EUR 613,78 EUR PÇA. DOCTOR ROBERT, MONTSERRAT 5, 08221 HOSP. CLINICO UNIVERSITARIO ACEVEDO GARCIA VALLADOLID SPAIN VALLADOLID N/A N/A 886,00 EUR 889,49 EUR 1.775,49 EUR ROSA MARIA AV. RAMON Y CAJAL, 3, 47003 HOSP. UNIVERSITARIO AGUADO BUENO DE LA PRINCESA MADRID SPAIN N/A N/A 200,00 EUR 200,00 EUR BEATRIZ C. DIEGO DE LEON, 62, 28006 HOSP. UNIVERSITARI I POLITECNIC LA FE DE AGUAS PERIS MARIAM VALENCIA SPAIN VALENCIA XXX8121XX N/A N/A 330,58 EUR 357,17 EUR 687,75 EUR AV. FERNANDO ABRIL MARTORELL, 106, 46026 HOSP. SANTA AGUILAR FRANCO BARBARA SORIA SORIA SPAIN N/A N/A 196,95 EUR 833,85 EUR 450,00 EUR 1.480,80 EUR CARLOS PS. SANTA BARBARA, SN, 42005 HOSP. DE JEREZ AGUILAR MARTINEZ JEREZ DE LA SPAIN AV. REINA SOFIA, SN, N/A N/A 350,00 EUR 313,73 EUR 663,73 EUR JUAN CRISTOBAL FRONTERA 11407 HOSP. CLINICO UNIVERSITARIO AGUILELLA DIAGO LOZANO BLESA DE ZARAGOZA SPAIN N/A N/A 350,00 EUR 460,25 EUR 810,25 EUR VICENTE ZARAGOZA AV. SAN JUAN BOSCO, 15, 50009 HOSP. UNIVERSITARIO DONOSTIA NUESTRA AGUIRRE ALLENDE SAN SEBASTIAN SPAIN SEÑORA DE ARANZAZU N/A N/A 526,50 EUR 526,50 EUR IGNACIO PS. DOCTOR BEGIRISTAIN, SN, 20014 HOSP. RIO CARRION ALBARRAN SEVERO PALENCIA SPAIN AV. DONANTES DE XXX8592XX N/A N/A 224,67 EUR 224,67 EUR BEATRIZ SANGRE, SN, 34005 HOSP. UNIVERSITARI ALBERT CARRASCO DOCTOR JOSEP GIRONA SPAIN N/A N/A 256,20 EUR 268,31 EUR 524,51 EUR MARC TRUETA AV. FRANÇA, SN, 17007 HOSP. DON BENITO- VILLANUEVA DE LA ALBINAGORTA SERENA HERRERA LUCIA DON BENITO SPAIN XXX6691XX N/A N/A 570,00 EUR 881,82 EUR 1.451,82 EUR CTRA. DON BENITO A REBECA VILLANUEVA, KM 3, 06400 HOSP. CLINICO UNIVERSITARIO ALCACERA LOPEZ LOZANO BLESA DE ZARAGOZA SPAIN N/A N/A 119,36 EUR 119,36 EUR MARIA ARANZAZU ZARAGOZA AV. SAN JUAN BOSCO, 15, 50009 HOSP. UNIVERSITARIO VIRGEN DE LA ALCAIN MARTINEZ MALAGA SPAIN VICTORIA XXX0964XX N/A N/A 1.692,84 EUR 1.692,84 EUR GUILLERMO JOSE C. JIMENEZ FRAUD, SN, 29010 CONSULTA PRIVADA ALCALA ESCRICHE TERUEL SPAIN C. AGUSTINA DE XXX2171XX N/A N/A 570,00 EUR 242,49 EUR 812,49 EUR MARIA JOSE ARAGON, 3 - 1 C, 44002 HOSP. VALL D'HEBRON ALCALA GONZALEZ UNIVERSITARI BARCELONA SPAIN N/A N/A 350,00 EUR 757,27 EUR 1.107,27 EUR LUIS GERARDO PS. VALL D'HEBRON, 119 - 129, 08035 HOSP. REGIONAL UNIVERSITARIO ALCALA PEÑA MARIA MALAGA SPAIN MALAGA N/A N/A 200,00 EUR 5.103,18 EUR 5.303,18 EUR MAGDALENA AV. DE CARLOS HAYA, SN, 29010 HOSP. UNIVERSITARIO ALCALDE RUBIO MARIA BADAJOZ SPAIN BADAJOZ XXX5337XX N/A N/A 200,00 EUR 586,60 EUR 1.950,00 EUR 2.736,60 EUR MAR AV. DE ELVAS, SN, 06006 HOSP. VIRGEN DE LA ALCANTARA TORRES SALUD TOLEDO SPAIN XXX8503XX N/A N/A 350,00 EUR 205,18 EUR 555,18 EUR MARIANO AV. DE BARBER, 30, 45004 HOSP. GENERAL DE ALCAZAR JAEN LUIS VALDEPEÑAS VALDEPEÑAS SPAIN N/A N/A 330,58 EUR 574,32 EUR 904,90 EUR MIGUEL AV. ESTUDIANTES, SN, 13300 HOSP. VIRGEN DE LA ALCOCER GONZALEZ LUZ MARIA PERPETUO CUENCA SPAIN C. HERMANDAD N/A N/A 150,00 EUR 150,00 EUR SOCORRO DONANTES SANGRE, 1, 16002 HOSP. UNIVERSITARI ALDEGUER MANTE DOCTOR JOSEP GIRONA SPAIN XXX2371XX N/A N/A 504,13 EUR 257,99 EUR 450,00 EUR 1.212,12 EUR XAVIER TRUETA AV. FRANÇA, SN, 17007 HOSP. UNIVERSITARIO GRAN CANARIA ALEMAN GONZALEZ LAS PALMAS DE GRAN SPAIN DOCTOR NEGRIN XXX9614XX N/A N/A 650,00 EUR 271,63 EUR 921,63 EUR HAIDEE CANARIA PZA. BARRANCO DE LA BALLENA, SN, 35010 HOSP. UNIVERSITARIO ALGARA SAN NICOLAS 12 DE OCTUBRE MADRID SPAIN XXX6100XX N/A N/A 305,79 EUR 582,35 EUR 888,14 EUR MARIA AV. DE CORDOBA, SN, 28041 HOSP. UNIVERSITARIO MEDICO QUIRURGICO ALMAGRO TORRES JAEN SPAIN CIUDAD DE JAEN XXX6068XX N/A N/A 895,02 EUR 1.237,26 EUR 600,00 EUR 2.732,28 EUR FRANCISCA AV. EJERCITO ESPAÑOL, 10, 23007 CONSEJERIA SANIDAD ALMAZAN SAEZ CATALUÑA BARCELONA SPAIN N/A N/A 450,00 EUR 450,00 EUR CARITAT C. DE ROC BORONAT, 81 - 95 2, 08005 HOSP. GENERAL UNIVERSITARIO DE CASTELLON DE LA ALMELA NOTARI PEDRO SPAIN CASTELLON XXX6334XX N/A N/A 450,00 EUR 450,00 EUR PLANA AV. BENICASIM, SN, 12004 HOSP. UNIVERSITARIO ALONSO ABREU LA CUESTA SPAIN CANARIAS XXX0943XX N/A N/A 853,93 EUR 900,00 EUR 1.753,93 EUR INMACULADA C. OFRA, SN, 38320 HOSP. UNIVERSITARIO DONOSTIA NUESTRA ALONSO GALAN SAN SEBASTIAN SPAIN SEÑORA DE ARANZAZU N/A N/A 350,00 EUR 454,31 EUR 804,31 EUR HORACIO PS. DOCTOR BEGIRISTAIN, SN, 20014 HOSP. DEL MAR ALONSO GONÇALVES PS. MARITIM BARCELONA SPAIN N/A N/A 337,62 EUR 337,62 EUR SANDRA BARCELONETA, 25 - 29, 8003 HOSP. UNIVERSITARIO ALONSO HERNANDEZ SON ESPASES PALMA DE MALLORCA SPAIN N/A N/A 365,75 EUR 365,75 EUR NATALIA CTRA. VALLDEMOSSA, 79 - 2 225, 07010 HOSP. COMARCAL ALONSO MADRIGAL SANTIAGO APOSTOL MIRANDA DE EBRO SPAIN N/A N/A 227,27 EUR 227,27 EUR CRISTINA CTRA. DE ORON, SN, 09200 HOSP. UNIVERSITARIO DONOSTIA NUESTRA ALTUNA MONGELOS SEÑORA DE ARANZAZU SAN SEBASTIAN SPAIN N/A N/A 536,00 EUR 675,43 EUR 1.211,43 EUR ANE PS. DEL DOCTOR BEGIRISTAIN, SN - 1, 20014 HOSP. MONTECELO ALVAREZ ALVAREZ MOURENTE (SANTA SPAIN AV. MOURENTE, SN, N/A N/A 600,00 EUR 600,00 EUR CARLOS MARIA) 36164 HOSP. DE TORTOSA ALVAREZ DE VERGE DE LA CINTA SOTOMAYOR BIERMAN TORTOSA SPAIN N/A N/A 595,04 EUR 924,84 EUR 1.519,88 EUR C. ESPLANETES, 14, DIEGO ANTONIO 43500 HOSP. VALL D'HEBRON ALVAREZ GARCIA UNIVERSITARI BARCELONA SPAIN N/A N/A 50,00 EUR 292,96 EUR 342,96 EUR MARIA EUGENIA PS. VALL D'HEBRON, 119 - 129, 08035 HOSP. ALVARO CUNQUEIRO ALVAREZ JUAREZ VIGO SPAIN C. CLARA N/A N/A 652,89 EUR 501,16 EUR 1.154,05 EUR MIGUEL ANGEL CAMPOAMOR, 341, 36213 ALVAREZ PEQUEÑO HOSP. POVISA VIGO SPAIN N/A N/A 162,50 EUR 162,50 EUR LETICIA C. SALAMANCA, 5, 36211 HOSP. UNIVERSITARIO ALVAREZ SANCHEZ SEVERO OCHOA LEGANES SPAIN N/A N/A 136,35 EUR 136,35 EUR MARTA AV. DE ORELLANA, SN, 28911 FUND. HOSP. SON LLATZER AMER SALAS NEUS SON FERRIOL SPAIN N/A N/A 377,00 EUR 403,04 EUR 780,04 EUR CTRA. MANACOR, KM 4, 07198 HOSP. UNIVERSITARI I POLITECNIC LA FE DE ANDREU LAPIEDRA VALENCIA SPAIN VALENCIA N/A N/A 750,00 EUR 750,00 EUR RAFAEL AV. FERNANDO ABRIL MARTORELL, 106, 46026 HOSP. GENERAL UNIVERSITARIO DE ANDUJAR TRONCOSO CIUDAD REAL SPAIN CIUDAD REAL N/A N/A 636,00 EUR 225,26 EUR 861,26 EUR GISELLE VICTORIA C. OBISPO RAFAEL TORIJA, SN, 13005 HOSP. GENERAL DE TOMELLOSO ANGUEIRA LAPEÑA TOMELLOSO SPAIN C. VEREDA DE N/A N/A 40,00 EUR 40,00 EUR MARIA TERESA JESUS SOCUELLAMOS, SN, 13700 HOSP. UNIVERSITARIO CLINICO SAN CARLOS ANGUITA MANDLY MADRID SPAIN C. DEL PROFESOR N/A N/A 200,00 EUR 200,00 EUR EDUARDO MARTIN LAGOS, SN - BJ, 28040 HOSP. REGIONAL UNIVERSITARIO ANGULO MCGRATH MALAGA SPAIN MALAGA N/A N/A 50,00 EUR 371,90 EUR 421,90 EUR ISABELA AV.