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SIX SIGMA BLACK BELT Submitted by

FINAL PROJECT
Eduardo Lopez

This work is to fulfill the Final Project requirement for the Aveta Certified Six
Sigma Black Belt Program
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

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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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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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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.

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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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Factor Weight
Price 54%
Speed of Delivery 26%
Packaging Quality 13%
Customer Service 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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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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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 Mean StdDev


(D)ALBENDAZOL 400 MG X 100 COMPRIMIDOS 2.36 2.70
V-5 MULTIVITAMINAS X 140 UNID S. NARANJA 2.89 4.90
V-5 MULTIVITAMINAS X 140 UNID S.FRUTILLA 5.53 1.88
GLIBENCLAMIDA 5 MG X 100 COMPRIMIDOS 14.06 13.18
CREMA CURATIVA DR. SELBY 5 GR. 15.98 2.87
CREMA CURATIVA DR. SELBY X 20 GR. 17.90 5.19
KETOCONAZOL CREMA AL 2% X 30 GR 18.29 21.22
SALBUTAMOL INHALADOR 29.08 5.89
COMPLEJO B X 10 AMP 34.50 4.14
CIPROFLOXACINA 200 MG X 1 FCO AMP 39.16 39.24
METOCLOPRAMIDA 10 MG X 10 AMPOLLAS 40.31 4.56
CREMA CURATIVA DR. SELBY 40 GR. 46.53 1.70
(D)OMEPRAZOL 40 MG + SOLVENTE 66.19 14.90
METRONIDAZOL 500 MG INYECTABLE 84.63 18.71
UP.VITAMINA K 10 MG/1ML X 1 AMP 189.06 35.98
AGUA CON LIDOCAÍNA AL 1% X 5 ML X 1 Amp 250.00 31.54
METAMIZOL INY 1G 2ML X 1 AMP 360.40 33.23
VITAMINA C 1 GR. X 1 AMPOLLA 575.00 147.81
UP.DEXAMETASONA 4 MG X 1 AMP 606.67 55.22
AGUA DESTILADA 5 ML X 1 AMP 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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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.

Customer Scenario Probability Cost


Will Wait 55% 0%
Discount to Wait 10% 15%
Will Not Wait 35% 40%

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ANALYZE PHASE

Evaluating Causes of Stock-Outs


In order to better understand the causes of Stock-Outs we not only mapped the Sales and Re-
ordering 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 stock-
out.

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 stochastic

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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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STOCK-OUT COST CARRYING COST

DECREASES 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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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.

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Criteria Cost Customer Satif


Do Nothing Base base
Increase SS to 80% S +
Increase SS to 90% + +
Increase SS to 99% - +
Find Local Supplier S +
Find Reliable Carrier S 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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 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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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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Appendix I – WBS and Schedule

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Appendix II – AHP Matrix

ANALYTICAL HIERARCHY PROCESS MATRIX

Price Delivery Speed Packaging Qual. Cust. Service


Price 1,00 6,00 5,00 4,00
Speed of Delivery 0,17 1,00 6,00 4,00
Packaging Quality 0,20 0,17 1,00 4,00
Customer Service 0,25 0,25 0,25 1,00
Sum 1,62 7,42 12,25 13,00
Weight
Price 0,62 0,81 0,41 0,31 54%
Speed of Delivery 0,10 0,13 0,49 0,31 26%
Packaging Quality 0,12 0,02 0,08 0,31 13%
Customer Service 0,15 0,03 0,02 0,08 7%

Factor Weight
Price 54%
Speed of Delivery 26%
Packaging Quality 13%
Customer Service 7%

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Appendix III – Ishikawa Diagram

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Appendix IV – Reordering Process Flowchart

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Appendix V – Value Stream Map

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Appendix VI – Sales and Stock-out Flowchart

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SKU-Daily Demand Mean StdDev DxL E(D)^2 Var(L) E(L)^2 Var(D) Var(DL) Std. Dev (DL) Z(90%) Reorder Point Safety Stock
(D)ALBENDAZOL 400 MG X 100
2 3 12 6 4 25 7 207 14 1 30 18
COMPRIMIDOS
V-5 MULTIVITAMINAS X 140
3 5 14 8 4 25 24 638 25 2 72 58
UNID S. NARANJA
V-5 MULTIVITAMINAS X 140
6 2 28 31 4 25 4 225 15 3 77 49
Appendix VII – Safety Stock Calculation for Top 20 SKUs

UNID S.FRUTILLA
GLIBENCLAMIDA 5 MG X 100
14 13 70 198 4 25 174 5,225 72 4 380 309
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COMPRIMIDOS
CREMA CURATIVA DR. SELBY 5
16 3 80 255 4 25 8 1,342 37 5 273 193
GR.
CREMA CURATIVA DR. SELBY X
18 5 89 320 4 25 27 2,099 46 6 377 288
20 GR.
KETOCONAZOL CREMA AL 2% X
18 21 91 335 4 25 450 12,745 113 7 913 822
30 GR
SALBUTAMOL INHALADOR 29 6 145 846 4 25 35 4,632 68 8 709 564
COMPLEJO B X 10 AMP 35 4 173 1,190 4 25 17 5,728 76 9 875 702
CIPROFLOXACINA 200 MG X 1
39 39 196 1,534 4 25 1,540 45,325 213 10 2,385 2,189
FCO AMP
METOCLOPRAMIDA 10 MG X 10
40 5 202 1,625 4 25 21 7,755 88 11 1,195 994
AMPOLLAS
CREMA CURATIVA DR. SELBY 40
47 2 233 2,165 4 25 3 9,711 99 12 1,443 1,210
GR.
(D)OMEPRAZOL 40 MG +
66 15 331 4,381 4 25 222 25,052 158 13 2,433 2,102
SOLVENTE
METRONIDAZOL 500 MG
85 19 423 7,162 4 25 350 40,635 202 14 3,302 2,879
INYECTABLE
UP.VITAMINA K 10 MG/1ML X 1
189 36 945 35,745 4 25 1,295 191,509 438 15 7,633 6,687
AMP
AGUA CON LIDOCAÍNA AL 1% X
250 32 1,250 62,500 4 25 995 303,125 551 16 10,214 8,964
5 ML X 1 Amp
METAMIZOL INY 1G 2ML X 1
360 33 1,802 129,888 4 25 1,105 605,889 778 17 15,254 13,452
AMP
VITAMINA C 1 GR. X 1 AMPOLLA 575 148 2,875 330,625 4 25 21,847 2,018,156 1,421 18 28,846 25,971
UP.DEXAMETASONA 4 MG X 1
607 55 3,033 368,044 4 25 3,050 1,714,809 1,310 19 28,283 25,249
AMP

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AGUA DESTILADA 5 ML X 1 AMP 967 129 4,833 934,444 4 25 16,752 4,579,050 2,140 20 48,233 43,400
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