Invoice Chemist in Israel Jerusalem –Free Word Template Download with AI
12 King David Street, Old City District
Jerusalem 9710000, Israel
Tel: +972-2-625-4830 | Fax: +972-2-625-4831
Email: [email protected]
VAT Registration: 51-234-567-8
Ministry of Health License No. PH-2019-0847
Billed To
Client Name: Dr. Miriam Levi
Organization: Hadassah Medical Center
Department: Internal Medicine, Mount Scopus Campus
Address: 12 King David Street, Jerusalem 91401, Israel
Phone: +972-2-677-7111
Email: [email protected]
Invoice Reference
PO Number: HMC-2025-3391
Service Period: 01 June 2025 – 14 June 2025
Chemist Account No.: JC-ACC-7721
Prescribing Physician: Dr. Yosef Ben-David
Insurance Ref.: Clalit-8842-2025
Country of Service: Israel, Jerusalem
| # | Description of Pharmaceutical Item / Service | Product Code | Quantity | Unit Price (ILS) | Amount (ILS) |
|---|---|---|---|---|---|
| 1 | Amoxicillin 500mg Capsules – 28-day supply, prescribed for respiratory infection treatment. Dispensed by licensed chemist at Jerusalem Chemist & Pharmacy. | AMX-500-28 | 2 boxes | 42.50 | 85.00 |
| 2 | Metformin Hydrochloride 850mg Tablets – 90-day supply for Type 2 Diabetes management. Compounded and verified by the chemist team in Jerusalem. | MTF-850-90 | 1 box | 68.00 | 68.00 |
| 3 | Atorvastatin 20mg Tablets – 30-day supply for cardiovascular risk reduction. Quality-controlled by the Jerusalem chemist laboratory. | ATV-20-30 | 1 box | 35.75 | 35.75 |
| 4 | Custom-compounded topical corticosteroid cream (Hydrocortisone 1%) – 30g tube, prepared in-house by the chemist at Jerusalem Chemist & Pharmacy for dermatological treatment. | CMP-HC-30G | 1 tube | 54.00 | 54.00 |
| 5 | Pharmaceutical consultation and medication review service provided by the senior chemist at our Jerusalem, Israel location. Includes drug interaction screening and dosage optimization. | SVC-CONS-01 | 1 session | 120.00 | 120.00 |
| 6 | Insulin Glargine 100 IU/mL Pen – 3-pen supply for long-acting glycemic control. Stored and dispensed under strict cold-chain protocol by the Jerusalem chemist facility. | INS-GLA-100 | 3 pens | 185.00 | 555.00 |
| 7 | Emergency medication delivery service within Jerusalem city limits. The chemist courier team delivered the above prescriptions to Hadassah Medical Center within 45 minutes of order confirmation. | SVC-DEL-JER | 1 delivery | 35.00 | 35.00 |
| 8 | Pharmaceutical waste disposal and compliance documentation service. The chemist at Jerusalem Chemist & Pharmacy handled the safe disposal of expired medication vials in accordance with Israeli Ministry of Health regulations. | SVC-WASTE-01 | 1 service | 45.00 | 45.00 |
| Subtotal | 1,002.75 ILS |
| Insurance Co-Payment (Clalit Ref. 8842) | -210.00 ILS |
| Net Subtotal | 792.75 ILS |
| VAT (18% – Israel Standard Rate) | 142.70 ILS |
| Grand Total Due | 935.45 ILS |
Payment Instructions – Jerusalem Chemist & Pharmacy, Israel
Bank: Bank Hapoalim, Jerusalem Branch
Account Name: Jerusalem Chemist & Pharmacy Ltd.
Account Number: 002-123456-7
IBAN: IL16 0121 2200 0000 1234 567
SWIFT/BIC: POBALILM
Reference: Please include Invoice No. JC-2025-04872 in all payment references.
Accepted Methods: Bank transfer, credit card (Visa, Mastercard, Amex), or Clalit insurance direct billing.
Important Notes & Terms of Service
- This invoice is issued by Jerusalem Chemist & Pharmacy, a licensed pharmaceutical establishment operating in Jerusalem, Israel, under the authority of the Israeli Ministry of Health.
- All pharmaceutical products listed above were dispensed, compounded, or verified by a registered chemist (pharmacist) holding a valid Israeli pharmacy license. The chemist responsible for this invoice is Pharm. David Cohen, License No. PH-IL-2014-3391.
- Payment is due within fourteen (14) calendar days from the invoice date. Late payments will incur a monthly interest charge of 1.5% in accordance with Israeli commercial law.
- Prescription medications dispensed by this chemist in Jerusalem are subject to Israeli pharmaceutical regulations. No substitution of active ingredients is permitted without written authorization from the prescribing physician.
- For insurance claims, please submit this invoice along with the original prescription copy to your Clalit, Maccabi, or Meuhedet insurance provider within 30 days of the service date.
- Jerusalem Chemist & Pharmacy maintains full compliance with the Israeli Pharmacopoeia and all applicable regulations of the Ministry of Health, State of Israel. All products are sourced from approved Israeli and international manufacturers.
- Any disputes regarding this invoice should be directed to the billing department of Jerusalem Chemist & Pharmacy, 12 King David Street, Jerusalem, Israel, within thirty (30) days of the invoice date. All legal matters are subject to the jurisdiction of the Jerusalem District Court, Israel.
- This invoice constitutes a valid tax document for the State of Israel. The VAT number 51-234-567-8 is registered with the Israel Tax Authority (Mishebet HaMas). A duplicate invoice may be requested by contacting the chemist office directly.
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