Invoice Chemist in Israel Tel Aviv –Free Word Template Download with AI
Rothschild Boulevard 245, Floor 3
Tel Aviv-Yafo, 6370300, Israel
Phone: +972-3-621-4488
Email: [email protected]
VAT Registration No. (Mehir): 51-704-882-19
Pharmacy License No. (Rokach): IL-2019-04472
Ministry of Health Permit: MOH-TLV-2019-0883
| Name: | Dr. Miriam Levi, M.D. – Internal Medicine Department |
| Institution: | Ichilov Medical Center (Sassoon Medical Center) |
| Address: | Weizmann Street 37, Tel Aviv-Yafo, 6423600, Israel |
| Tax ID (Mehir): | 51-502-331-07 |
| Contact: | Procurement Office – Tel: +972-3-697-4000 |
This invoice is issued by Tel Aviv Chemist & Pharmacy, a licensed chemist and dispensing pharmacy operating under the jurisdiction of the Israeli Ministry of Health, located in the city of Tel Aviv-Yafo, Israel. The following line items represent pharmaceutical products, medical supplies, and professional chemist services rendered to the above-named client in accordance with Israeli pharmaceutical regulations (Regulations on the Sale of Medicines, 5747-1987) and the Pharmacy Law (Rokach Law, 5712-1952).
| # | Description of Item / Service | Category | Quantity | Unit Price (NIS ₪) | Line Total (NIS ₪) | VAT Rate |
|---|---|---|---|---|---|---|
| 1 | Amoxicillin 500mg Capsules – 21-day course (Prescription Ref: Rx-2025-88412) | Prescription Medication | 3 boxes | ₪ 42.50 | ₪ 127.50 | 18% |
| 2 | Insulin Glargine 100 IU/mL – 10mL Vial (Prescription Ref: Rx-2025-88415) | Prescription Medication | 5 vials | ₪ 185.00 | ₪ 925.00 | 18% |
| 3 | Chemist Consultation & Medication Review Service (30 min) | Professional Service | 1 session | ₪ 150.00 | ₪ 150.00 | 18% |
| 4 | Sterile Gauze Pads 10x10cm – Box of 100 (Medical Supply) | Medical Supply | 4 boxes | ₪ 28.75 | ₪ 115.00 | 18% |
| 5 | Electrolyte IV Solution 0.9% NaCl – 500mL Bag (Hospital Grade) | Medical Supply | 20 bags | ₪ 12.30 | ₪ 246.00 | 18% |
| 6 | Custom Compounding – Topical Corticosteroid Cream 0.1% (50g tube) | Chemist Compounding | 2 tubes | ₪ 95.00 | ₪ 190.00 | 18% |
| 7 | Refrigerated Storage & Cold Chain Transport (Tel Aviv Metro Area) | Logistics Service | 1 delivery | ₪ 75.00 | ₪ 75.00 | 18% |
| 8 | Pharmaceutical Waste Disposal Certificate & Documentation | Regulatory Service | 1 certificate | ₪ 45.00 | ₪ 45.00 | 18% |
| Subtotal (Excluding VAT / Mehir) | ₪ 1,873.50 |
| VAT – Mehir (18% – Standard Israeli Rate) | ₪ 337.23 |
| Grand Total (Including VAT / Mehir) | ₪ 2,210.73 |
| Amount in Words: | Two Thousand Two Hundred and Ten Israeli New Shekels and Seventy-Three Agorot |
Bank: Bank Hapoalim (Israel's National Bank)
Branch: Tel Aviv – Rothschild Branch, Branch No. 010
Account Name: Tel Aviv Chemist & Pharmacy Ltd.
Account No. (Chesav): 010-004-882-193
IBAN: IL15 0100 0000 0048 8219 3
SWIFT / BIC: POBALIL2
Reference: TLV-CHEM-2025-00487
Payment Due: Within 14 calendar days from the date of issue (by 28 June 2025). Late payments are subject to a penalty of 1.5% per month in accordance with the Israeli Late Payment Law (Hokhachat Toldot, 5761-2001).
Terms & Conditions- This invoice is issued in compliance with the Israeli Value Added Tax Law (Hokhachat Mehir, 5736-1975) and all applicable regulations of the Israel Tax Authority (Mishebet HaMehir) in Tel Aviv.
- All prescription medications listed herein were dispensed by a licensed Israeli chemist (Rokach) in full compliance with the Pharmacy Law and the Regulations on the Sale of Medicines. Original prescriptions have been retained at the Tel Aviv Chemist pharmacy premises as required by law.
- The chemist compounding services (Item 6) were performed in the in-house compounding laboratory of Tel Aviv Chemist & Pharmacy, which holds a valid compounding permit issued by the Israeli Ministry of Health (Permit No. MOH-COMP-TLV-2020-0341).
- Cold chain integrity for refrigerated pharmaceutical products (Items 2 and 5) is guaranteed from the point of dispensing at our Tel Aviv facility through to delivery at the recipient's address in Tel Aviv-Yafo. Temperature logs are available upon request.
- Any disputes regarding this invoice must be submitted in writing to the billing department of Tel Aviv Chemist & Pharmacy within 30 days of the invoice date. All legal matters are subject to the jurisdiction of the Tel Aviv District Court, Israel.
- This invoice constitutes a valid tax document (Sichon Mehir) for the purposes of VAT deduction under Israeli tax law. The customer is entitled to claim the 18% VAT (Mehir) portion as a deductible input tax, subject to the provisions of the VAT Law.
- Pharmaceutical products, once dispensed by the chemist, are non-returnable except in cases of manufacturing defect or dispensing error, in which case the product must be returned to the Tel Aviv Chemist pharmacy within 72 hours in its original sealed packaging.
- This invoice is valid for a period of 12 months from the date of issue. After this period, a replacement invoice may be requested in writing.
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Prepared By: Yael Ben-David, Pharm.D. Licensed Chemist (Rokach) – License No. IL-RK-2014-0091 Tel Aviv Chemist & Pharmacy Signature: _________________________ Date: 14 June 2025 |
Approved By: David Katz, M.B.A. Managing Director, Tel Aviv Chemist & Pharmacy Ltd. Company Registration No. 51-704-882-19 Signature: _________________________ Date: 14 June 2025 |
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