Invoice Pharmacist in United States Miami –Free Word Template Download with AI
Lead Pharmacist: Dr. Elena Rodriguez, RPh
1200 Brickell Avenue, Suite 400
Miami, Florida 33131
United States
Phone: (305) 555-0199
Email: [email protected]
FL Board of Pharmacy License: #PH-998877
Invoice Number: INV-2023-10-045
Date Issued: October 24, 2023
Due Date: November 24, 2023
Payment Terms: Net 30
Bill To
Apex Medical Group, LLC
Attn: Accounts Payable Department
800 SW 8th Street
Miami, Florida 33130
United States
Tax ID: 59-1234567
Service Location
Apex Medical Group - Main Clinic
800 SW 8th Street, Floor 2
Miami, Florida 33130
United States
| # | Description of Pharmacist Services | Hours / Qty | Rate / Price | Amount (USD) |
|---|---|---|---|---|
| 1 |
Comprehensive Medication Therapy Management (MTM) Conducted by licensed Pharmacist in Miami. Includes review of patient medication profiles, identification of drug interactions, and optimization of therapeutic regimens for chronic conditions. |
12.0 | $150.00 | $1,800.00 |
| 2 |
Immunization Administration Services Administration of flu vaccines and travel vaccinations compliant with Florida Board of Pharmacy regulations. Includes patient counseling and documentation. |
45 | $25.00 | $1,125.00 |
| 3 |
Specialty Pharmacy Consultation Expert consultation regarding high-cost specialty medications for oncology patients. Coordination with insurance providers within the United States healthcare network. |
5.0 | $200.00 | $1,000.00 |
| 4 |
Inventory Management & Compliance Audit Audit of controlled substances and general inventory to ensure compliance with DEA and Florida state laws. Includes waste disposal documentation. |
1 | $750.00 | $750.00 |
| 5 |
Patient Education Workshop On-site workshop at Miami clinic regarding diabetes management and insulin administration techniques led by a certified Pharmacist. |
3.0 | $175.00 | $525.00 |
Payment Instructions
Please make checks payable to Miami Coastal Pharmacy Services.
Bank Transfer Details:
Bank Name: First National Bank of Miami
Account Name: Miami Coastal Pharmacy Services
Routing Number: 067014822
Account Number: 9876543210
Important: Please include the Invoice Number (INV-2023-10-045) in the memo line of your payment.
Terms and Conditions
1. Payment Terms: Payment is due within 30 days of the invoice date. Late payments may be subject to a 1.5% monthly interest charge.
2. Services Rendered: All services listed above were performed by a licensed Pharmacist in accordance with the laws of the State of Florida and the United States.
3. Disputes: Any discrepancies regarding this invoice must be reported within 10 business days of receipt. Please contact our billing department in Miami immediately.
4. Confidentiality: All patient data handled during these services remains confidential under HIPAA regulations.
5. Governing Law: This invoice and the services described are governed by the laws of the State of Florida.
Authorized Signature (Provider)
Dr. Elena Rodriguez, RPh
Lead Pharmacist
Received By (Client)
__________________________
Date: _______________
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