Purchase Order Doctor General Practitioner in United States New York City –Free Word Template Download with AI

Purchase Order No.: PO-NYC-GP-2025-04872
Date of Issue: June 12, 2025
Valid Until: July 12, 2025 Payment Terms: Net 30 Days
Delivery Method: Freight Collect
Incoterms: DDP (Delivered Duty Paid) Buyer Information Dr. Margaret E. Sullivan, M.D., F.A.C.P.
Doctor General Practitioner — Primary Care & Internal Medicine
Sullivan General Practice Clinic
1420 Lexington Avenue, Suite 840
New York, NY 10028
United States New York City
Telephone: (212) 555-0147
Email: [email protected]
NPI Number: 1497823651
New York State Medical License: 41A-2876543 Supplier Information MedSupply Provisions, Inc.
2200 Commerce Drive, Building C
Paramus, NJ 07652
United States
Telephone: (201) 555-0392
Email: [email protected]
Tax ID (EIN): 52-8847291
New York State Sales Tax Certificate: ST-4472910 Line Items — Medical Supplies for Doctor General Practitioner Practice

Item #	Description	SKU / Catalog Ref.	Qty	Unit Price (USD)	Extended Price (USD)
001	Disposable Nitrile Examination Gloves, Medium, Box of 100 (FDA-cleared for Doctor General Practitioner clinical use)	MSP-GLV-NIT-M-100	200	$12.50	$2,500.00
002	Automated Blood Pressure Monitor, Upper Arm, Digital Display (HIPAA-compliant data logging for United States New York City clinic records)	MSP-BPM-ARM-7200	4	$389.99	$1,559.96
003	Stethoscope, Dual Head, Stainless Steel, Pediatric and Adult Diaphragm (Standard issue for Doctor General Practitioner consultations)	MSP-STH-DUAL-340	6	$124.50	$747.00
004	Portable Pulse Oximeter, Fingertip, Rechargeable (For patient monitoring in United States New York City outpatient settings)	MSP-POX-FTR-210	10	$45.75	$457.50
005	Sterile Gauze Pads, 4x4 inches, Box of 100 (Wound care supplies for Doctor General Practitioner minor procedures)	MSP-GZE-4X4-100	150	$8.25	$1,237.50
006	Electronic Thermometer, Infrared Forehead, Clinical Grade (For triage and patient intake at United States New York City practice)	MSP-THM-IRF-550	5	$67.00	$335.00
007	Exam Table Paper Rolls, 24-inch width, 500 sheets per roll (Patient comfort and infection control for Doctor General Practitioner examinations)	MSP-EXM-PRR-24-500	40	$14.80	$592.00
008	Medical Waste Disposal Bags, 55-gallon, Red, Biohazard Labeled (Compliant with New York State DOH and United States New York City sanitation regulations)	MSP-WST-55G-RD	60	$6.95	$417.00
009	Prescription Pad, Triplicate, 100 pads per book (For Doctor General Practitioner medication prescribing in United States New York City)	MSP-RX-TRP-100	30	$11.25	$337.50
010	Hand Sanitizer, 60% Alcohol, 1-gallon Jug, Hospital Grade (Infection prevention for Doctor General Practitioner clinic in United States New York City)	MSP-HSG-60-1G	24	$22.00	$528.00
Subtotal:					$9,711.46
New York State Sales Tax (8.875%):					$861.88
Freight & Delivery (United States New York City Metro):					$185.00
TOTAL AMOUNT DUE (USD):					$10,758.34

Terms and Conditions

This Purchase Order is issued by Dr. Margaret E. Sullivan, M.D., a licensed Doctor General Practitioner operating a primary care clinic in United States New York City, and constitutes a binding offer to purchase the goods and services described herein upon acceptance by the Supplier.
All medical supplies and equipment listed in this Purchase Order must comply with the Food and Drug Administration (FDA) regulations, the New York State Department of Health (NYSDOH) standards, and all applicable United States New York City municipal health codes governing the operation of a Doctor General Practitioner practice.
Delivery of all items shall be made to the clinic address listed above in United States New York City no later than thirty (30) calendar days from the date of this Purchase Order. Late deliveries exceeding five (5) business days shall entitle the Doctor General Practitioner buyer to a 2% discount per week of delay, up to a maximum of 10%.
Payment shall be remitted via ACH transfer to the Supplier's designated bank account within thirty (30) days of receipt of a valid invoice and confirmed delivery of all line items. The Doctor General Practitioner practice reserves the right to withhold payment for any items found to be defective, expired, or non-compliant with the specifications stated in this Purchase Order.
The Supplier warrants that all pharmaceutical-adjacent supplies, diagnostic instruments, and patient-contact materials are new, unopened, within their full shelf life, and manufactured in accordance with Good Manufacturing Practices (GMP) as required for use in a United States New York City medical facility.
This Purchase Order is subject to the New York State Uniform Commercial Code (UCC) as adopted in New York State. Any disputes arising from this Purchase Order shall be governed by the laws of the State of New York, and jurisdiction shall lie exclusively in the courts of New York County, United States New York City.
The Supplier acknowledges that the goods procured under this Purchase Order are intended for use by a Doctor General Practitioner in the direct care of patients in United States New York City. The Supplier assumes full liability for any product defects that result in patient harm or regulatory non-compliance at the Doctor General Practitioner clinic.
All packaging must be clearly labeled with the Purchase Order number (PO-NYC-GP-2025-04872) and the receiving clinic name. Deliveries to the United States New York City address must be scheduled between 8:00 AM and 4:00 PM, Monday through Friday, to minimize disruption to the Doctor General Practitioner's patient appointments.
This Purchase Order may not be assigned or transferred without the prior written consent of the Doctor General Practitioner buyer. Any modifications to this Purchase Order must be made in writing and signed by both parties.
The Supplier shall maintain adequate product liability insurance (minimum $2,000,000 per occurrence) and shall provide a certificate of insurance upon request. This requirement is mandatory for all vendors supplying medical goods to practices in United States New York City.

Authorized Signatures

For the Buyer (Doctor General Practitioner):

Dr. Margaret E. Sullivan, M.D., F.A.C.P.
Doctor General Practitioner
Sullivan General Practice Clinic
United States New York City
Date: ______________________

For the Supplier (MedSupply Provisions, Inc.):

Authorized Representative
MedSupply Provisions, Inc.
Title: ______________________
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX

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