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Purchase Order Ophthalmologist in United States New York City –Free Word Template Download with AI

Formal Procurement Document for Ophthalmologist Professional Services

Jurisdiction: United States New York City, New York 10001

PO No.: NYC-OPH-2025-004872
Purchase Order Number: NYC-OPH-2025-004872 Date of Issue: June 12, 2025
Required Delivery/Service Date: July 1, 2025 Payment Terms: Net 30 Days
Currency: United States Dollar (USD) Incoterms: N/A (Professional Services)

Purchasing Entity

Organization: Manhattan Comprehensive Medical Center

Department: Ophthalmology Division

Address: 450 Park Avenue South, Suite 1200, United States New York City, NY 10016

Phone: (212) 555-0147

Email: [email protected]

Tax ID (EIN): 12-3456789

Authorized Purchasing Agent

Name: Dr. Margaret L. Whitfield, MD, MBA

Title: Director of Procurement & Vendor Relations

License No.: NY-PROC-2024-8821

Phone: (212) 555-0193

Email: [email protected]

Ophthalmologist Provider

Name: Dr. James R. Callahan, MD, FACS

Specialty: Comprehensive Ophthalmologist – Retina, Glaucoma, and Cataract Surgery

Practice: Callahan Vision & Ophthalmology Associates, PLLC

Address: 285 Madison Avenue, 7th Floor, United States New York City, NY 10017

Phone: (212) 555-0382

Email: [email protected]

Licensing & Credentials

NY Medical License: 28A-4471920

Board Certification: American Board of Ophthalmology

Fellowship: American College of Surgeons (FACS)

DEA Registration: FW4829103

NYC Health Dept. Permit: HCD-OPH-2025-00341

Item # Description of Ophthalmologist Service / Supply Qty Unit Unit Price (USD) Extended Price (USD)
001 Comprehensive Ophthalmologist Consultation – Diagnostic Eye Examination (per patient session, including visual acuity testing, tonometry, and dilated fundus examination) 120 Sessions $285.00 $34,200.00
002 Ophthalmologist Surgical Procedure – Phacoemulsification Cataract Extraction with Intraocular Lens Implantation (per procedure) 45 Procedures $4,850.00 $218,250.00
003 Ophthalmologist Surgical Procedure – Laser-Assisted Glaucoma Treatment (SLT) (per procedure) 30 Procedures $1,200.00 $36,000.00
004 Retinal Imaging and OCT (Optical Coherence Tomography) – Ophthalmologist Supervised Diagnostic Imaging (per scan set) 200 Scan Sets $175.00 $35,000.00
005 Post-Operative Ophthalmologist Follow-Up Visits – Cataract and Glaucoma Recovery Monitoring (per visit) 180 Visits $150.00 $27,000.00
006 Specialized Ophthalmologist Equipment – Portable Phacoemulsification Machine (Model: Alcon Centurion LX) – One-time procurement 1 Unit $185,000.00 $185,000.00
007 Ophthalmologist Consumable Supplies – Intraocular Lenses (IOLs), Phaco Tips, and Surgical Kits (monthly supply contract, 6-month term) 6 Months $12,500.00 $75,000.00
TOTAL PURCHASE ORDER AMOUNT (USD): $610,450.00
  1. This Purchase Order is issued by Manhattan Comprehensive Medical Center, a licensed healthcare facility operating within the United States New York City, and constitutes a binding agreement upon acceptance by the named Ophthalmologist service provider.
  2. All Ophthalmologist services rendered under this Purchase Order shall comply with the New York State Education Law, the New York City Health Code, and all applicable federal regulations including HIPAA (Health Insurance Portability and Accountability Act) and CMS guidelines.
  3. The Ophthalmologist, Dr. James R. Callahan, MD, FACS, warrants that all services and procedures listed in Section 4 shall be performed in accordance with the standard of care established by the American Academy of Ophthalmology and the American College of Surgeons.
  4. Payment for this Purchase Order shall be made via electronic funds transfer (EFT) to the account designated by the Ophthalmologist within thirty (30) calendar days of receipt of a valid invoice referencing Purchase Order No. NYC-OPH-2025-004872.
  5. The Ophthalmologist shall maintain full malpractice liability insurance with a minimum coverage of $5,000,000 per occurrence and $10,000,000 aggregate, naming Manhattan Comprehensive Medical Center as an additional insured party. Proof of insurance shall be provided prior to the commencement of services.
  6. All patient records, imaging data, and clinical documentation generated in connection with this Purchase Order shall be stored in compliance with New York State Public Health Law Article 27-F and the New York City Department of Health and Mental Hygiene data retention requirements.
  7. Any modification, amendment, or cancellation of this Purchase Order must be made in writing and signed by both the authorized purchasing agent of the Buyer and the Ophthalmologist or their designated representative.
  8. This Purchase Order is governed by the laws of the State of New York, and any disputes arising hereunder shall be subject to the exclusive jurisdiction of the state and federal courts located in the United States New York City, specifically the New York County (Manhattan) Supreme Court.
  9. The Ophthalmologist shall not subcontract any portion of the services outlined in this Purchase Order without prior written consent from the Buyer's Director of Procurement.
  10. Failure to meet the required service delivery dates specified in this Purchase Order may result in a penalty of 1.5% of the affected line item value per day of delay, up to a maximum of 15% of the total Purchase Order value.

By signing below, both parties acknowledge and agree to all terms, conditions, and line items specified in this Purchase Order for Ophthalmologist professional services to be delivered within the United States New York City.

For the Buyer:

Manhattan Comprehensive Medical Center

Dr. Margaret L. Whitfield, MD, MBA

Director of Procurement & Vendor Relations

Date: ______________________

For the Ophthalmologist / Seller:

Callahan Vision & Ophthalmology Associates, PLLC

Dr. James R. Callahan, MD, FACS

Principal Ophthalmologist

Date: ______________________

Purchase Order No. NYC-OPH-2025-004872 | Issued in the United States New York City, New York | Page 1 of 1

This document is the property of Manhattan Comprehensive Medical Center. Unauthorized reproduction or distribution is prohibited under New York State law.

For questions regarding this Purchase Order, contact the Procurement Office at (212) 555-0147 or [email protected].

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