Purchase Order Pharmacist in Belgium Brussels –Free Word Template Download with AI
Pharmacie du Centre – Brussels
124 Rue de la Loi, 1040 Brussels, Belgium
VAT No: BE 0765.432.109 | RIB: BE68 5390 0754 7034
Contact: Dr. Marie Van den Berg, Licensed Pharmacist | Tel: +32 2 555 0142 | Email: [email protected]
| Company Name: | PharmaSupply Benelux NV |
| Address: | Industrielaan 45, 1110 Brussels, Belgium |
| VAT No: | BE 0812.567.234 |
| Contact Person: | Mr. Jan Peeters, Sales Director |
| Phone / Email: | +32 2 777 3388 / [email protected] |
This Purchase Order is issued by the undersigned Pharmacist operating in Belgium Brussels for the procurement of pharmaceutical products, medical supplies, and dispensing equipment required for the daily operation of the community pharmacy in accordance with the regulations set forth by the Belgian Federal Agency for Medicines and Health Products (FAMHP / AFMPS).
| Item No. | Description | Quantity | Unit Price (€) | Subtotal (€) |
|---|---|---|---|---|
| 01 | Amoxicillin 500 mg capsules, 21-count blister packs (ATC: J01CA04) | 200 | 4.85 | 970.00 |
| 02 | Ibuprofen 400 mg tablets, 20-count blister packs (ATC: M01AE01) | 350 | 2.10 | 735.00 |
| 03 | Omeprazole 20 mg gastro-resistant capsules, 28-count (ATC: A02BC01) | 150 | 6.40 | 960.00 |
| 04 | Insulin Glargine 100 IU/mL prefilled pens, 5-pack (ATC: A10AE04) | 80 | 42.50 | 3,400.00 |
| 05 | Pharmacist-grade digital dispensing scale, 0.01 g precision, CE marked | 2 | 385.00 | 770.00 |
| 06 | Pharmaceutical-grade nitrile gloves, size M, box of 100 | 50 | 8.90 | 445.00 |
| 07 | Refrigerated storage unit, 200 L, temperature range 2–8 °C, for Belgium Brussels pharmacy compliance | 1 | 2,850.00 | 2,850.00 |
| 08 | Pharmacist training manual – Belgian Pharmacovigilance & Reporting (2025 edition, French/Dutch/English) | 5 | 35.00 | 175.00 |
| TOTAL (excl. VAT 21%): | 10,305.00 | |||
| VAT (21% – Belgian standard rate): | 2,164.05 | |||
| GRAND TOTAL (incl. VAT): | 12,469.05 | |||
All goods listed in this Purchase Order shall be delivered to the pharmacy premises located at 124 Rue de la Loi, 1040 Brussels, Belgium Brussels. The Pharmacist or an authorized representative of the pharmacy shall be present at the time of delivery to inspect the goods, verify quantities, and confirm that all pharmaceutical products are within their stated expiry dates (minimum 18 months remaining). Cold-chain items (Item 04) must be transported in validated temperature-controlled packaging and delivered between 08:00 and 12:00 CET to ensure uninterrupted refrigeration. The supplier bears full responsibility for any damage, loss, or temperature excursion occurring during transit within the Belgium Brussels metropolitan area.
- Regulatory Compliance: All pharmaceutical products supplied under this Purchase Order must hold a valid Marketing Authorization (MA) issued by the Belgian Federal Agency for Medicines and Health Products (FAMHP) or an equivalent EU Member State authorization recognized under mutual recognition procedures. The Pharmacist reserves the right to reject any product that does not meet the regulatory standards applicable in Belgium Brussels.
- Quality Assurance: The supplier warrants that all goods conform to the Good Distribution Practice (GDP) guidelines as defined by the European Commission and the Belgian Royal Decree of 22 December 2006. Certificates of Analysis (CoA) must accompany each batch of pharmaceutical product.
- Payment: Payment of the full amount of this Purchase Order shall be made via bank transfer to the supplier's designated account within thirty (30) calendar days from the date of the validated invoice, in accordance with the commercial practices standard in Belgium Brussels.
- Warranty and Returns: Any pharmaceutical product found to be damaged, expired, or non-conforming upon receipt may be returned within fourteen (14) days. The Pharmacist shall notify the supplier in writing, and the supplier shall issue a credit note or replacement at no additional cost.
- Pharmacovigilance: The Pharmacist in Belgium Brussels is the designated point of contact for any adverse drug reaction (ADR) reporting related to the supplied products. The supplier shall provide full batch traceability information upon request.
- Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the Kingdom of Belgium. Any disputes arising from this Purchase Order shall be submitted to the competent courts of Brussels, Belgium Brussels.
- Confidentiality: All pricing, patient-related data, and operational details exchanged in connection with this Purchase Order shall be treated as confidential by both parties in compliance with the Belgian Data Protection Act and the EU General Data Protection Regulation (GDPR).
This Purchase Order is hereby authorized and approved by the undersigned Pharmacist, acting in the capacity of the legal operator of the pharmacy in Belgium Brussels, and is accepted by the supplier as a binding commercial commitment.
For the Pharmacist (Buyer):
Dr. Marie Van den Berg
Licensed Pharmacist – Belgium Brussels
Signature: ___________________________
Date: 14 June 2025
For the Supplier (Vendor):
Mr. Jan Peeters
Sales Director, PharmaSupply Benelux NV
Signature: ___________________________
Date: ___________________________
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