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Purchase Order Pharmacist in United States San Francisco –Free Word Template Download with AI

Bay Area Pharmacy Supply Co., Inc.

1425 Market Street, Suite 800, San Francisco, California 94102, United States

Phone: (415) 555-0172 | Fax: (415) 555-0173 | Email: [email protected]

PO Number: BAPS-2025-04871

Authorized by Licensed Pharmacist

Buyer Information

Company: Bay Area Pharmacy Supply Co., Inc.

Address: 1425 Market Street, Suite 800

City/State/ZIP: San Francisco, CA 94102

Country: United States

Authorized Pharmacist: Dr. Elena M. Vasquez, PharmD, RPh

License No.: CA-Pharm-2019-44821

Board of Pharmacy: California Board of Pharmacy

Phone: (415) 555-0172

Supplier Information

Company: Pacific Pharmaceutical Distribution LLC

Address: 2890 Industrial Parkway, Building C

City/State/ZIP: Oakland, CA 94601

Country: United States

Contact: Mr. David Chen, Sales Director

Phone: (510) 555-0348

Email: [email protected]

Tax ID (EIN): 94-2847103

Order Details

Order Date: June 12, 2025

Required Delivery Date: June 26, 2025

Delivery Location: 1425 Market Street, Loading Dock B, San Francisco, CA 94102

Payment Terms: Net 30 Days

Shipping Method: Ground Freight (Temperature-Controlled)

Incoterms: DDP – San Francisco, United States

Pharmacist Certification

Verified By: Dr. Elena M. Vasquez, PharmD, RPh

Role: Director of Pharmacy Operations

DEA Registration: FS-2021-884301

Scope of Authority: All pharmaceutical and medical supply purchases up to $250,000 per order

Compliance: California Business & Professions Code, Section 4000 et seq.

Item # Description SKU / NDC Qty Unit Unit Price (USD) Line Total (USD)
001 Amoxicillin 500mg Capsules (Bulb Pack, 100 ct) NDC 00071-0555-01 200 Box $42.50 $8,500.00
002 Insulin Glargine 100 units/mL Vial (10 mL) NDC 00002-0980-01 150 Vial $187.00 $28,050.00
003 Sodium Chloride 0.9% IV Solution (1000 mL Bag) NDC 0409-1440-10 500 Bag $6.75 $3,375.00
004 Pharmaceutical Grade Ethanol 95% (Gallon Jug) SKU PGE-95-001 40 Gallon $34.00 $1,360.00
005 Pharmacist Compounding Gloves, Nitrile, Size M (Box of 100) SKU NG-NTL-M-100 300 Box $12.80 $3,840.00
006 Pharmaceutical Balance Scale, 0.001g Precision (Lab Grade) SKU PB-0001-LAB 4 Unit $1,245.00 $4,980.00
007 Refrigerated Storage Unit, 2-8°C, 400L (Pharmacist-Grade) SKU RF-400-28 2 Unit $3,890.00 $7,780.00
008 Pharmacist Labeling Machine, Thermal Transfer (A4) SKU PLM-AT4-2025 3 Unit $2,150.00 $6,450.00
009 Controlled Substance Log Books (Federal DEA Compliant) SKU CSL-DEA-2025 50 Book $18.50 $925.00
010 Pharmacist White Lab Coats, Size L (Cotton Blend) SKU WC-L-CTN 25 Coat $45.00 $1,125.00
Subtotal $66,385.00
California Sales Tax (8.5%) $5,642.73
Temperature-Controlled Freight Surcharge $1,250.00
San Francisco Port Handling Fee $320.00
Grand Total (USD) $73,597.73

Terms and Conditions

  1. This Purchase Order is issued by Bay Area Pharmacy Supply Co., Inc., a licensed pharmacy operating in San Francisco, California, United States, and is subject to all applicable federal, state, and local regulations governing the distribution and sale of pharmaceutical products.
  2. All pharmaceutical items listed herein must be shipped in compliance with the United States Pharmacopeia (USP) standards and the California Board of Pharmacy regulations. The authorized Pharmacist, Dr. Elena M. Vasquez, PharmD, RPh, shall inspect all incoming shipments upon delivery at the San Francisco facility.
  3. Controlled substances, if any are included in future amendments to this Purchase Order, must be shipped in accordance with 21 CFR Part 1301 and the DEA regulations in effect in the State of California. The Pharmacist of record shall verify chain-of-custody documentation prior to acceptance.
  4. Payment shall be made within thirty (30) calendar days of the date of invoice, via ACH transfer to the supplier's designated account. Late payments shall accrue interest at a rate of 1.5% per month, consistent with California Commercial Code Section 2310.
  5. The supplier warrants that all pharmaceutical products are manufactured in facilities registered with the United States Food and Drug Administration (FDA) and comply with current Good Manufacturing Practices (cGMP) as defined in 21 CFR Parts 210 and 211.
  6. Delivery shall be made to the specified address in San Francisco, California, United States. Risk of loss transfers to the buyer upon delivery and acceptance by the authorized Pharmacist at the receiving dock. Any temperature excursions during transit must be documented on the shipping manifest and reported to the Pharmacist within four (4) hours of delivery.
  7. This Purchase Order is governed by the laws of the State of California and the federal laws of the United States. Any disputes arising from this order shall be resolved through binding arbitration in San Francisco, California, in accordance with the rules of the American Arbitration Association.
  8. The supplier agrees to maintain adequate product liability insurance with a minimum coverage of $5,000,000 per occurrence for all pharmaceutical products delivered under this Purchase Order.
  9. This Purchase Order becomes effective upon signature by the authorized Pharmacist and the supplier's designated representative. No modifications shall be valid unless made in writing and signed by both parties.

Authorized Pharmacist / Buyer

Dr. Elena M. Vasquez, PharmD, RPh
Director of Pharmacy Operations
Bay Area Pharmacy Supply Co., Inc.
San Francisco, CA 94102, United States
Date: _______________

Supplier Representative

Mr. David Chen
Sales Director
Pacific Pharmaceutical Distribution LLC
Oakland, CA 94601, United States
Date: _______________

Bay Area Pharmacy Supply Co., Inc. | 1425 Market Street, Suite 800, San Francisco, California 94102, United States

CA Pharmacy License No. 0004821 | DEA Corporate Registration No. FS-2021-884301 | EIN: 94-7721056

This Purchase Order document is confidential and intended solely for the named parties. Unauthorized reproduction or distribution is prohibited under California law.

Document generated: June 12, 2025 | Version 1.0 | Page 1 of 1

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