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
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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, RPhDirector of Pharmacy Operations
Bay Area Pharmacy Supply Co., Inc.
San Francisco, CA 94102, United States
Date: _______________
Supplier Representative
Mr. David ChenSales Director
Pacific Pharmaceutical Distribution LLC
Oakland, CA 94601, United States
Date: _______________ ⬇️ Download as DOCX Edit online as DOCX
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