ORDER

Pharmacy Stock Order – Kenya

Pharmacy Stock Order Form

Supplier Name

PPB Wholesale License No.

Address / Contact

Pharmacy Name *

PPB Premises Reg. No. *

Physical Address

County

Annual License No.

Superintendent Pharmacist *

Contact Number *

Order Number

Order Date

Requested Delivery Date

Source of Funds

Add items one by one. Only KEML/KEMSL or registered products.

#	Product Code	Generic Name & Strength	Dosage Form	Pack Size	Qty	Unit Price (KES)	Total (KES)

Grand Total (KES): 0.00