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This Consignment Agreement is entered into by and between:
xxxxxxxxxxxxxxxxx with principal address at xxxxxxxxxxxxxxxxxxxxxxxxx, represented
by xxxxxxxxxxxxxxxxxxx, hereinafter referred to as the CONSIGNOR/SUPPLIER;
xxxxxxxxxxxxxxxxxxxxxxxxxxx, with principal address at
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx represented by xxxxxxxxxxxxxxxxxxxxxxxxx,
hereinafter referred to as the CONSIGNEE/RECIPIENT;
WHEREAS, in view of the high procurement cost of drugs, medicines and other
hospital supplies and items, access to the same by patients and other members of the
population in need has been limited;
WHEREAS, the Supplier desires to offer its products by making stocks available, at
reasonable costs, without disbursement of government funds, but payable upon sale of the
same by the XXXXXXXXX Satellite Pharmacy or by the forward-stocking or consignment
WHEREAS, the Supplier possesses all the qualifications and none of the
disqualification as an entity allowed to supply/consign products according to the DOH rules
and regulations;
WHEREAS, the Supplier was among those who qualified during the latest bidding
conducted by the XXXXXXXXX for drugs and medicines;
WHEREAS, both parties are fully aware of the guidelines set forth for this purpose
specifically the DOH Administrative Order No. 2006-0039, dated December 8, 2006; DOH
Memorandum No. 2017-0033-A, dated February 22, 2017, among other relevant orders and
NOW THEREFORE, for and in consideration of the foregoing premises, and the terms
and conditions hereunder enumerated, the parties to this CONSIGNMENT Agreement hereby
agree that:
1. The Supplier shall undertake to supply Drugs and Medicines for sale which will be
payable after consumption of the XXXXXXXXX Satellite Pharmacy;
2. XXXXXXXXX shall undertake to sell the delivered drugs and medicines to the
public at a reasonable and affordable price;
3. The specific description of the goods and their quantities shall be covered by a
Supply Order Form;
4. The Supply Order Form for the initial stocking shall be based at the time a
Consignment Agreement is perfected; A copy of the Supply Order Form is made
an integral part of this Agreement;
5. A Supply Order Form shall be issued by the XXXXXXXXX Satellite Pharmacy at any
time the inventory of delivered goods reaches its reorder point;
6. Prices shall be competitively determined in order to arrive at the cheapest and
reasonable price but the initial stock shall in no way higher than the bid offer of
the Supplier during the latest bidding or that of the price of retail drugstores
within the area of the XXXXXXXXX;
7. The Supplier shall be bound to maintain the price of the delivered goods for at
least seven (7) months from the date of delivery; However, it can be adjusted
subject to periodic determination of the prevailing market price;
8. Deliveries will be made directly to the Satellite Pharmacy in the presence of the
Pharmacist-in-Charge or her/his designated representative AND all members of
the XXXXXXXXX Inspection and Acceptance Committee. A representative from the
Commission on Audit shall be invited to act as witness.
9. A Delivery Receipt shall be issued by the Supplier for every delivery made to the
XXXXXXXXX and shall bear the following information:
a. Name of the Supplier as Heading
b. Date of the Delivery Receipt;
c. Delivery Receipt Number;
d. Consignment Order Number;
e. Name of the Authorized Representative of the Supplier effecting the Delivery
with the necessary Special Power of Attorney;
f. Item Number;

unless extended with reasonable cause as shall be justified by the Head/Chief of the CONSIGNEE. Biologicals b. The CONSIGNOR shall hold the CONSIGNEE free and harmless from. The delivered goods shall not be removed from the Satellite Pharmacy without prior consent of the Supplier. 18. 14. 22. Dosage Form 3. in connection with. Any loss arising from fortuitous events shall relieve the XXXXXXXXX from any responsibility. damages and liabilities arising out of. Total price 10. Payments shall be made within thirty (30) days after the inventory taking. to avoid stock availability gaps. Generic Name 2. Delivery of the items should be done within seven (7) working days from the receipt of the Supply Order Form. 15. Any expired or unsold stocks shall be returned to the Supplier every quarter. but with expiration dates of less than 12 months 13. EXCEPT: a. XXXXXXXXX shall be bound to pay only for the drugs and medicines sold. g. 12. XXXXXXXXX Satellite Pharmacy shall conduct an inventory of goods supplied every end of the month or at the last working day of the month as the case may be. Unit j. Description of the Requested Goods 1. 2017. CONSIGNEE shall apply the zero inventory concept by turning over all unused stocks to the CONSIGNOR within seven (7) days after each of the quarters covered in the Agreement or within the following day from the receipt of the Replenishment Goods. these has to be immediately invoiced back to the Supplier for immediate replacement. A Return Invoice Receipt shall be issued to this effect stating the specific description and quantity of the items. and shall be solely responsible. 21. in case of loss arising from pilferage and theft. the XXXXXXXXX shall be liable for the monetary value of the goods lost or stolen. Ownership and title to the delivered goods shall remain with the Supplier. In cases of items with expiration dates of less than 12 months from date of delivery. Batch Number/Lot Number. The Supplier shall observe the inventory taking at all times. A Delivery Receipt must be supported with a Certificate of Analysis coming from the Quality Control Department of the manufacturer reflecting therein the same batch/lot numbers covered in the Delivery Receipt. xxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxx . Manufacturing Date 6. No items shall be received which have expiration dates of less than 12 months from the date of delivery. the CONSIGNEE may upon previous notice/demand. or resulting from the use of the consigned goods. In instances where the Satellite Pharmacy is in urgent need of the item requested and the supplier has stocks. Expiration Date 7. 16. Strength 4. Sub-packing Unit h. Unit Price k. if the latter is proved to be negligent. Quantity i. Supplied goods may be subjected to random sampling and testing by the Food and Drugs Administration through an authorized DOH representative or FDA inspector during deliveries and the corresponding items retained tested by the FDA/DOH shall be promptly replaced by the Supplier at no cost to the Government. Inventory may also be done at any time upon the determination of the Pharmacist-in-Charge. 20. 19. IN VIEW THEREOF. suit. and the reason for the return. require the CONSIGNOR to remove from the Hospital the consigned goods and medicines. This Agreement shall have a validity duration of six (6) months from the signing of this Contract. 5. cost of expenses. the parties have hereunto set their hands this _________ day of ______________. for any claim. The drugs and medicines returned shall be covered with the appropriate invoices. 17. action. However. Upon the expiration or earlier termination for breach of any term or condition. The same batch/lot numbers must appear on the invoices for billing purposes. 11.

.. X ..... Book No. Doc.. Series of 2017....... personally appeared xxxxxxxxxxxxxxxxxxx who is personally known to me and presented to me her TIN Card No. Philippines this __________________... xxxxxxxxxxxxxxxxxxx and to me known to be the same person who executed the foregoing instrument and he acknowledged to me that the same is her own free and voluntary act and deed. a Notary Public for and in the City of Iloilo... ___. xxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxx ACKNOWLEDGMENT REPUBLIC OF THE PHILIPPINES } xxxxxxxxxxxxxx } S. No..-X BEFORE ME.. .S. Page No. ___... ___.