Original Copy

vertex pharmaceuticals
Bari mukhani Distt-Nainital(UK)Haldawani-263139
GST No. : 05AFHPB8478H1ZB, DL No:OBW-01/NTL/NOV/2009, Contact
No:9412035428,
Phone No1:8581852823 ,Phone No2:9837936941 ,Email ID:
saverakalyansamiti@gmail.com
GST Invoice
Store Code PMBJK04852 Invoice No. 2018190052
Store Name PRADHANMANTRI BHARTIYA JANAUSHADHI KENDRA Date 03/01/2019
(PMBJK04852)
Cont.Person Mr. Ashok Lohani Lr No
Address District Hospital, Bageshwar, Bageshwar Lr Date 03/01/2019
,Tal Bageshwar , Uttarakhand 263642
Bageshwar BAGESHWAR -263642 Uttrakhand
India
Drug Lic. UA-BAG-102965, UA-BAG-1029696 No. Of Cases 0
Gst No. Transporter

Pan No. Mobile No. 8126018778

Sr. DC Product Name Unit HSN Batch Qty. ExpDate MfgDate MRP Rate Amount Dis(%) CGST SGST IGST
Code Code value value value
(%) (%) (%)
1 8 Diclofenac 10's 3004 T8020 20 01/Y 02-18 12.0 8.57 171.40 0.00 10.28 10.28 0.00
Sodium 50mg + 018 0 (6.00) (6.00) (0.00)
Serratiopeptidas
e 10mg Tablet
Mnf:
2 4 Acetaminophen 10's 3004 746- 20 08/Y 09-17 8.00 5.71 114.20 0.00 6.85 6.85 0.00
325mg + Tramadol 18 (6.00) (6.00) (0.00)
Hydrochloride
37.5mg film
coated Tablet
Mnf:
3 179 Albendazole 10's 3004 T- 20 10/Y 11-17 26.2 18.71 374.20 0.00 22.45 22.45 0.00
Tablets IP 400MG 17746 0 (6.00) (6.00) (0.00)
Mnf: 01

4 682 Rabeprazole 20mg 10's 3004 800- 100 09/Y 04-18 20.0 14.29 1429.00 0.00 85.74 85.74 0.00
+ Domperidone 10 0 (6.00) (6.00) (0.00)
10mg Capsule
Mnf:
5 223 PYRIDOXINE HCl 30's 3004 CT758 20 11/Y 12-17 32.0 22.86 457.20 0.00 27.43 27.43 0.00
10 mg+ 5 0 (6.00) (6.00) (0.00)
DOXYLAMINE 10 mg
+ FOLIC ACID 2.5
mg Tablets
Mnf:
6 992 Olmesartan Film 10's 3004 18SGD 30 03/Y 04-18 13.0 9.29 278.70 0.00 16.72 16.72 0.00
coated Tablets T013 0 (6.00) (6.00) (0.00)
20mg
Mnf:
7 456 ATORVASTATIN 10's 3004 GT171 30 08/Y 09-17 18.0 12.86 385.80 0.00 23.15 23.15 0.00
Tablets IP 40 mg 146 0 (6.00) (6.00) (0.00)
Mnf:

8 100 Ofloxacin 200 mg 10's 3004 OCZT5 20 01/Y 02-18 22.5 16.07 321.40 0.00 19.28 19.28 0.00
+ Ornidazole 03 0 (6.00) (6.00) (0.00)
500 mg film
coated Tablet
Mnf:
9 509 HYDROXYCHLOROQUI 10's 3004 CQN- 20 06/Y 07-18 27.0 19.29 385.80 0.00 23.15 23.15 0.00
NE Tablets IP 254 0 (6.00) (6.00) (0.00)
200 mg
Mnf:
10 44 Amoxycillin 10's 3004 1718- 20 05/Y 06-18 10.0 7.14 142.80 0.00 8.57 8.57 0.00
Capsules IP 512 0 (6.00) (6.00) (0.00)
250mg
Mnf:
11 381 CEFIXIME 200 mg 10's 3004 CT708 10 10/Y 11-17 36.0 25.71 257.10 0.00 15.43 15.43 0.00
+ OFLOXACIN 200 7 0 (6.00) (6.00) (0.00)
mg Tablets
Mnf:
12 86 Ciprofloxacin 10's 3004 TV319 20 07/Y 08-17 17.0 12.14 242.80 0.00 14.57 14.57 0.00
500 mg Film 9 0 (6.00) (6.00) (0.00)
Coated Tablet IP
Mnf:

Page 1 of 4
 Original Copy

vertex pharmaceuticals
Bari mukhani Distt-Nainital(UK)Haldawani-263139
GST No. : 05AFHPB8478H1ZB, DL No:OBW-01/NTL/NOV/2009, Contact
No:9412035428,
Phone No1:8581852823 ,Phone No2:9837936941 ,Email ID:
saverakalyansamiti@gmail.com
GST Invoice
Store Code PMBJK04852 Invoice No. 2018190052
Store Name PRADHANMANTRI BHARTIYA JANAUSHADHI KENDRA Date 03/01/2019
(PMBJK04852)
Cont.Person Mr. Ashok Lohani Lr No
Address District Hospital, Bageshwar, Bageshwar Lr Date 03/01/2019
,Tal Bageshwar , Uttarakhand 263642
Bageshwar BAGESHWAR -263642 Uttrakhand
India
Drug Lic. UA-BAG-102965, UA-BAG-1029696 No. Of Cases 0
Gst No. Transporter

Pan No. Mobile No. 8126018778

Sr. DC Product Name Unit HSN Batch Qty. ExpDate MfgDate MRP Rate Amount Dis(%) CGST SGST IGST
Code Code value value value
(%) (%) (%)
13 14 Ibuprofen 400 mg 10's 3004 IPT- 30 07/Y 08-17 5.50 3.93 117.90 0.00 7.07 7.07 0.00
+ Paracetamol 3117 (6.00) (6.00) (0.00)
325 mg Tablet
Mnf:
14 556 MONTELUKAST 10 10's 3004 GT180 30 04/Y 05-18 33.0 23.57 707.10 0.00 42.43 42.43 0.00
MG + 539 0 (6.00) (6.00) (0.00)
FEXOFENADINE HCl
120 MG TABLETS
Mnf:
15 115 Calamine Lotion 100 3004 JTE/0 10 06/Y 07-17 19.5 13.94 139.40 0.00 8.36 8.36 0.00
Mnf: ml 13 2 (6.00) (6.00) (0.00)

16 432 OLMESARTAN 10's 3004 17SGI 30 08/Y 09-17 30.0 21.43 642.90 0.00 38.57 38.57 0.00
MEDOXOMIL T027 0 (6.00) (6.00) (0.00)
Tablets IP 40 mg
Mnf:
17 246 Fexofenadine 120 10's 3004 CT739 30 09/Y 10-17 19.4 13.86 415.80 0.00 24.95 24.95 0.00
mg film coated 0 0 (6.00) (6.00) (0.00)
Tablet
Mnf:
18 371 VOGLIBOSE 10's 3004 GT180 20 04/Y 05-18 10.0 7.14 142.80 0.00 8.57 8.57 0.00
Tablets IP 0.2 560 0 (6.00) (6.00) (0.00)
mg
Mnf:
19 45 Amoxycillin 10's 3004 PC813 20 06/Y 07-18 26.0 18.57 371.40 0.00 22.28 22.28 0.00
Capsules IP 2 0 (6.00) (6.00) (0.00)
500mg
Mnf:
20 49 Azithromycin 250 10's 3004 MT180 20 05/Y 06-18 40.0 28.57 571.40 0.00 34.28 34.28 0.00
mg film coated 567 0 (6.00) (6.00) (0.00)
Tablet IP
Mnf:
21 13 Etoricoxilb 10's 3004 OBEJ0 20 04/Y 05-18 25.0 17.86 357.20 0.00 21.43 21.43 0.00
Tablets IP 90mg 5 0 (6.00) (6.00) (0.00)
Mnf:

22 209 Ondansitron 10's 3004 ONTU- 20 10/Y 11-17 4.00 2.86 57.20 0.00 3.43 3.43 0.00
Tablets IP 4mg 01 (6.00) (6.00) (0.00)
Mnf:

23 878 "Drotaverine HCl 10's 3004 DPS- 20 11/Y 12-17 15.2 10.91 218.20 0.00 13.09 13.09 0.00
80mg, Mefenamic 52 7 (6.00) (6.00) (0.00)
Acid 250mg
Tablets"
Mnf:
24 511 PARACETAMOL 15's 3004 UPRO1 30 02/Y 03-18 8.00 5.71 171.30 0.00 10.28 10.28 0.00
Tablets IP 650 804 (6.00) (6.00) (0.00)
mg
Mnf:
25 793 Atenolol Tablets 14's 3004 1704 20 04/Y 05-17 2.81 2.01 40.20 0.00 2.41 2.41 0.00
25 mg (6.00) (6.00) (0.00)
Mnf:

Page 2 of 4
 Original Copy

vertex pharmaceuticals
Bari mukhani Distt-Nainital(UK)Haldawani-263139
GST No. : 05AFHPB8478H1ZB, DL No:OBW-01/NTL/NOV/2009, Contact
No:9412035428,
Phone No1:8581852823 ,Phone No2:9837936941 ,Email ID:
saverakalyansamiti@gmail.com
GST Invoice
Store Code PMBJK04852 Invoice No. 2018190052
Store Name PRADHANMANTRI BHARTIYA JANAUSHADHI KENDRA Date 03/01/2019
(PMBJK04852)
Cont.Person Mr. Ashok Lohani Lr No
Address District Hospital, Bageshwar, Bageshwar Lr Date 03/01/2019
,Tal Bageshwar , Uttarakhand 263642
Bageshwar BAGESHWAR -263642 Uttrakhand
India
Drug Lic. UA-BAG-102965, UA-BAG-1029696 No. Of Cases 0
Gst No. Transporter

Pan No. Mobile No. 8126018778

Sr. DC Product Name Unit HSN Batch Qty. ExpDate MfgDate MRP Rate Amount Dis(%) CGST SGST IGST
Code Code value value value
(%) (%) (%)
26 387 TERBINAFINE 250 7's 3004 18SGG 30 06/Y 07-18 36.0 25.71 771.30 0.00 46.28 46.28 0.00
MG TABLETS T029 0 (6.00) (6.00) (0.00)
Mnf:

27 571 Tamsulosin 0.4 15's 3004 DT081 10 04/Y 05-18 22.0 15.71 157.10 0.00 9.43 9.43 0.00
mg + Dutasteride 5 0 (6.00) (6.00) (0.00)
0.5 mg Tablets
Mnf:
28 628 Etophylline IP 10's 3004 FAQ2A 30 01/Y 02-18 4.00 2.86 85.80 0.00 5.15 5.15 0.00
231mg. + 804 (6.00) (6.00) (0.00)
Theophylline
69mg Tablet
Mnf:
29 102 Ofloxacin Tablet 10's 3004 NP170 20 09/Y 10-17 22.0 15.71 314.20 0.00 18.85 18.85 0.00
IP 400 mg film 34 0 (6.00) (6.00) (0.00)
coated Tablet
Mnf:
30 36 "Amoxycillin 200 30 3004 18A06 10 10/Y 03-18 25.0 17.86 178.60 0.00 10.72 10.72 0.00
mg, Clavulanic ml 3 0 (6.00) (6.00) (0.00)
acid 28.5 mg
/5ml Oral
Suspension"
Mnf:
31 906 Glyceryl 30's 3004 MT180 5 04/Y 05-18 68.0 48.57 242.85 0.00 14.57 14.57 0.00
Trinitrate 324 0 (6.00) (6.00) (0.00)
Tablets IP 2.6mg
(Nitroglycerin
Tablets)
Mnf:
32 402 AMOXYCILLIN and 6's 3004 BT180 10 04/Y 05-18 63.0 45.00 450.00 0.00 27.00 27.00 0.00
POTASSIUM 322 0 (6.00) (6.00) (0.00)
CLAVULANATE
Tablets IP
(875mg+125mg)
Mnf:
33 224 Folic Acid 15's 3004 FD701 30 04/Y 05-17 3.08 2.20 66.00 0.00 3.96 3.96 0.00
Tablets IP 5mg (6.00) (6.00) (0.00)
Mnf:

34 383 CEFPODOXIME 200 6's 3004 CT170 20 11/Y 12-17 64.4 46.00 920.00 0.00 55.20 55.20 0.00
mg+ CLAVULANIC 988 0 (6.00) (6.00) (0.00)
ACID 125 mg
Tablets
Mnf:
35 229 Haematinic syrup 100 3004 HMTS1 10 12/Y 07-18 31.0 22.14 221.40 0.00 13.28 13.28 0.00
of Iron,Folic ml 8003B 0 (6.00) (6.00) (0.00)
acid and Vitamin
B12
Mnf:
36 687 Lactulose 10 gm/ 200 3004 ML180 5 05/Y 06-18 100. 71.43 357.15 0.00 21.43 21.43 0.00
15 ml ml 187 00 (6.00) (6.00) (0.00)
Mnf:

Page 3 of 4
 Original Copy

vertex pharmaceuticals
Bari mukhani Distt-Nainital(UK)Haldawani-263139
GST No. : 05AFHPB8478H1ZB, DL No:OBW-01/NTL/NOV/2009, Contact
No:9412035428,
Phone No1:8581852823 ,Phone No2:9837936941 ,Email ID:
saverakalyansamiti@gmail.com
GST Invoice
Store Code PMBJK04852 Invoice No. 2018190052
Store Name PRADHANMANTRI BHARTIYA JANAUSHADHI KENDRA Date 03/01/2019
(PMBJK04852)
Cont.Person Mr. Ashok Lohani Lr No
Address District Hospital, Bageshwar, Bageshwar Lr Date 03/01/2019
,Tal Bageshwar , Uttarakhand 263642
Bageshwar BAGESHWAR -263642 Uttrakhand
India
Drug Lic. UA-BAG-102965, UA-BAG-1029696 No. Of Cases 0
Gst No. Transporter

Pan No. Mobile No. 8126018778

Sr. DC Product Name Unit HSN Batch Qty. ExpDate MfgDate MRP Rate Amount Dis(%) CGST SGST IGST
Code Code value value value
(%) (%) (%)
37 144 Metformin 10's 3004 V1180 30 01/Y 02-18 11.0 7.89 236.70 0.00 14.20 14.20 0.00
Hydrochloride 23 5 (6.00) (6.00) (0.00)
1000 mg SR
Tablets IP
Mnf:
38 78 Cefuroxime 10's 3004 CT707 20 10/Y 11-17 56.0 40.00 800.00 0.00 48.00 48.00 0.00
Axetil 250 mg 3 0 (6.00) (6.00) (0.00)
Film Coated
Tablets IP
Mnf:
39 528 PARACETAMOL 10's 9804 VPC70 10 10/Y 11-17 16.0 11.43 114.30 0.00 6.86 6.86 0.00
325mg+ 04 0 (6.00) (6.00) (0.00)
PHENYLEPHRINE 10
mg+
CHLORPHENIRAMINE
2 mg Tablets
Mnf:
40 473 LEVOSULPIRIDE 75 10's 3004 18SGD 20 03/Y 04-18 47.0 33.57 671.40 0.00 40.28 40.28 0.00
MG+ PANTOPRAZOLE C004 0 (6.00) (6.00) (0.00)
40 MG CAPSULE
Mnf:
41 232 Vitamin B- 200 3004 VBNS1 5 11/Y 06-18 42.0 30.00 150.00 0.00 9.00 9.00 0.00
Complex Syrup ml 8006B 0 (6.00) (6.00) (0.00)
Mnf:

42 372 METFORMIN 10's 3004 MT172 50 01/Y 02-18 8.00 5.71 285.50 0.00 17.13 17.13 0.00
HYDROCHLORIDE 629 (6.00) (6.00) (0.00)
TABLETS IP
PROLONG RELEASE
500 MG
Mnf:
Total Qty: 945 Taxable Amount: 14535.50
Tax Details CGST: 872.11
Taxable Tax Type Tax % Tax Total SGST: 872.11
Amount
IGST: 0.00
14535.50 CGST 6.00 872.11
Freight: 0.00
14535.50 SGST 6.00 872.11
Round Off: 0.28
14535.500 1744.22
Net Amount: 16280

Amount Inword : Sixteen Thousand Two Hundred Eighty Only

All Disputes are Subject to Jurisdiction Only. vertex pharmaceuticals

E.&O.E

Authorised Signature

Page 4 of 4