Republic of the Philippines
Province of Tarlac
Municipality of San Jose
San Jose Rural Health Unit
MEMORANDUM OF AGREEMENT
KNOWN ALL MEN BY THESE PRESENTS:
This Memorandum of Agreement (MOA) made and entered into this ______ day of _____________________,
in San Jose, Tarlac, Philippines by and between:
SAN JOSE RURAL HEALTH UNIT a government owned health facility established and existing under the
laws of the Republic of the Philippines, located at Barangay Villa Aglipay, San Jose, Tarlac represented
herein by the owner Municipal Government of San Jose, hereinafter referred to as the FIRST PARTY.
MEDIAN DRUGMART, located at Randum Commercial Stall, Brgy. Lawacamulag, San Jose Tarlac, a Drug
Store and owner of a FDA Licensed Pharmacy, duly licensed to the Food and Drug Administration
represented herein by MEDIEN R. AGUIRRE hereunto duly authorized and hereinafter referred to as
the SECOND PARTY.
Both party are collectively known as "PARTIES"
WITNESSETH:
WHEREAS, the FIRST PARTY is a government health facility owned by the Municipal Government of San Jose.
WHEREAS, the SECOND PARTY is a Drug Store with an FDA Licensed Pharmacy.
WHEREAS, the FIRST PARTY having no approved FDA licensed Pharmacy wishes its patient to be provided with
the services by the Referral Facility.
WHEREAS, the FIRST PARTY having no approved license for a pharmacy, is desirous to obtain the pharmacy
services of the SECOND PARTY.
WHEREAS, the SECOND PARTY agrees to provide pharmacy services on patients coming from the FIRST
PARTY.
NOW THEREFORE, in consideration of the foregoing premises, the Parties hereby agree to the following:
Section 1. Duties and Responsibilities and Obligations of the FIRST PARTY
The FIRST PARTY shall:
1. Refer to the Philippine National Formulary Manual for Primary Healthcare for the list of approved medicines
to be requested and procured
2. Refer to the Philippine Drug Price Reference Index as basis for selection of supplier for bidding.
3. Abide with the prescribed bidding and procurement guidelines.
4. Transport medicine to the SECOND PARTY upon delivery if possible.
5. Prescribe medications for patients who sought consultation/services at the health facility.
Section 2. Duties and Responsibilities and Obligations of the SECOND PARTY
The SECOND PARTY shall:
1. Provide an adequate number of qualified, trained and competent staff
2. Keep medicines on proper storage area.
3. Review and dispense prescriptions to patients who bear the agreed prescription form with the FIRST
PARTY.
4. Communicate with FIRST PARTY anytime a prescription order is unclear or to confirm dosage and
formulation.
5. Counsel patients on the prescribed intake of medications, its possible side effects and adverse reactions.
6. Promptly inform the FIRST PARTY in case of nearly stock out of medicines.
7. Submit Summary of Supplies and Materials Issued (SSMI) Report weekly.
8. Adhere to all policies and procedures, any applicable government rules and regulations, and applicable
state licensure laws and regulations for the provision of pharmacy services.
9. Will not discriminate in provision of pharmacy services with respect to age, race, color, religion, g
preference,
sex, marital status, nationality, disability of economic status.
Section 3.
1. In consideration of the services rendered by the second party, the FIRST PARTY will provide the
SECOND PARTY with the list of drugs and medicines that are NOT available in the Rural Health Unit.
2. The FIRST will send patients along with their prescriptions to the SECOND PARTY to buy the drugs that
are not available at RHU w/c is the only BFAD accredited Pharmacy in San Jose, Tarlac.
Section 4. Amendment
No modification, alteration or amendment of any provision of this Agreement shall be binding on the
PARTIES hereto unless mutually agreed unless made in writing and signed by both PARTIES.
Section 6. Term
This agreement shall be in effect for one (1) year and will be automatically renewed at the end of each
subsequent year upon the time of signing of the representative of the PARTIES and shall terminate upon
mutual consent of the Parties. Either party may terminate this Agreement at any time, with or without cause,
by providing at least thirty (30) days advance written notice of the termination date to the other party. Such
termination will have no effects on the rights and obligations resulting from any transactions occurring prior to
the effective date of termination.
This Agreement will be governed by and construed in accordance with the laws of the Republic of the
Philippines.
If any law or regulation is enacted, modified or judicially interpreted so that this Agreement would be
found not to comply with such law or regulation; the parties shall, upon notification of such change in the law
or regulation, renegotiate the terms of this Agreement so that it complies with such law, this Agreement will
terminate immediately upon either party's receipt of notice of termination from the other party.
IN WITNESS WHEREOF, the both PARTIES have set their hands to this MEMORANDUM OF AGREEMENT
this _______ day of ______________, year _____________ in the ____________________________,
Philippines.
HON. ROMEO G. CAPITULO MEDIEN R. AGUIRRE
Municipal Mayor Owner
SAN JOSE RURAL HEALTH UNIT, BIRTHING CLINIC MEDIANCE DRUG MART
Signed in the Presence of:
LEO G. TARECTECAN
Municipal Health Officer
SAN JOSE RURAL HEALTH UNIT, BIRTHING CLINIC
REPUBLIC OF THE PHILIPPINESC)
PROVINCE OF _____________ ) SC
CITY OF __________________ )
BEFORE ME, a notary public for and in the above jurisdiction, personally appears:
ID NO. Issued on: Issued at:
Romeo F. Capitulo ____________________ ____________________ ____________________
Dr. Leo G. Tarectecan ____________________ ____________________ ____________________
Both known to me to be the same persons who executed the foregoing instrument and
acknowledgement is written, had been signed by the parties and their instrumental witnesses on each and
every page hereof.
WITNESS MY HAND SEAL, this _______ day of _________________, year ________________ in the
________________________________________________, Philippines
Doc No: ________
Page No. ________
Book of: ________
Series of: ________
_____________________________________________
Notary Public
