Pharmacy order form · DMI Production

Pharmacy name / manager

Phone number

City / region

Product	Unit price (DZD)	Total
Condoms PREVEX
Box of 3	2,808	0
Box of 6	2,592	0
Box of 12	2,421	0
Vanilla	2,592	0
Banana	2,592	0
Chocolate	2,592	0
Strawberry	2,592	0
Pregnancy tests TEST+
Cassette format	2,100	0
Rapid Pen format	2,026	0

Total: 0 DZD

By sending this order form, your pharmacy will be contacted by our team to confirm the order and delivery details. Your data is only used for this purpose — see our privacy policy.