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Home My WebLink About236680 09/03/14 *p" CITY OF CARMEL, INDIANA VENDOR: 360209 ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $*****1,633.02* s. CARMEL, INDIANA 46032 ATTN:CAROLYN TERRY,ACCT REPTNG CHECK NUMBER: 236680 9y�*oN. 10330 N MERIDIAN ST SUITE 430 CHECK DATE: 09/03/14 INDIANAPOLIS IN 46290 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 13419 1,633.02 SPECIAL DEPT SUPPLIES St.Vincent Hospital&Healthcare Center, Invoice T-- Attn: -..Attn: Carolyn Terry,Acct Rptg 10330 N.Meridian St., Suite 430 North DATE INVOICE# Indianapolis, IN 46290-1024 7/21/2014 13419 BILL TO Carmel Fire EMS Attn: Accounts Payable 2 Carmel Civic Square Carmel,IN 46032 TERMS Due on receipt DESCRIPTION AMOUNT EMS Supplies Purchased June 2014 1,633.02 Medical Supplies $522.79 Transfer Drugs 1,110.23 June Total due: $1,633.02 46029-160085-65050. Please note invoice number Total $19633.02 that you are paying on check/stub. Thank you! Inquiries: Carolyn Terry Payments/Credits $0.00 317.583.3301 cmterry@stvincent.org Balance Due $1,633.02 Depatmental Transfer of Supplies date submissed Requesting Department: Carmel Fire Dept Supplying Department ER Cost Center 8213 Cost Center 27230 ITEM# QUANTITY UNIT COST TOTAL COST Alcohol preps $2.67 $0.00 Angiocath 18g 11 $1.50 $16.50 Angiocath 20g 50 $1.50 $75.00 Angiocath 22g 20 $1.50 $30.00 Angiocath 24 $1.55 $0.00 Basin kidney shaped $0.08 $0.0 Basin round 1 $0.31 $0.31 Cold paks 4 $0.57 $2.28 EKG Electrodes 5 $3.12 $15.60 Emesis Bas(perpack) 1 $11.52 $11.52 EZ-10 Adult Needles $495.00/box of 5 $99.00 $0.00 Foam-Quikcare $2.67 $0.00 Guaze, 2 x 2 Cotton bail $1.88 $0.00 Gauze Kerlex 20 $0.67 $13.40 Gloves Med $5.41 $0.00 Gloves-Large 2 $5.41 $10.82- Gloves-Marge $5.95 $0.00 IV Adapter, Luerlock $0.15 $0.00 IV Dial a flow $3.15 $0.00 IV Extension 19" $1.91 $0.00 IV Lock with Ext 66 $1.87 $123.42 IV Start Kits 100/bx 20 $1.00 $20.00 IV Start Kits Sobraview 100/bx 48 $2.66 $127.68 IV Tubing 15 tt 53 $1.17 $62.01 Kerlix 4.5"x6ply $0.73 $0.00 Razor, dis oseable $0.12 $0.00 Normal Saline 1000 cc bags/ca $9.48 $0.00 Sca el#11 $1.30 $0.00 Sharps Container $4.59 $0.00 Sterile H2O bottle $0.71 $0.00 Suction Canister&to $3.26 $0.00 Suture Kit 1 $1.09 $0.00 Syringe w/Needle 1 ml $0.07 $0.00 Syringe W/Needle 3 ml 25 $0.05 $1.25 Syringe w/Needle 5ml $0.10 $0.00 Syringe w/Needle 10 ml 5 $0.12 $0.60 Syringe w Saline 3ml 10 $0.28 $2,80 Syringe w/Saline10mi $0.32 $0.00 30 ml saline vials(per box -- $9.63 $0.00 Tape 2" 6 rolls/box 1 $1.00 $1.00 Tae 1" $0.50 $0.00 Tape 2"cloth adh $1.29 $0.00 Tape Trans ore 1/2" $1.28 $0.00 Ultra Trak Ultimate Test Control $83.30 Ultra Trak Ultimate Test Strips/10 BX $330.00 $0.00 Warm paks $1.46 $0.00 Wound Cleanser $5.04 $0.00 Suction Canister&to $3.26 $0.00 Yankauers $0.34 $0.00 Ambu Ba w/mask-Adult 1 $8.60 $8.60 Ambu Ba w/mask-Peds $15.00 $0.00 Ambu Ba w/mask-Infant cs/10 $16.00 $0.00 CPAP mask $50.00 $0.00 Lg Bitrac Full Face Mask $29.00 $0.00 ET Tube Stylette 1 $0.00 Wi es Disenfect $11.52 $0.00 Grand Total $522.79 VOUCHER NO. WARRANT NO. ALLOWED 20 St. Vincent Hospital Attn: Carolyn Terry, Acct. Reporting IN SUM OF$ 10330 N. Meridian Street, Ste. 430 N Indianapolis, IN 46290 $1,633.02 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 13419 102-390.11 $1,633.02 1 hereby certify that the attached invoice(s), or bill(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except SEP — 2 2014 Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service,where performed,dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 13419 $1,633.02 1 hereby certify that the attached invoice(s), or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer