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Home My WebLink About238396 10/21/2014 i `u ��p'• CITY OF CARMEL, INDIANA VENDOR: 357526 ® ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*****1,241.31' _� CARMEL, INDIANA 46032 DEPT CH 10241 CCHECK HECK NUMBER: 2383964 roH� PALATINE IL 60055-0241 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 3'275663-01 930.00 SPECIAL DEPT SUPPLIES 102 4239011 3284984-01 181.31 SPECIAL DEPT SUPPLIES 102 4239011 7503737-02 130.00 SPECIAL DEPT SUPPLIES ORDER# E— ORDER DATE IDUE DATE 23070884 10/06/14 11/05/149 D&B#:01-243-0880 WHSE DEA# RHO]62494 Fed ID: 11-3136595 is rhis order as been processed by our MIDWEST D.C. 5315 WES'' 74TH 3TREET INDIANAP LIS,IN 46268 1 499-0627 EA REGULATOR STD W/FLOW & 2 DISS 10 10 93.00 930.00 1 ----=====--------- ---------- PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TE ZMS OF SALE ----------- --------- -- ------- MERCHANDI E TOTAL 930.00 invoice Date + 30 days 930.00 Please remi: payments only to the following aldress: Henry Scheii, Inc. Dept CH 102 1 Palatine, IL 60055-0241 BILL TO SHIP TO INVOICEINVOICE AMOUNT ITEM STATUS KEY F,—REM KEY School B-Backordered:Item will follow :I Z Charge 1308571 1308572 327S663-01 930.00 D-Discontinued tern no longer available NC- 1-. -Special Schein Free Goods ORDER# ORDER DATE INVOICE JDATE 4iOF BOXES M-Manufacturer will ship Item directly to you 11 Prescription Drug:Return Authorization Required 23070884 10/06/14 10/06/14 1 R Refrigerated Item:May be shipped separately $ Special Schein pricing CUSTOMER P 4 PAGE# T Taxable Item U-Temporarily unavailable:please reorder TOM 10/06/14 1 OF 1 -Item has MSDS LP300 �...�.�.............................................................�. . ....,......f.. �.... ....f.. ....�....... ,v ,v ua ..avw. �,.. a.aa.. • .. u � aa.a.av, . f ..., � ,... u.•a,. ,uv.. poirdslcredits redeemable for certain goods or services,in accordance with discount program odes.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened and used equipment may not be returned for credit.Before opening equipment,vie suggest that you cheek the shipping container and packing list to DELIVERY TERMS: ensure.that you are getting exactly what you ordered.Equipment must be returned Unless otherwise agreed,Ireight terms are FOB Shipper's Duck(Tx Works,outside, in the original unopened packaging,unmarked and properly packaged.Speical order North America).Title passes at the time the shipment is loaded at the shipper's dock. equipment is riot returnable.Pdrequipinent returns aro subject to a restocking fee. Equipment is barked by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon taking delivery of All orders will be subject to a handling charge.This charge includes freight,except for your ne:v equipment.Open or defective equipment is subject to the manufacturer's additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additional freight charges. Prescription Drug_Returns: Alaska,Hawaii&Pacific Protec[grates: Phase note that.in order to comply with Federal and Stara Pedigree requir:menis, Stanched shipping methods provide direct.reduced cost,expedited air delivery Henry Schein's policy on the return of Rx.Drugs is as follows: seniire to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Henry Schein has purchased f rom wholesalers are riot returnable. are offered dire cf surface transport,or postal services for reliable delivery. These items will be identified in vour invoice with the code WEI. No additional surcharges apply,except when special services are requested. Rx Drugs which are purchased Ly Henry Schein directly from the;manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the to[Inwing key elements are met Commodity ID 8000)are no-w available via LIPS 2nd-day air. llOnly returns flue to error in order or delh,,ery will be allowed. Guam.Puerto Rico,II.S.Trust Territories&Virgin Islands: 2 Returns of Rx Drugs will only be accepted it HSI is notified within 14 calendar days • All orders will be subject to a handling charge.This charge includes freight through of receipt of[tie shipment and valid return authorization is issued by HSI. the United States Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any cuslomer r;Turning Fix Drugs • Six;vial delivery orders and hazardous material shipmr:nis can he shipptrf uta UniTad to complete and return a Prescription Drug Return Authorization form.Federal lave Parcel Services(LIPS)for an additional charge.No minimum order amount or wieight requires that the healthcare entity returning Rx Drugs document that the product applies.Speak to your International Representative for details. was kept under proper storage.and handling conditions while in their possession and during the return of the product. to get a copy of the form and proper return Outside U.S. 50 states): authorization,please contort Customer Service.. iI your order is being shipped outside the U.S.(90 states);please refer to the 4)In addition.Pedigree regulations require that the healthcare entity returning nternational Terms&Conditions at henryschein.conl.Unless otherwise agreed, Rx Drugs certifies feiht terms are FC?R Shipper's Dock("Ex Works"outside North America). that the product being returned is the same exact product purchased from HSI. 1"ritlegpasses at the time the shipment is loaded at the.shipper's dock. 5)Henry Schein will not issue credit for any returaecl Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. Pampered with,are out of date or where the labeling has been altered in anyway, RX PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD Regulations require us to limit[he sale of Fix and controlled substances only to registered, 21/n Cash Back or Maximum Rewards on all purchases with the Henry Schein licensei healthcare piolessio mals.It you are a new customer or have recentiv moved, Credit Card.To apply now,call:1.866.398.9296 or online please furnish its witty a copy of your updated stale DEA registration.For controlled www.henrysclieiii.coili/creditcard Reduce the cost and administration of of substances,furnish a copy of your DEA registration verifying your shipping address. y paying Please nota that all orders for r;ontrollod substances are subject to a due:diligence review Henry Scheirt—Pay electronically(ACH Debit)or set up AutoPay. process.Schedule 11 controlled substances can be ordered electronically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System pleasevisit For your convenience,we provide several payment alternatives.Orders billed to your wutiv.henrdschein.com/e222:if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,of Check..If you peeler. Schedule ll controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express,Visa, MasterCard or Henry Schein,Inc. • Suite 300.5315 West 74th Street • Indianapolis,IN 46268 Discover Card;when placing your order.All sales are subjer,T in our normal terms and REGULATORY REQUIREMENT: conditions.All sales are subject to credit approval.Invoices are payable."within agreed Local regulatory requirernenls may apply to use or installation of certain products. terms of sale. Be sure to understand and comply with airy such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due ar.subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 340B Proqram Henry Schein Medical/EMS Customer Service: 1.800.472.43468arrr91)m.ct. Customer Service: 1.877.344.34028:3(Mm--5:30prn.et. Customer Service: 1.800.845.3550`3:3(lam-5:30pm,,I. Place an Order: 1.800.772.43468am-9pm,et. Place an Order. 1.677.344.3402 8:30am-5:301)m,et. Place an Order: 1.800.845.3550 8:30am-5:301)m,et. Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.886.885.2253 24 Hoots. Fax an Order: 1.800.533.4793 2.4 Hours. Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 Sam—bpm,et. Internet: www.henWebein.cont,errs E-Mail: custservs^henryschein.com Internet: wwiv.henryschein.com/340B E-Mail: scott.bruner@henryschein.com E-Mail: customer.stipport@henryschein.coin Please see-lift p:/JWww.Henry schain.coat-EN,'Medical/LegalTerms.ASPX for Conditions&FxceptionS. ORDER# ORDER DATE DUE DATE 22887877 09/29/14 11/02/14 D&B#:01-243-0880 WHSE DEA# PG0229321 Fed ID: 11-3136595 CONTAINS MULTIPLE INVOICES M J M This order has been processed by Lur GIV D.C. 80 SUMMI" VIEW ANE BASTIAN VA 2431_4 This is a backordered shipment for order:22887877 or-ginal invoice:75037 7-01 PO# ALVERS04 1 499-1861 EA ULTRA TRAUMA PACK RED 1 1 130.00 130.00 1 PLEASE REFEZ TO BACK OF PAPERWORK FOR DISCLOSJRES/TES OF SALE MERCHANDI E TOTAL 130.00 Invoice Date + 30 days 130.00 lease remi- payments only to the following a dress: enry Scheii, Inc. ept CH 10211 alatine, 1 , 60055-0241 BILL TO -SHIP TO INV OICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 13-Backord red:Item will follow SK-school Kit 1308571 1308572 7503737-02 130 .00 D-Discontjnucd�Item no longer available NC-No Charge 1, -Special Schein Free Goods ORDER# ORDER DATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you 11 Prescnpuon Drug:Return Authorization Required 22887877 09/29/14 10/03/14 1 R Refrigerated Item:May he shipped separately $ Special Schein pricing CUSTOMER PO# PA T Taxable Item U-Temporarily unavailable:please reorder ALVERSON 1 OF 1 -Item has MSDS LP300 poirds/credits redeemable for certain goods or services,in accordance with discount program rules.Upon discount receipt by redemption of your earned points/credits,you are receiving or Equipment: will receive notice of the discount value.Accordingly,you should retain these records. Opened anti used equipment may not be returned for credit.Before opening equipment.vie suggest[hat you check the shipping container arid packing list to DELIVERY TERMS: ensure that you are getting exactly what you ordered.Fqurpment must be returned Unless otherwise agreed,freight terms are FOB Shipper's Duck"'Ex Works"outside in the,original unopened packaging,unmarked and properly packaged.Spcical order North America).Title passes at the time the shipment is loaded at the men shipper's dock. equipment is not returnacle.Alrequipment returns are subject to a restocking lee. Equipment is barked by the manufacturer's repair or replacement warranty.Please Continental U.S.: read and return all warranty information required immediately upon taking delivery of All orders will be subject to a handling charge.This charge includes freight,except for your new equipment.C;por or defective equipment is subject to the manufacturer's additional carrier charges related to special delivery services and hazardous material warranty. shipments.Special orders are subject to additional freight charges. Prescription Drug Returns: Alaska,Hawaii&Pacilic Protectorates: Please note that.in ordr r to comply with Federal and State Pedigree requirements, Standal'd shippingmethods praride direct,(educed cost.expedite(]air delivery Henry,)chain's policy on the return of Rx Drugs is as follows: service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which Henry Schein has purchased lion)wholesalers are.riot returnable. are offered direct surface transport,or postal services for reliable delivery. These items will be identified in your invoice with the code WH. No additional surcharges apply,except when special services are requested. Rx Drugs v4iich are purchased Ly henry m Schein directly from the manufacturer may Low-level hazardous items(dangerous goods in accepted quantities and Consumer be returned providing that the toll owing key elements are met: Commodity ID 8000)are.now available via LIPS 2nd-day,air. 1 Only returns due to error in order or delivery will be allowed. Guam.Puerto Rico U.S.Trust Territories&Virgin Islands: 2 Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days • All orders will be Subject to a handling charge.This charge includes freight through of receipt of the shipment and valid return authorization is issued by HSI. [he United Slates Postal Service(USPS). 3)The Prescription Drug Marketing Act requires any customer returning Fix Drugs • Special delivery orders and hazardous material shipments can be shipped via United to complete and return a Prescription Drug Return Authorization form.Federal favi Parcel Services(UPS)for an additional charge.No minimum order ameuntor o,,aight requires that the healthcare entity returning Rx Drugs document[hat the product applies.Speak to your international Representative for details. was kept under proper storage and handling conditions whife in their possession and during the return of the product. to eget a copy of the form arid proper return Outside U.S. b0 slates): ( authorization,please contact Customer Service. if your order is being shipped outside the U.S.(`)0 states),please refer to the 4)In addition.Padgree regulations require that the healthcare entity returning nternational Terms&Conditions at henryschein.com.Urifess otherwise agreed, Rx Drugs cerUties freight terms are FOR Shipper's Dock("NWorks"outside North America). that the product being returned is the,same exact product purchased from HSI. title passes at the time the shipment is loaded at the shipper's dock. 5)Henry Schein will not issue credit for any returned Rx Drugs which have been Customer is responsible for compliance with any applicable import requirements. tampered with,are out of date or when;the labeling has been altered in any wry. RX PRODUCTS & CONTROLLED SUBSTANCES: CHOOSEYOUR PAYMENT METHOD Regulations require us to limit[tie sale of Rx and controlled substances only to registered, 2%Cash Back or Maximum Rewards on all purchases with the Henry Schein licensed healthcare professionals.It you are a new customer or have recently moved, Credit Card.To apply now,call:1.866.398.9296 or online please furnish its with a copy of your updated stale ULA registration.For controlled www.henryscliein.com/creditcard Reduce the cost and administration of paying substances.furnish a ropy of your DEA registration verifying your shipping address. Please note that all orders for controlled substances are subject to a due diligence review Henry Schein—Pay electronically(ACH Debit)or set up AutoPay. process.Schedule II controlled substances can be ordered electrunically or by mail. Please call Customer Service for details. For information on our Controlled Substance Ordering System please visit For your convenience,we provide several payment alternatives.Orders billed to your wu�lv.henrysrhein.com/e22.2:if you prefer to continue using Federal 222 Forms to order account may be paid by ACH Debit,Check by Phone,or Chuck.If you prefer. Schedule II controlled substances,please mail the form to: you may useyour Henry Schein Credit Card,American Express;Visa; MasterCard or Henry Schein,Inc. • Suite 300,5315 West 74th Street • Indianapolis,iN 46268 Discover(-.ard;when placing your order.All sales are subject to our normal terms and REGULATORY REQUIREMENT: c:onditions.All sales are subject to credit approval.Invoices are payable within agreed Lural regulatury requirernents rnav apply to use or installation of certain products. terms of sale. Be Sure to understand and comply with army such requirements prior to purchase,use, Open Accounts Receivable: or installation of products. All unpaid accounts receivable past due are subject to a 1.5%finance charge. To arrange for a product return,simply call Customer Service as noted below: Henry Schein Medical 3448 Program Henry Schein Medical/EMS Customer Service: 1.800.472.4346 Sam-9prn.ct. Customer Service: 1.877.344.3402 8:30ani-5:30prn.el. Customer Service: 1.800.845.3550 3:3Wm 5:30prn,,I. Place an Order: 1.800.772.4346 Sanr9pm,et. Place an Order. 1.877.344.3402 3:30am-5:301)m,et. Place an Order: 1.800.845.3550 8:30am-5:301)m,et. Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.885.2253 24 liums. Fax an Order. 1_800.533.4793 24 Hours. Internet: www.heiiryscheiii.com/medical E-Commerce Support: 1.800.711.6032 Sam—bpm;et. Internet: www.henryschein.com/ems E-Mail: custservghenryschein.corn Internet: www.henryschein.com/340B E-Mail: scott.bruner@henryschein.com E-Mail: customecsupport0henryschein.com Please see.:http://wwiv.Henryschein.com,'US-EN;Medical/LegaiTerms.ASPX for Conditions R.Fxcepfions. ORDER# ORDER DATE I IDUE DATE 23070944 10/06/14 11/05/14 D&B#:O 1-243-0880 WHSEDEA# RHO162494 Fed ID: 11-3136595 t;g, ggw Mvw zi nm This order has been processed by our MIDWEST D.C. 5315 WES" 74TH 3TREET INDIANAP LIS,IN 46268 1 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 20 20 6.50 130.00 3 2 499-5557 24/CA INSTANT HEAT PACKS DISPOS 2 2 *C 12.98 25.96 2 _-ASE GOOD IrEM, MAY BE SHIPPED SEPARATELY. 3 499-6870 EA ET TUBE UNCUFFED 3.0 5 5 0.95 4.75 3 4 499-7629 EA ET TUBE CUFFED 7.0 20 20 1.03 20.60 3 PLEASE REFE Z TO BACK OF PAPERWORK FOR DISCLOS JRES/TE ZMS OF SALE MERCHANDI E TOTAL 181.31 Invoice Date + 30 days 181.31 Please remi: payments only to the following aldress: Henry Scheii, Inc. Dept CH 10211 Palatine, 1, 60055-0241 BILL TO SHIP TO INV OICE# TNVO iCE AMOUNT ITEM STATUS KEY REM KEY B-Backordered:Item will follow SK-School Kit 1308571 1817102 3284984-01 181 .31 D Discontinued:Item no longer available NC-No Charge F Special Schein Free Goods ORDER# ORDER DATE INVOICE DATE 4 OF BOXES M-Manufacturer will ship Item directly to you 11 prescription Drug:Return Authorization Required 23070944 10/06/14 10/06/14 3 R Refrigerated Item:May he shipped separately $ Special Schein pricing CUSTOMER PO# PAGEO T-Taxable Item � -Temporanly unavailable:please reorder TOM 10/06/14 1 OF 1 -Item has MSDS LP300