HomeMy WebLinkAbout247302 07/15/15 CITY OF CARMEL, INDIANA VENDOR: 357526
® ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $*******907..62*
CARMEL, INDIANA 46032 DEPT CH 10241 CHECK NUMBER: 247302 ,
PALATINE IL 60055-0241 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 20556928 333.81 SPECIAL DEPT SUPPLIES
102 4239011 20759185 18.81 SPECIAL DEPT SUPPLIES
102 4239011 20855735 555.00 SPECIAL DEPT SUPPLIES
i
I
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I
i
ORDER4 I ORDER DATE ,UE.DATE
31273403 1 06/19/15 j 07/26/15
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed IDJ 11-3136595
IN
WEEN
1 763-8853 EA TRIAGE TAPE YELLOW 11 11 1.71 18.81
1
PRODUCT IS BEING SHIPPED TO YOU DIRECTLY FROM THE MAqUFACTERER.
---------- --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
LEASE REFE TO BACK OF PAPERWORK FOR DISCLOS ES/TE S OF SALE
------------=--------- _____
MERCHANDI E TOTAL 18.81
Invoice Date + 30 days 18.BI1
lease remi payments only to the following a dress:
Henry Schei , Inc.
Dept CH 10211
Palatine, I 60055-0241
i
BILL TD SHTP TO INVOICEffNVOI AMOUNT ITEM STATUS KEY REMi KEY
B-Backordered:Item will follow SK-School Kit
1308571 1308572 20759185 18 .81 D-Discontinued:Item no longer available NC-No Charge
ORDER ORDER DATE 'INVOI E DATE OF BOXESF-Special t '
M-Manufacctureure r will ship Item directly to you
P-Prescription Drug:Return Authorization Required
31273403 OG/19/15 6/26/15 R-Refrigerated Item:May be shipped separately
CUSTOMER PO# PAGE $ -Special Schein Pricing
T-Taxable Item
TOM 1 OF 1 *1-Item h MISDS unavailable:please reorder
Inclutung offers or promotions,appucame to ine inwificou pi-oaucts1prices;to e r r e if your
purchase(s)are subject to a bundled discount or rebate.Any such discounts must be Equipment:
calculated pursuant to the terms of the applicable purchase offer,promotion,or discount Opened and used equipment may not he returned for credit.Before opening
program.Participation in a promotional discount program Is only permissible In accordance equipment,yve Suggest that you Check the shipping container and packing list t0
with discount program rules.By participation In such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. order
equipment is not returnable.All equipment returns are sublect to a restoclang tee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside read and return all warranty information required immediately upon taking deliverer of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturer s
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,exceptfor Prescription Drug Returns:
additional carrier charges related to special delivery services and hazardous material Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska.Hawaii&Pacific Protectorates: Rx Drugs which Henan Schein has purchased from wholesalers are not returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the code WH.
serrice'to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased by Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that Ute following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delivey�will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2)Returns of Pox Drugs will only be accepted if HSI is notified within 14 calendar days
Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: of receipt of the shipment and valid return authorization is issued by HSI.
d 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge.This charge includes freight through to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(USPS) requires that the healthcare entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount or weight and during the return of the product.To gel a copy of the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S.(50 states): 4)In addition,Pedigree regulations require that tie healthcare entity returning
if your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
nternational Terms&Conditions at henryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freiglhtterms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Title passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
RX PRODUCTS& CUNTROLLED_S.UBSTANCES:--- --2%Cash Sack-or-Maximum-Rawardson-all-purchases with the-Henry Schein —
Regulations require us to limit the sale of Rx and controlled substances only to registered, Credit Card.To apply now;call:1.866.398.9296 or online
licensed healtmash us w professionals.If you area new customer regi tr have recently moved, www.henryschein.coili/cr�diteard Reduce the cost and administration of paying
please furnish us with a copy of your updated state DEA registration.For controlled Y P Y� 9
substances,furnish a copy of your DEA registration verifying your shipping address. Henry Scheirt-Pay electronically(ACH Debt)or set up AutoPay.
Please note that all orders for controlled substances are subject to a due diligence review Please call Customer Service for details.
Process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System pleasevisit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer,
wtiww.henryschein.com/e222;if you prefer to continue using Federal 222 Forms to order you may useyour Henry Schein Credit Card,American Express,visa,MasterCard or
Schedule II controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300.5315 West 74t1t Street • Indianapolis,IN 46268 condifions.All sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory,requirements may appply t0 use or installation of certain products. Open Accounts Receivable:
Be sure to understand and comply wiUi any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henr3jSchein Medical/EMS
Customer Service: 1-800-472.4346 Barrr9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 8:30:un-5:30prn,et.
Place an Order: 1-800-772.43468am-9pm,et. Place an Order. 1.877.344.3402 8:30am-5:30pm,et. Place an Order. 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1.800-329.9109 24 Houis. Fax an Order: 1.888.885.2253 24 Hours. Fax an Order. 1.000.533.4793 24 Hours.
Internet: www.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pin,et. Internet: wvvw.hourVschein.com/Dins
E-Mail: custsery@henryschein.com Internet: %=w-henryschein.com/34011 E-Mail: scoU.brunerQhearyschein.com
E-Mail: customer.support@henryschein.com
Please see:Irttp://wvnv.Henryschein.com/US-ENIMedical/LegalTerms.ASPX for Conditions&Exceplions.
LP300
iORDER# ORDER DATE DUE DATE
31060768 06/12/15 07/22/15
D&B#:01-243-0880
WHSEDEA# RHO162494 FedID:l1-3136595 CONTAINS MULTIPLE INVOICES
No MM
OM 061215!
-----------
1 763-7460 EA TRIAGE BELT WITH POUCH 12 12 15.50 186.00
PRODUCT IS EING SHIPPED TO YOU DIRECTLY FROM THE MA,7UFACTLRER.
2 763-0683 EA TRIAGE TAPE BLACK/WHITE 12 12 2.07 24.84
PRODUCT IS; EING SHIPPED TO YOU DIRECTLY FROM THE MA qUFACTLRER.
3 763-3699 EA TRIAGE TAPE GREEN 12 12 1.71 20.52
PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MATUFACTLRER.
4 763-7371 EA TRIAGE TAPE RED 12 12 1.71 20.52
PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MAMFACTIRER.
5 763-8853-- -EA- TRIAGE TAPE YELLOW 1 1 1.71 1.71
PRODUCT IS 3EING SHIPPED TO YOU DIRECTLY FROM THE MANUFACTLRER.
6 763-0258 EA TRIAGE FLAG KIT 1 1 80.22 80.22'
RODUCT IS EING SHIPPED TO YOU DIRECTLY FROM THE FACT RER.
---------= --------------------------------- ------ ----- ------------- -------
---------- --------------------------------- ------ ----- ------------- -------
i
LEASE REF E e TO BACK OF PAPERWORK FOR DISCLOS ES/TE ZMS OF SALE
MERCHANDI E TOTAL 333.811
1
Invoice Date + 30 days 333.81
BILL T HIP T E INVOICE AMO ITEM STATUS KEY FSK-_Schoohl�lKit
M EY
B-Backordered;Item will follow
1308571 1308572 20556928 333 .81 D-Discontinued;Item no longer available o Carge
F-Special offer
-'
ORDER# ORDER-DATE INVOICE-DATE # OF BOXES M-Manufacturer will Ship Item directly to you
31060768 06/12/15 1 6/22/15 P-Refrigerated
rite Drug;Return shipped
cepa Required
R-Refri erased Item;May be shi ed separately
$ Special Schein
CUSTOMER PO PAGE T-Taxable Item Pricing
U-Item has MSDS unavailable;please reorder Continued On Next Page........
TOM 061215 1 OF 2 g
ORDER - ORDER DATE'_ DUE'.DATE
31060768 06/12/15 07/22/15
D&B#:01-243-0880
WHSE DEA# RHO162494 Fed ID:111-3136595
COME 101-
Um
Please remil. payments only to the following address:
enry Schein, Inc.
Dept CH 102 k.L
Palatine, 1, 60055-0241
I
i
i
I
I
I
i
BILL T INVOICE INVOICE Auto ITEM STATUS KEY REM KEY
B-Backordered;Item will follow SK-Setiool Kit
1308571 1308572 20556928 333 .81 D-Discontinued;Item no longer available NC-Nod Charge
F-Special otter
ORDER# ORDER DATE 'INVOICE DATE 4 OF BOXES
M-Manufacturer will ship Item directly to you
P-Prescription Drug:Return Authorization Required
31060768 06/12/15 6/22/15 R-Refrigerated Item:May be shipped separately
CUSTOMERO -( - ---- _pp g $ -SpecialScheinPricing
T-Taxable Item
TOM 0 61215 2 OF 2 U-Temporarily unavailable:please reorder
•-Item has MSDS
p[irchase(s)are subject to a bundled dlscouid for rebate.Any such discounts must be Equipment:
calculated pursuant to the terms of the applicable purchase offer,promotion,or discould Opened and used equipment may not be returned for credit.Before opening
program.Participation in a promotional discount program is only permissible in accordance equipment,we suggest that you check the shipping container and packing list to
with discount program rules.By participation in such program,you agree that,to your ensure that you are getting exactly what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. in the original unopened packaging,unmarked and properly packaged.Speical order
equipment is not returnable.At equipment returns are subject to a restocking fee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock C'Ex Works"outside read and return all warranty information required immediately upon taking delivery of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturer's
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for Prescon Drug Returns:
additional carder charges related to special delivery services and hazardous material Pleripti
ase note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional treight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska,Hawaii&Pacific Protectorates: Rx Drugs whicti Henry Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air deliver These items will be identified in vour invoice with the code Wit
service to all accounts in Alaska and Hawaii.Customers in the Pacific ProtectoratesRx Drugs vrliich are purchased by Henry Schein directly from tie manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that tie following key elements are met:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items(dangerous goods in accepted quantities and Consumer 1 Only returns due to error in order or delivel�l will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2�Returns of Rx Drugs will only be accepted if HSI is notified within 14 calendar days
Guam.Puerto Rico.U.S.Trust Territories&Urr in Islands: of receipt of the shipment and valid return authorization is issued by HSI.
d 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be Subject to a handling charge.This charge includes freightthrough to complete and return a Prescription Drug Return Authorization form.Federal law
.
the United States Postal Service(USPS p
) requires that the healthcare entity returning Rx Drugs document that the product
• Special delivery orders and hazardous material shipments can be shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount orweight and during the return of the product.To get a copy at the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service,
Outside U.S. 50 slates
)7). 4)In addition,Pedigree regulations require that the healthcare entry returning
If your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
International Terms&Conditions at henrschein.com.Unless otherwise as reed, that the product being returned is the same exact product purchased from HSI.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Jlte passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METi-IOD
_RX PRODUCTS& CONTROLLED SUBSTANCES: 2%Cash-Back-or Maximum-Rewards on-all purchases-with-the Henry-Schein
Regulations require us to limit the sale of Rx and controlled substances only to registered, Credit Card.To apply now,call:1.866.398.9296 or online
licensed healthcare professionals.If you area new customer or have recently moved,
please furnish us with a copy of your updated slate DEA registration.For controlled www.henryschein.coin/creditcard Reduce the cost and administration of paying
substances,furnish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
Please note that all orders for controlled substances are subjectto a due diligence review Please call Customer Service for details.
process.Schedule ii controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System please visit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer.
wom,.henryschein.com/e222;if you prefer to continue using Federal 222 Forms to order you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule If controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 conditions.All sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may apply to use or installation of certain products. Open Accounts Receivable:
Be sure to understand and comply with any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 340B Program Henry Schein Medical/EMS
Customer Service: 1.800.472.4346 8am-9prn,et. Customer Service: 1.877.344.3402 8:30arn-5:30pm.el. Customer Service: 1.800.845.3550 8:30am-5:30pin,et.
Place an Order: 1.800.772.4346 8ani-9pm,et. Place an Order: 1.877.344.3402 8:30am-5:301)m,et. Place air Order 1.800.845.3550 8:30am-5:30pm,et.
Fax an Order. 1.800.329.9109 24 Hours. Fax an Order. 1.888.885.2253 24 Hours, Fax an Order. 1.800.533.4793 24 Hours.
Internet: %vww.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-8pm,at. Internet: www.henryschein.com/erns
E-Mail: custservshenryschein.com Internet: www.henryschein.com/3408 E-Mail: scott.bruner@henryschein.com
E-Mail: custom er.supporttfhenryschein.com
Please see:hdtp:/Jwww.Henryschein.com/US-EN/Medical/LegalTerms.ASPX for Conditions&Exceptions.
LP300
ORDER# ORDER DATE IDUE DATE
31361727 06/23/15 07/23/159
D&B#:01-243-0880
WHSE DEA# RHO 162494 Fed ID:11-3136595
14 ............
1, "�g,-
MIT
at as
lgft, � MW
NO
Phis order!has been processed by our MIDWEST M.C.
5315 WES" 74TH STREET
INDIANAPOLIS,IN 46268
ON 317 2600
1 499-2923 10/CA GRAHAM MEGA MOVER 1500 1 1 C 177.33 177.33 1
1
CASE GOOD IPEM, MAY BE SHIPPED SEPARATELY.
2 499-5558 24/CA INSTANT COLD PACKS DISPOS 3 3 *C 8.21 24.63 4
2ASE GOOD IrEM, MAY BE SHIPPED SEPARATELY.
3 935-6155 50/PK BLUE SENSOR SP ELECTRODES 20 20 12.08 241.60 6
4 890-6868 3/PK LIFEPAK 12 PAPER EKG 5 5 10.66 53.30 6
5 890-4792 EA SHARPSTAR SHARPS CONTAINE 5-QT 10 io 4.17 41.70 5
6 703-0009 EA FIELD GUIDE EMS-ALS VERSI 19TH ED 1 1 16.44 16.44 6
PLEASE REFSZ TO BACK OF PAPERWORK FOR DISCLOSURES/TE ZMS OF SALE
MERCHANDI E TOTAL 555.00
invoice Date + 30 days 555.00
REMY
Y
Sc
c,
be
BILL T 1 0 sHip ro INVOICE# INVOICE AMOUNT e ITEM STATUS KEY SK-School Kie,
B-Backordered:Item will follow NC_No Charge
1308571 1817102 20855735 555.00 D-Discontinued;Item no longer available No
Char,
i ,-Special offer
ORDER# ORDER DATE INV OTCE DATE # OF BOXES M-Manufacturer will ship Item directly to you
P Prescription Drug;Return Authorization Required
31361727 06/23/15 6/23/15 6 R Refrigerated Item;May be shipped separately
$ Special Schein Pricing
CUSTOMER PO# PAGE# T-Taxable It m
U-Temporarily unavailable;please reorder
JON 062315 1 OF 2 Item has MSDS Continued,on Next Page........
_ 7--
ORbBR# -ORDER DATE'_. DUE DATE
31361727 06/23/15 07/23/15
D&B#:01-243-0880
WHSE DEA# RH0162494 Fed ID: 11-3136595
lease remi payments only to the following a dress:
enry Schein, Inc.
ept CH 102 1
alatine, I 60055-0241
I
I
HIP TO i INV I E oicE Amo ITEM STATUS KEY �Schl
B-Backordered;Item will follow
1308571 1817102 208.55735 555.00 D-Discontinued;Item no longer available
` l offer
ORDE ORDER'DATE INVOICE DAT # OF BOXES F-ManuSpecifacturer
M-Manufacturer will ship Item directly to you
I P-Prescription Drug;Return Authorization Required
31361727 06/23/15 ,6/23/15 6 R-Refrigerated Item;May be shipped separately
--- --- - - - $ -Special Schein Pricing
CUSTOMER P - PAGE T-Taxable Item
U-Temporarily unavailable;please reorder
JON 062315 2 OF 2 * -Item has MSDS
purchases)are s6lect to a bundled discount or rebate.Any such discounts must he Euiprnent:
calculated pursuant to the terms of the applicable purchase offer,promotion,or discount Opened and used equipment may not be returned for credit.Before opening
program.Participation In a promotional discount program Is only permissible In accordance equipment,vie suggest that you check the shipping container and packing lislto
with discount program rules.By participation In such program,you agree that,to your ensure that you are getting exacUy what you ordered.Equipment must be returned
knowledge,your practice complies with the discount program requirements. in tie original unopenedpackaging,unmarked and properly packaged.Speical order
equipment is not returnable.At equipment returns are subject to a restocking fee.
DELIVERYTERMS: Equipment is backed by the manufacturer's repair or replacement warranty.Please
Unless otherwise agreed,freight terms are FOB Shipper's Dock('Ex Works"outside read and return all warranty information required immediately upon taking deliver of
North America).Title passes at the time the shipment is loaded at the shipper's dock. your new equipment.Open or defective equipment is subject to the manufacturers
Continental U.S.: warranty.
All orders will be subject to a handling charge.This charge includes freight,except for El scription Drug Relums:
additional carrier charges related to special delivery services and hazardous material Please note that,in order to comply with Federal and State Pedigree requirements,
shipments.Special orders are subject to additional freight charges. Henry Schein's policy on the return of Rx Drugs is as follows:
Alaska,Hawaii&Pacific Protectorates: Rx Drugs which Heng Schein has purchased from wholesalers are riot returnable.
Standard shipping methods provide direct,reduced cost,expedited air delivery These items will be identified in your invoice with the code WH.
service to all accounts in Alaska and Hawaii.Customers in the Pacific Protectorates Rx Drugs which are purchased Gy Henry Schein directly from the manufacturer may
are offered direct surface transport,or postal services for reliable delivery. be returned providing that the following key elements are mel:
No additional surcharges apply,except when special services are requested.
Low-level hazardous items,(dangerous goods in accepted quantities and Consumer 1)Only returns due to error in order or delivew�will be allowed.
Commodity ID 8000)are now available via UPS 2nd-day air. 2 Returns of Rx Drugs will only be accepted jt HSI is notified within 14 calendar days
Guam.Puerto Rico,U.S.Trust Territories&Virgin Islands: of receipt of the shipment and valid return authorization is issued by HSI.
g 3)The Prescription Drug Marketing Act requires any customer returning Rx Drugs
• All orders will be subject to a handling charge.this charge includes freight through to complete and return a Prescription Drug Return Authorization form.Federal law
the United States Postal Service(USPS). requires that the healthcare entity returning Rx Drugs document that the product
• Special defivery orders and hazardous material shipments can be shipped via United was kept under proper storage and handling conditions while in their possession
Parcel Services(UPS)for an additional charge.No minimum order amount orweight and during the return of the product.To gel a copy of the form and proper return
applies.Speak to your International Representative for details. authorization,please contact Customer Service.
Outside U.S. 50 states
4)In addition,Pedigree regulations require that Use healthcare entity returning
If your order is being shipped outside the U.S.(50 states),please refer to the Rx Drugs certifies
International Terms&Conditions at hcnryschein.com.Unless otherwise agreed, that the product being returned is the same exact product purchased from HSI.
freight terms are FOB Shipper's Dock("Ex Works"outside North America). 5)Henry Schein will not issue credit for any returned Rx Drugs which have been
Title passes at the time the shipment is loaded at the shipper's dock. tampered with,are out of date or where the labeling has been altered in any way.
Customer is responsible for compliance with any applicable import requirements. CHOOSE YOUR PAYMENT METHOD
_ _RX PRODUCTS & CONTROLLED SUBSTANCES: 21/6-Cash Back or_Maximum_Rewards_on all purchases with the_Henry Schein
Ragulation`s rregdire us tolrmifUie safe of Rx and controlled substances-onlyt0 registerzd; -Credit Card.To appl�r noui,call:1.866.398.9296 or online .
licensed healthcare professionals.If you are anew customer or have recently moved, www.hen .Td a .com/cre call: d Reduce the cost and administration ofpaying
please furnish us with a copy of your updated stale DFA registration.For controlled ry paV g
substances,fumish a copy of your DEA registration verifying your shipping address. Henry Schein-Pay electronically(ACH Debit)or set up AutoPay.
er Service
Please note that all orders for ronTrolled substances are subject to a due diligence re:�iew Please call Cust om for details.
I .
process.Schedule II controlled substances can be ordered electronically or by mail. For your convenience,we provide several payment alternatives.Orders billed to your
For information on our Controlled Substance Ordering System pleasevisit account may be paid by ACH Debit,Check by Phone,or Check.If you prefer.
www.henryschein.com/e222;if you prefer to continue using Federal 222 Forms to order you may useyour Henry Schein Credit Card,American Express,Visa,MasterCard or
Schedule II controlled substances,please mail the form to: Discover Card when placing your order.All sales are subject to our normal terms and
Henry Schein,Inc.• Suite 300,5315 West 74th Street • Indianapolis,IN 46268 conditions.191 sales are subject to credit approval.Invoices are payable within agreed
REGULATORY REQUIREMENT: terms of sale.
Local regulatory requirements may apply 10 use or installation of certain products. Open Accounts Receivable:
Be sure to understand and comply with any such requirements prior to purchase,use, All unpaid accounts receivable past due are subject to a 1.5%finance charge.
or installation of products.
To arrange for a product return,simply call Customer Service as noted below:
Henry Schein Medical 3408 Program Henry Schein MedlcalfEMS
Customer Service: 1.800.472.4346 8am-9pm,et. Customer Service: 1.877.344.3402 8:30am-5:30pm,el. Customer Service: 1.800.845.3550 3:30am-5:30prn,oL
Place an Order: 1.800.772.4346 Bam-9pm,et. Place an Order. 1.877.344.3402 3:30am-5:301)m,et. Place an Order: 1.800.845.3550 8:30am-5:30pm,et
Fax an Order. 1.aOO.329.9109 24 Hours. Fax an Order: 1.888.885.2253 24 Hours. Fax an Order. 1.800.533.4793 24 Hours.
Internet: wvAv.henryschein.com/medical E-Commerce Support: 1.800.711.6032 8am-Bpm,et. Internet: www.henryschein.com/erns
E-Mail: custserv@henryschein.com Internet: www.henryschein.com/34011 E-Mail: scoU.brun erghenryschein.com
E-Mail: customer.support@henryschein.com
Please see:Irttp://www.Henryschein.com/US-EN/Medical/LegaiTerms.ASPX for Conditions&Exceptions.
LP300
VOUCHER NO. WARRANT NO.
ALLOWED 20
Henry Schein
IN SUM OF$
Dept Ch 10241
Palatine, IL 60055
$907.62 - -I
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#frITLE AMOUNT Board Members
1120 20855735 102-390.11 $555.00 1 hereby certify that the attached invoice(s), or
1120 20556928 102-390.11 $333.81 bill(s) is (are)true and correct and that the
1120 20759185 102-390.11 $18.81 materials or services itemized thereon for
which charge is made were ordered and
received except
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))
20855735 $555.00
20556928 $333.81
20759185 $18.81
I 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