HomeMy WebLinkAbout250855 10/21/15 ,Coq
M' CITY OF CARMEL, INDIANA VENDOR: 360209
® f ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $**.....378.02*
CARMEL, INDIANA 46032 ATTN:KATREENASHIREY CHECK NUMBER: 250855
' .oN. .` 10330 N MERIDIAN ST SUITE 430 CHECK DATE: 10/21/15
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 13638 378.02 SPECIAL DEPT SUPPLIES
St. Vincent Hosp & Healthcare Center, Inc. Invoice
Attn: Carolyn Terry, Acct Rptg
10330 N. Meridian St., Suite 430 North DATE INVOICE#
Indianapolis, 1N 46290-1024 9/30/2015 13638
BILL TO
Carmel Fire EMS
Attn: Denise Snyder
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased September 2015 378.02
Medical Supplies: 0.00
Transfer Drugs: 378.02
Total September due: $378.02
46029-160085-65050. Please nolo invoice number Total $378.02
that you are paying on checklstub. Thank you!
Inquiries: Carolyn Terry Payments/Credits $0.00
CMTerry@stvincent.org Balance Due $378.02
Control Controll Control Contro12 TotalPic TotalPicl
02-8213 Carmel Fire Department Acetaminophen Tab 325 MG TYLENOL Tab 325 MG 3000 EA 3 0.03
02-8213 Carmel Fire Department ADENOSINE INJ 6 MG ADENOSINE INJ 6 MG 2 ML 3 6.75
02-8213 Carmel Fire Department AMIODARONE HCL INJ 50 MG/mL AMIODARONE HCL INJ 50 MG/mL 3 ML 1 5.81
02-8213 Carmel Fire Department Aspirin Tab Chew 81 MG ASPIRIN Tab Chew 81 MG 750 EA 108 3.24
02-8213 Carmel Fire Department Atropine Sulfate INJ-SYRNG 1 MG/10 mL ATROPINE SULFATE INJ-SYR 1 MGI 10 mL 10 ML 1 7.69
02-8213 Carmel Fire Department CALcium CHLORide INJ-SYRNG 100 MG/mL CALcium CHLORide INJ-SYRNG 100 MG/mL 10 ML 3 21.87
02-8213 Carmel Fire Department Dextrose-DOPamine INJ 400 MG/250 mL DEXTROSE/DOPamine HCL INJ 400 MG/250 mL 250 ML 2 22.76
02-8213 Carmel Fire Department Dextrose INJ-SYRNG 50% DEXTROSE INJ-SYRNG 50% 50 mL 5 42.75
02-8213 Carmel Fire Department DiphenhydrAMINE INJ 50 MG/mL DIPHENHYDRAMINE HYDROCHLORIDE INJ 50 MG/mL 1 ML 4 2.24
02-8213 Carmel Fire Department EpiNEPHrine HCL INJ 0.1 MG/ML EPINEPHRINE HCL INJ 0.1 MG/ML 10 ML 17 73.1
02-8213 Carmel Fire Department Epinephrine INJ 1 MGIML EpiNEPHrine INJ 1 MG/ML 30 ML 1 2.54
02-8213 Carmel Fire Department FentaNYL INJ 100 MCG/2 mL FENTANYL CITRATE INJ 100 MCGI 2 mL 2 ML 15 11.25
02-8213 Carmel Fire Department Glucose(Dextrose)GEL 40% GLUTOSE 15 GEL 40% 15 GM 1 5.81
02-8213 Carmel Fire Department Lidocaine HCL JELLY 2%30 GM LIDOCAINE JELLY 2%JELLY 2%30 GM 30 1 5.63
02-8213 Carmel Fire Department MIDAZOLAM INJ 10 MG/2 mL MIDAZOLAM HCL INJ 10 MG/2 mL 2 ML 5 4.2
02-8213 Carmel Fire Department Naloxone INJ 0.4 MG/ml- NALOXONE HCL INJ 0.4 MG/mL 1 ML 2 28.8
02-8213 Carmel Fire Department Naloxone INJ 1 MG/ML NALOXONE HYDROCHLORIDE INJ 1 MG/ML 2 ML 3 84.33
02-8213 Carmel Fire Department Nitroglycerin Tab 0.4 MG NITROSTAT TAB 0.4 MG 100 ea 1 11.97
02-8213 Carmel Fire Department Ondansetron INJ 2 mg/mL ONDANSETRON INJ 2 mg/mL 2 ML 9 2.97
02-8213 Carmel Fire Department Racemic Epinephrine SOL 2.25%UD S-2 INHALANT SOL 2.25%UD 0.5 ML 3 3.45
02-8213 Carmel Fire Department Sodium Bicarbonate INJ 7.5% SODIUM BICARBONATE INJ 7.5% 50 ML 1 10.44
02-8213 Carmel Fire Department Sodium Chloride INJ 0.9% 1000 mL SODium CHLORide 0.9%INJ 0.9%1000 mL 1000 ML 21 16.59
02-8213 Carmel Fire Department Sodium Chloride INJ 0.9%500 mL SODium CHLORide 0.9%INJ 0.9%500 mL 500 ML 5 3.8
378.02
Drescribed 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
✓vhom, 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))
13638 $378.02
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
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
$378.02
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120 13638 102-390.11 $378.02 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
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1-111-141V'c l
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund