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HomeMy WebLinkAbout306270 12/16/16 `���'`� CITY OF CARMEL, INDIANA VENDOR: 355031 ? t`. COMMUNITY OCCUPATIONAL HEALTH WAQK AMOUNT: S'"'"""'"94.00" q ONE CIVIC SQUARE 7169 SOLUTION CENTER CHECK NUMBER: 306270 M,lrtiri-, CARMEL, INDIANA 46032 CHICAGO IL 60677-7001 CHECK DATE: 12/16/16 DESCRIPTION DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT MEDICAL FEES 474820 47.00 1081 4340700 474820 47.00 MEDICAL FEES 1091 4340700 « % \ / k \ 0 k / 2 ae 2 D f { k co 2 / © 2 / o _ 4 -4 \ CO) E g o ] \ A # # q m (Q ? 2 c 00ƒ { o o § q e k \ $ # # o / / 0 / \ � � � � 2 2 -4 \/ K (a U) C) � q o dm / k fo o / o o f 2 z [ m C g \ z / q ƒ 2 k ƒ $ a « ] 9 — L o =r \ Cl) CD E 0 & a a j k D 0 Q \ m - k \ \2 § \ W 2 $ 2 % J 7 2 -uGCD i \ § k @ if / } } CD \ M E 7 \ � \ q k CD � . K o k » / 2 0 o \ ; & cr | $ a ƒ 7 CD 2 m a \ R Community Occupational Health Svs 7169 Solution Center 1!;1 V Chicago, IL 60677-7001 Phone: 317-621-0341 �JI�(; 7 13 FEIN: 35-1955223 13Y. - - Invoice December 02, 2016 Bill to: Lynn Russell For: Carmel Clay Parks & Recreation Carmel Clay Parks &Recreation 11/16 1411 E. 116th St. Carmel, IN 46032- Invoice# 474820 Proc Code ICD Date Description Qty_ Charge Recei t Adjust Balance 746404 11/03/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 Michael J Norris Balance Due: 47.00 746404 1) 11/29/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00 S39.012A 2) Y33.XXX A James Ransford Balance Due: 47.00 Invoice# 474820 Balance Due: 94.00 Please remit payment promptly Cut and return with payment ------------ -------------------------