HomeMy WebLinkAbout306962 01/12/17 (9)
CITY OF ARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CWRQ% AMOUNT: $*******141.00*
CARMEL, I DIANA 46032 7169 GO IUL ION CENTER
7001 CHECK NUMBER: 306962
CHECK DATE: 01/12/17
DEPARTMENT ACCOUNT PO NUMBtR INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 476744 141.00 MEDICAL FEES
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Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
�I FEIN: 35-1955223 � {
DEC � a2016
BY:
Invoice
December 15, 2016
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 12/16
1411 E. 1 I 6th St.
Carmel, M 46032-
Invoice# 476744
Proc Code Date Descriptigo QtV Charge Receipt Adjust Balance
746404 12/08/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Christian I Franklin Balance Due: 47.00
746404 12/13/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alexandra J Lemen Balance Due: 47.00
746404 11/29/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Lauren M Phillips Balance Due: 47.00
Invoice# 476744 Balance Due: 141.00
Please remit payment promptly
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Cut and returnwi h payment