306858 1/06/17 J`� s CITY OF CARMEL, INDIANA VENDOR: 371298 CHECK AMOUNT: $*****1,442.45"
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ONE CIVIC SQUARE MDX MEDICAL INC
,� CARMEL, INDIANA 46032 1VITALS
60 CHUBB AVE SUITE 301 CHECK NUMBER: 306858
'''�roii��O' LYNDHURST NJ 07071 CHECK DATE: 01/06/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
301 5023990 15093 1,442.45 OTHER EXPENSES
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Invoice
MDx Medical, Inc. Date 12/14/2016
Vitals Invoice# 15093
160 Chubb Ave. Terms Due on Receipt
Suite 301
Lyndhurst NJ 07071 Due Date 12/14/2016
PO# MONTHLY ADMIN FEE
Memo December 2016
Bill To
City of Carmel
1 Civic Square
Carmel IN 46032
Description Quantity
SmartShopper PMPM Admin Fee for December 2016 1,697 0.85 1,442.45
Submitted To
1,442.45—
F
0 3 2017
Clerk Treasurer
We appreciate your prompt payment. Total $1,442.45
Payment by ACH Mailing Address for Checks
Silicon Valley Bank PLEASE NOTE OUR NEW ADDRESS BELOW:
3003 Tasman,Santa Clara,CA 95054 Vitals
Account Name:MDx Medical Inc. Accounts Receivable
Account#3300783836 160 Chubb Ave
ACH ABA Routing#121140399 Suite 301
Lyndhurst, NJ 07071