HomeMy WebLinkAbout309310 3/22/17 (9)
CITY OF CARMEL, INDIANA VENDOR: 355031 +,f*,,,,ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH�dROK AMOUNT: S 423.00;
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 309310
CHICAGO IL 60677_7001 CHECK DATE: 03/22/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 483760 376.00 MEDICAL FEES
1091 4340700 483760 47.00 MEDICAL FEES
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Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001 R E C E,4T 77sD
Phone: 317-621-0341
FEIN: 35-1955223 LIAR 0 8 2011
BY:
Invoice
March 02, 2017
Bill to: Lynn Russell For: Carmel Clay Parks & Recreation
Carmel Clay Parks & Recreation 02/17
1411 E. 116th St.
Carmel, IN 46032-
Invoice# 483760
Proc Code ICD Date Description Qty Charge Receipt Adjust Balance
746404 02/28/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Joseph A Bainbridge Balance Due: 47.00
746404 02/23/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Keyara J Ballard Balance Due: 47.00
746404 1) 02/28/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
S00.80XA
2)Y93.11
Sean M Farrell Balance Due: 47.00
746404 02/23/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ashley E Kasper Balance Due: 47.00
746404 02/23/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Jamileh Kessilyas Balance Due: 47.00
746404 11/08/2016 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Ethan Mott Balance Due: 47.00
746404 02/24/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Joshua A Smith Balance Due: 47.00
746404 02/28/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Colin R Taylor Balance Due: 47.00
746404 02/23/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Alana G Waldrip Balance Due: 47.00
Invoice# 483760 Balance Due: 423.00
Please remit payment promptly
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