HomeMy WebLinkAbout310297 04/18/17 9, )
CITY OF CARMEL, INDIANA VENDOR: 355031
ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTHWPtQK AMOUNT: S********76.00*
CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 310297CHICAGO IL 60677-7001 CHECK DATE: 04/18/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340799 485876 76.00 OTHER MEDICAL FEES
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Community Occupational Health Svs
7169 Solution Center
Chicago, IL 60677-7001
Phone: 317-621-0341
FEIN: 35-1955223
Invoice
April 04, 2017
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 3/17
1 Civic Square
Carmel, IN 46032-
Invoice# 485876
Proc Code Date Description QtV Charge Receipt Adjust Balance
80301 03/14/2017 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 03/14/2017 Breath Alcohol Test 1.00 32.00 32.00
Jeff W Fuchs XXX-XX-6663 Balance Due: 83.00
Invoice# 485876 Balance Due: 83.00
Please remit payment promptly
Cut and return with payment
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Please remit 83.00 to Community Occupational Health Services
7169 Solution Center
Please place invoice number 485876 on check Chicago,IL 60677-7001
Phone: 317-621-0341