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HomeMy WebLinkAbout313554 07/10/17 ``u ��'*'� CITY OF CARMEL, INDIANA VENDOR: 355031 ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH eARQK AMOUNT: $********94.00* :# _� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 313554 �biTON�. CHICAGO IL 60677-7001 CHECK DATE: 07/10/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1081 4340700 490059 94.00 MEDICAL FEES C) 0 0 z CA) -1 2 0 0 P E 0 0 - k % 2 0 \ k (n m 0 0 2 ƒ ƒ co § co k e A ƒ % 03 0 m ¢ 2 0 & ® 2 4 § 0 m o LA. q ) 0 # 44 £ \ 0 7 � q � d C \ 40 + > P 2 O 2 o 2 co � k 0 CO 2 R 2 CD « ] n / D 0 n f ¢ J i \ E &® ®aCL q 0 © S o q- / R ƒ m- Z 0 C- 3 (D k @ \ \ k 7 2 2 7 $ / S C? 0 m / 0 / C C \ k 0 m & & 0 k » A 2 a / CL 81 \ M CD � | 0 o Community Occupational Health Svs �t 7169 Solution Center ' Chicago, IL 60677-7001 2017 Phone: 317-621-0341 JUN 2 9 FEIN: 35-1955223 BY: Invoice May 02, 2017 Bill to: Lynn Russell For: Carmel Clay Parks &Recreation Carmel Clay Parks &Recreation 04/17 1411 E. 116th St. Carmel, IN 46032- Invoice# 490059 Proc Code ICD Date Description QtV Charge Receipt Adjust Balance 746404 1) 04/28/2017 Drug Screen-Non NIDA 5 Panel 1,00 47,00 47.00 S90.512A 2) W23,OXX A Kiya D Eldridge Balance Due: 47.00 746404 04/29/2017 Drug Screen-Non NIDA 5 Panel 1.00 47,00 47,00 Xia Liu Balance Due: 47.00 Invoice# 490059 Balance Due: 94.00 Please remit payment promptly Cut and return with payment