HomeMy WebLinkAbout315569 8/30/2017 "`• CITY OF CARMEL, INDIANA VENDOR: 355031
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ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH QVRQ9 AMOUNT: $********83.00*
�; CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 315569
+ CHICAGO IL 60677-7001 CHECK DATE: 08/30/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1120 4340799 499442 83.00 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
August 16, 2017
Bill to: Accounts Payable For: Carmel Fire Department
City of Carmel 08/17
1 Civic Square
Carmel, IN 46032- _
Invoice#499442 �-
Proc Code Date Description Q_yt Charge Receipt Adjust Balance
80301 08/06/2017 Rapid 5 Panel UDS 1.00 51.00 51.00
82075 08/06/2017 Breath Alcohol Test 1.00 32.00 32.00
Carson M Joehl XXX-XX-3784 Balance Due: 83.00
Invoice# 499442 Balance Due: 83.00
Please remit payment promptly
O�.r1
Cut and return with payment