HomeMy WebLinkAbout318106 10/31/17 am c�qM
�;. '� CITY OF CARMEL, INDIANA VENDOR: 355031
(y ONE CIVIC SQUARE COMMUNITY OCCUPATIONAL HEALTH CMEOK AMOUNT: $********94.00*
,; ?� CARMEL, INDIANA 46032 7169 SOLUTION CENTER CHECK NUMBER: 318106
";', CHICAGO IL 60677-7001 CHECK DATE: 10/31/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1081 4340700 505280 94.00 MEDICAL FEES
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Community Occupational Health Svs
7169 Solution Center
RECr jV'�D Chicago, IL 60677-7001
Phone: 317-621-0341
0 C T 2 3 201 7 FEIN: 35-1955223
BY:
Invoice
October 19, 2017
Bill to: Lynn Russell For: Carmel Clay Parks &Recreation
Carmel Clay Parks &Recreation 10/17
1411 E. 116th St.
Carmel, IN 46032-
_Invoice#� 505280
Proc Code Date Description Q_yt Charge Receipt Adjust Balance
746404 10/04/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Payton Cirrincione Balance Due: 47.00
746404 10/11/2017 Drug Screen-Non NIDA 5 Panel 1.00 47.00 47.00
Anna E Gans Balance Due: 47.00
Invoice# 505280 Balance Due: 94.00
Please remit payment promptly
Cut and return with payment