HomeMy WebLinkAbout320537 01/11/18 CITY OF CARMEL, INDIANA VENDOR: 360209 CHECK AMOUNT: $*****1,110.19*
�i ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 ATTN:KRISTINE BROWN,ACCT.RPTNG CHECK NUMBER: 320537
10330 N MERIDIAN ST SUITE 430 CHECK DATE: 01/11/18
INDIANAPOLIS IN 46290
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 14040 1,110.19 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 360209
IN SUM OF$ CITY OF CARMEL
ST VINCENT HOSPITAL
ATTN: KRISTINE BROWN, ACCT. RPTNG An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
10330 N MERIDIAN ST SUITE 430 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46290
Payee
$1,110.19
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
14040 42-390.11 $1,110.19 1 hereby certify that the attached invoice(s),or 12/30/17 14040 $1,110.19
1120 102 Prior Year 1120 102
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Friday,January 05,2018
David Haboush
Fire Chief
hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
St. Vincent Hosp&Healthcare Center, Inc. Invoice .
ATTN: Kristine Brown,Accg Rptg DATE INVOICE#
10330 N.Meridian Street, Suite 430 North
Indianapolis,IN 46290-1024 12/30/2017 14040
BILL TO
Carmel Fire EMS
Attn: Denise Snyder
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased November 2017 0.00
.Medical Supplies November 111.76
Drugs Transferred September.-November-the pharmacy system.used to track 998:43
transfers was manual.
46029-160085-65100. Please note invoice number Total $19110.19
that you are paying on check/stub. Thank you!
Inquiries: Kristine Brown Payments/Credits $0.00
Kristine.Brown@ascension.org Balance Due $19110.19
A4, Carmel Fire Department Pharm-acv Order Form 70 q vZy
Outdate Month:November Date Submitted.-90-30-2097 '
DrugName nng3Qe - . eh M M M Re V C14 M w. v Total
Notes v p et s Filled
ti�, V O O
Acetaminophen 325,thgeP"O ****Individual Ta6lets'count*�"*
r ered
2 7. 9.✓..
Adenosine 6r6g Vial 0
Albuterol 2.5mg/3ml.ud 0,
Amiodarone 150mg 0
ASA, -:.
81 mg Battle `,. . .
Atropine 1 mg bj 3 6 6 6 5 2 _
0 �( - 7� 60
. yO -1 Z ,
Atrovent 11.,ipatropium ' 0.5rh .
Calcium Chloride. .1g bj 0 _
anokit_.,. 5g Kit 2 ✓ g-
1 1 �7�
136W . 50ml 0
Dextrose 25% 10m1 bj 0
Dextrose 50% 25g 0 v�
Diphenhydramine 50mg 0,
Epinephrine 1:1,000 30mg multi
Epinephrine'_1:10,000' 1 mg bj
Glucagon 1mg Val 2 1 2 : 1 6 ,/,
Giucose;:Oral . tubes
Levophed 4.mg/4ml Vial 0 Z. i
Lidocaine Bolus I00mg b' 0
Lidocaine Jelly Tube 0
Ma Sulfate. 5nig viaVbj ,Z?� VIAL 4 1 2 7„
Na Bicarb 44.6 mEq bj 0
Naloxone-(Narcan) 2rrig bj 3. 2
Nitro Tab
Normal saline 0.9% 50m1 0
Normal saline 0.9% 500ml 0
Normal wdine'0.9% 1000m1 0
0dansetron-(Z6fran) 4mg vial 0
Odansetron4Zofran ODT 4mg 2
PredniSONE 20mg Tablet 0
Racemic Epi". , .. 1.1.25mg/.5mL ud2 3 4 2 2. 13 f
Solu-Medrol 125mg vial 0
Toradol=(.Ketorolac F;Omg V' 1
STATION TOTAL: 22 .11 4 18 14 Z 5 1 .5 087 0 ,�
Depatmental Transfer of Supplies date submissed
Requesting Department: Carmel Fire Dept Supplying Department ER Jul-17
Cost Center Cost Center 27230
QUANTITY UNIT COST TOTAL COST
Alcohol preps $0.25 $0.00
Angiocath 14 $1.58 $0.00
Angiocath 16 $1.56 $0.00
Angiocath 18 $1.50 $0.00
Angiocath 20 $1.50 $0.00
Angiocath 20q 1.88 per box $95.00 $0.00
Angiocath 22 $1.50 $0.00
Angiocath 24 $1.55 $0.00
Bandaids
Basin kidney shaped $0.08 $0.00
Basin round $0.31 $0.00
Ca no-Line Sampling ETCO2 Smart Ped per bx $253.00 $0.00
Ca no-Circuit Nasal with Tubing Adult per cs $312.50 $0.00
Ca no-Circuit Nasal with Tubing Adult per cs 100 $940.00 $0.00
Ca no-St filter lin Adlt/ ed 1 case $356.30 $0.00
Coban T Roll ea $1.75 $0.00
Cold paks $0.57 $0.00
Drill Driver Power EZ-10 $295.00 $0.00
EKG Electrodes $3.12 $0.00
Emesis Bas(perpack) $11.52 $0.00
EZ-10 Adult Needles $495.00/box of 5 $99.00 $0.00
EZ-10 Power Driver - $295.00 $0.00
Foam-Quikcare $2.67 $0.00
Guaze, 2 x 2 Cotton bail $1.88 $0.00
Guaze, 2 X 2 Sterile $0.02 $0.00
Gauze 4 X 3 sponge(per box $1.24 $0.00
Gauze 4 x 4 tub $0.32 $0.00
Gauze Kerlex $0.67 $0.00
Gloves-Med $10.35 $0.00
Gloves-Large $10.35 $0.00
Gloves-Marge $10.35 $0.00
IV Adapter, Luerlock 0.151 0.00
IV Dial a flow $3.15 $0.00
IV Extension 19" $1.91 $0.00
IV Lock with Ext $1.87 $0.00
IV Start Kits ea $2.88 $0.00
IV Start Kits Sobraview 100/bx $2.66 $0.00
IV Tubing 10 tt $1.16 $0.00
IV Tubbing 10 tt per case of 48 2 $55.88 $111.76
Kleenex $0.19 $0.00
KY pkt $0.10 $0.00
Kerlix 4.5"x6ply $0.73 $0.00
Lancets per box $57.78 $0.00
Largyngscope Blades Stat 3 box $180.50 $0.00
Largyngscope Blades Stat 4 box $135.74 $0.00
Microdot Xtra Test Strips $29.98 $0.00
Microdot Xtra Control Solutions $12.00 $0.00
Normal Saline 1000 cc bags/ca $9.48 $0.00
Pulse Ox,Adult $5.18 $0.00
Pulse Ox, Peds $5.17 $0.00
Razor, dis oseable $0.12 $0.00
Sca el#11 $1.30 $0.00
Sharps Container $4.59 $0.00
Sterile H2O bottle $0.71 $0.00
Suction Canister&to $3.26 $0.00
Suture Kit 1 $1.09 $0.00
SYR Hypo w/needle $0.25 $0.00
Syringe w/Needle 1 ml $0.07 $0.00
Syringe w/Needle 3 ml $0.05 $0.00
S rin a w/Needle 3 ml per case $35.76 $0.00
Syringe w/Needle 5ml $0.10 $0.00
Syringe w/Needle 5ml.1 case $69.30 $0.00
Syringe w/Needle 10 ml $0.12 $0.00
Syringe 20ml $0.16 $0.00 CFD Supply Forms FY 18
Nov'17
Syringe 30ml $0.42 $0.00
Syringe w Saline 3ml $0.28 $0.00
Syringe w/Saline10ml $0.32 $0.00
10 ml saline vials(per box $9.63 $0.00
Tape 2" 6 rolls/box $1.00 $0.00
Tape 1" $0.50 $0.00
Tape 2"cloth adh $1.29 $0.00
Tape Trans ore 1/2" $1.28
TB ET Cuffed Rediture $1.80
Warm paks $1.46 $0.00
Wound Cleanser $5.04 $0.00
Suction Canister&to $3.26 $0.00
Yankauers $0.34 $0.00
Ambu Ba w/mask-Adult $14.63 $0.00
Ambu Ba w/mask-Adult cs/10 $86.38 $0.00
Ambu Ba w/mask-Peds cs/10 $126.00 $0.00
Ambu Ba w/mask-Infant cs/10 $16.00 $0.00
CPAP Flow-Safe 11 Ez $443.95 $0.00
CPAP mask-1 case/10 $480.00 $0.00
CPAP Adapter Tee Valve $41.20 $0.00
Lg Bitrac Full Face Mask $29.001 0.00
ET Tube Stylette 1 $0.00
Wipes Disenfect 1 $11.521 $0.00
Grand Total $111.76 O
Approved by date
CFD Supply Forms FY 18
Nov'17