331679 10/25/18 � � CITY OF CARMEL, INDIANA VENDOR: 360209
® ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $*****1,772.43*
CARMEL, INDIANA 46032 ATTN:KRISTINE BROWN CHECK NUMBER: 331679
9;�*oN:�r' 4040 VINCENNES CIRCLE 4-NW-31 CHECK DATE: 10/25/18
INDIANAPOLIS IN 46268
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 14160 1,772.43 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201(Rev.1995)
Vendor# 360209 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ST VINCENT HOSPITAL IN SUM OF$ CITY OF CARMEL
ATTN: KRISTI N E BROWN An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
4040 VINCENNES CIRCLE 4-NW-31 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46268
Payee
$1,772.43
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
14160 42-390.11 $1,772.43 1 hereby certify that the attached invoice(s),or 10/23/18 14160 EMS Supplies $1,772.43
1120 102 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
Tuesday, October 23,2018
Dam -Z�- ----7�V"
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
4040 Vincennes Circle DATE INVOICE#
4-NW-31 10/22/2018 14160
Indianapolis,IN 46268
BILL TO
Carmel Fire EMS
Attn: Denise Snyder
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased
September 2018
September 2018 There were no supplies purchased
Pharmacy Supplies - September 2018 1,772.43
46029-160085-65100. Please note invoice number Total $19772.43
that you are paying on check/stub. Thank you!
Payments/Credits $0.00
Balance Due $19772.43
Pharmacy Orders
9/1/2018 through 9/30/2018
CARMEL FIRE 46029-704025-32154 TOM PAYNE
DEPARTMEN 00000 317-571-2630
T FIRE/AMB
(CC 32154) Date Ordered Pharmacy McKesson# Generic Name Brand Name Strength Form Package Size EA Quantity Quantity Total Price
Ordered Sent
9/18/2018 CAR-St Vincent 1718659 ONDANSETRO ZOFRAN 4MG INJ Ea 25 25 6.75
Carmel Pharmacy N 4MG INJ
9/18/2018 CAR-St Vincent 1753689 ADENOSINE ADENOCARD 6M INJ Ea 20 20 45.00
Carmel Pharmacy 6MG INJ
9/26/2018 CAR-St Vincent 2705077 Ketorolac Toradol 60mg/2 vial 25's NULL 25 25 23.50
Carmel Pharmacy 60mg/2ml vial ml
9/26/2018 CAR-St Vincent 1219278 Aspirin 81mg Aspirin 81mg chew 750's NULL 72 72 1.44
Carmel Pharmacy chew tablet tablet
9/26/2018 CAR-St Vincent 2247609 Methylprednis Solu-Medrol 125mg vial 25's NULL 5 5 33.70
Carmel Pharmacy olone Sodium
Succinate
125mg vial
9/26/2018 CAR-St Vincent 3556065 Nitroglycerin Nitrostat 0.4mg tablet bottle of 25 NULL 8 8 127.84
Carmel Pharmacy Sublinqual
0.4mg tab
9/26/2018 CAR-St Vincent 1482538 Sodium Sodium 0.90% 100Dm1 14's NULL 28 28 56.56
Carmel Pharmacy Chloride 0.9% Chloride 1V bag
1000ml IV Bag
9/26/2018 CAR-St Vincent 1718659 ONDANSETRO ZOFRAN 4MG INJ Ea 25 25 6.75
Carmel Pharmacy N 4MG INJ
9/26/2018 CAR-St Vincent 1763093 EPINEPHRINE ADRENALIN 30 MG INJ Ea 5 5 330.40
Carmel Pharmacy 1MG/ML30ML MDV
1
9/26/2018 CAR-St Vincent 2720340 ATROPINE ATROPINE 1 MG INJ Ea 10 10 72.40
Carmel Pharmacy 1.0MG
SYRINGE
9/26/2018 CAR-St Vincent 2720456 SOD SODIUM 50 MEQ, INJ EA EA 10 SO 111.80
Carmel Pharmacy BICARBONATE BICARB SYR
7.5%SYR
SOMEQ 50ML
ADULT
Pharmacy Orders
9/1/2018 through 9/30/2018
CARMEL FIRE , 9/26/2018 CAR=St Vincent 2720539 CA CHOLRIDE CALCIUM 1 GM INl EA 10 10 72.90
'DEPARTMEN Carmel Pharmacy 1Y21N SYR 10M CHLORIDE
'T FIRE/AMB 9/26/2018 CAR-St Vincent 3519857 GLUCAGON GLUCAGON 1 MG INl Ea 5 5 511.85
{CC 32154) Carmel Pharmacy 1MG KIT
9/26/2018 CAR-St Vincent 1131093 NALOXONE NARCAN 2MG/2M INl 10 EA 10 10 279.40
Carmel Pharmacy 2MG/2ML L
SYRINGE
9/27/2018 CAR-St Vincent 2452407 Dextrose 40% Glutose Lemon 40% oral 1 tube NULL 9 9 26.64
Carmel Pharmacy Gel 37.Sgm suspen
sion
9/27/2018 CAR-St Vincent 2787505 Dextrose Dextrose 50% 50ml 10's NULL 10 10 65.50
Carmel Pharmacy Syringe 50% Syringe syringe
50ml
277 277 1772.43