333597 12/14/18 �� p"�• CITY OF CARMEL, INDIANA VENDOR: 360209
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $*****1,947.37*
s? ?�: CARMEL, INDIANA 46032 ATTN:DEBBIE NUN14ALLY CHECK NUMBER: 333597
.v i7roN"cam _ 4040 VINCENNES CIRCLE 4-NW-29 CHECK DATE: 12/14/18
INDIANAPOLIS IN 46268
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 14194 1,947.37 SPECIAL DEPT SUPPLIES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 360209 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
ST VINCENT HOSPITAL IN SUM OF$ CITY OF CARMEL
ATTN: DEBBIE N U N NALLY An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
4040 VI NCEN N ES CIRCLE 4-NW-29 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46268
Payee
$1,947.37
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
14194 42-390.11 $1,947.37 1 hereby certify that the attached invoice(s),or 12/11/18 14194 EMS Supplies $1,947.37
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, December 11,2018
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 Debbie Nunnally
4040 Vincennes Circle DATE INVOICE#
4-NW-29 12/11/2018 14194
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
Pharmacy Supplies -November 2018 1,947.37
46029-160085-65100. Please note invoice number Total $19947.37
that you are paying on check/stub. Thank you!
Payments/Credits $0.00
Balance Due $19947.37
Pharmacy Orders
11/1/2018 through 11/30/2018
m --. --
',CARMEL`FIRE 46 _ .029-704025 32154 TOM PAYNE t
DEPARTMEN a
00000
417-571-2630
IT FIRE/AMB .._
(CC 32154) 'i Date Ordered Pharmacy McKesson# Generic Name Brand Name Strength Form Package Size EA Quantity Quantity Total Price
't Ordered Sent
11/9/2018 CAR-St Vincent 3590429 SODIUM NORMAL 0.9% INJ 30 EA 360 360 68.40
Carmel Pharmacy CHLORIDE 0.9% SALINE
e
FLUSH SYRINGE
10ML
;I 11/20/2018 CAR-St Vincent 2720621 EPINEPHRINE EPINEPHRINE O.1MG/ INJ 10 EA 40 40 160.00
Carmel Pharmacy O.1MG/ML ML 10ML
j°
10ML SYRINGE
(BRISTOJECT)
'i 11/23/2018 CAR-St Vincent 3241114 Ondansetron Zofran ODT 4mg tablet 30's NULL 150 150 55.50
- Carmel Pharmacy 4mg ODT
1 M
t
�4 11/23/2018 CAR-St Vincent 1451798 Diphenhydrami Benadryl 50mg/ml vial 25's NULL 25 25 14.00
Carmel Pharmacy ne 50mg/ml INJ
11/23/2018 CAR-St Vincent 1796010 Ipratropium/AI Duoneb 0.5mg/3 nebuliz 25's NULL 30 30 8.10
Carmel Pharmacy buterol mg ed soln
0.5mg/3ml neb
11/23/2018 CAR-St Vincent 1482538 Sodium Sodium 0.90% 1000ml 14's NULL 56 56 113.12
Carmel Pharmacy Chloride 0.9% Chloride IV bag
1000ml IV Bag
11/23/2018 CAR-St Vincent 2720340 ATROPINE ATROPINE 1 MG INJ Ea 10 10 72.40
Carmel Pharmacy 1.OMG
SYRINGE
11/23/2018 CAR-St Vincent 3643731 AMIODARONE AMIODARONE 150 INJ 25 EA 25 25 19.00
' Carmel Pharmacy 150MG/3ML MG/3ML
VIAL
11/23/2018 CAR-St Vincent 3519857 GLUCAGON GLUCAGON 1 MG INJ Ea 10 10 1023.70
j Carmel Pharmacy 1MG KIT
I' 11/23/2018 CAR-St Vincent 3601747 CEFAZOLIN 1 CEFAZOLIN 1 GM INJ Ea EA 25 25 13.75
Carmel Pharmacy GRAM VIAL
' 11/23/2018 CAR-St Vincent 2720621 EPINEPHRINE EPINEPHRINE 0.1MG/ INJ 10 EA 30 30 120.00
Carmel Pharmacy O.1MG/ML ML 10ML
$$: { 10MLSYRINGE
y (BRISTOJECT),
Pharmacy Orders
11/1/2018 through 11/30%zois
CARMEL FIIrE` 11/23/2018 CAR-St Vincent 1131093 NALOXONE NARCAN 2.MG/2M INJ 10 EA 10 10 279.40
DEPARTMEN Carmel Pharmacy 2MG/2ML L
T FIRE/AMB'. SYRINGE
771 771 1947.37