HomeMy WebLinkAbout205999 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 360209 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL
CARMEL, INDIANA 46032 ATTN' J ZIMMERMAN, ACCT REPTNG CHECK AMOUNT: $427.30
10330 N MERIDIAN ST SUITE 340
CHECK NUMBER: 205999
INDIANAPOLIS IN 46290
CHECK DATE: 1/31/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 12835 427.30 SPECIAL DEPT SUPPLIES
A Vincent Hospital Healthcare Center, Inc. Invoice
Attn: Jeremy Zimmerman, Acct Rptg
10330 N. Meridian St., Suite 430 North DATE INVOICE
Indianapolis, IN 46290 -1024 $t.VinCent
1/13/2012 12835
BILL TO
Carmel Fire EMS
Attn: Accounts Payable
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased Dec 2011 billed in Jan. 2012 427.30
Medical Supplies:
Transfer Drugs: 427.30
TOTAL: $427.30
See Attached
Any questions regarding the above charges can be directed to:
Pete Dillman, Program Director Emergency Medical Services
Phone: 317- 338 -7272
1- 8766 -1464. Please notate invoice number that you Total $427.30
are paying on check/stub. Thank you!!
Inquiries: Jeremy Zimmerman payments /Credits $0.00
317.583.3223
jrzimmer @stvincent.org Balance Due $427.30
r,
Control Controll Control Contro12 TotalPic TotalPicl
02 -8213 Carmel Fire Department ADENOSINE INJ 6 MG ADENOSINE INJ 6 MG 2 ML 1 $2.81
02 -8213 Carmel Fire Department Albuterol SULF NEB SOL (0.083 ALBUTEROL SULFATE 0.083% NEB SOL (0.083 3 ML 28 $5.60
02 -8213 Carmel Fire Department Albuterol SULF SOL 2.5 mg /0.5 mL (0.5 ALBUTEROL SULFATE SOL 2.5 mg /0.5 mL (0.5 0.5 ML 35 $12.60
02 -8213 Carmel Fire Department AMIODARONE HCL INJ 50 MG /mL AMIODARONE HYDROCHLORIDE INJ 50 MG /ml- 3 ML 10 $7.90
02 -8213 Carmel Fire Department Aspirin Tab Chew 81 MG ASPIRIN Tab Chew 81 MG 750 EA 144 $4.32
02 -8213 Carmel Fire Department Atropine Sulfate INJ -SYRNG 1 MG/ 10 mL ATROPINE SULFATE INJ -SYR 1 MG/ 10 mL 10 ML 9 $63.45
02 -8213 Carmel Fire Department Dextrose DOPamine INJ 400 MG /250 mL DEXTROSE /DOPamine HCL INJ 400 MG /250 mL 250 ML 12 $76.20
02 -8213 Carmel Fire Department Dextrose INJ -SYRNG 50% DEXTROSE INJ -SYRNG 50% 50 mL 6 $54.24
02 -8213 Carmel Fire Department EpiNEPHrine HCL INJ 0.1 MG /ML EPINEPHRINE HCL INJ 0.1 MG /ML 10 ML 24 $98.64
02 -8213 Carmel Fire Department Epinephrine INJ 1 MGAAL EpiNEPHrine INJ 1 MG /ML 30 ML 2 $10.86
02 -8213 Carmel Fire Department Glucose (Dextrose) GEL 40% GLUTOSE 15 GEL 40% 15 GM 4 $23.24
02 -8213 Carmel Fire Department Lactated Ringers INJ LACTATED RINGER'S INJ 1000 ML 1 $0.90
02 -8213 Carmel Fire Department Nitroglycerin Tab 0.4 MG NITROSTAT Tab 0.4 MG 25 2 $15.44
02 -8213 Carmel Fire Department Ondansetron INJ 2 mgimL ONDANSETRON INJ 2 mg /mL 2 ML 6 $1.92
02 -8213 Carmel Fire Department Ondansetron Tab ODT 4 MG ONDANSETRON Tab ODT 4 MG 30 EA 4 $0.68
02 -8213 Carmel Fire Department Pot Nit/ Silver Nit SWA 25 -75% SILVER NITRATE SWA 25 -75% 100 EA 10 $2.80
02 -8213 Carmel Fire Department Sodium Bicarbonate INJ 4.2% SODIUM BICARBONATE INJ 4.2% 10 ML 6 $31.86
02 -8213 Carmel Fire Department Sodium Chloride INJ 0.9% 1000 mL SODium CHLORide 0.9% INJ 0.9% 1000 mL 1000 ML 12 $9.48
02 -8213 Carmel Fire Department Sodium Chloride INJ 0.9% 50 mL SODium CHLORide 0.9% INJ 0.9% 50 mL 50 ML 4 $3.60
02 -8213 Carmel Fire Department Sodium Chloride INJ 0.9% 500 mL SODium CHLORide 0.9% INJ 0.9% 500 mL 500 ML 1 $0.76
$427.30
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
12835 $427.30
I 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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
St. Vincent Hospital
Attn: Jeremy Zimmerman, Acct. Reporting IN SUM OF
10330 N. Meridian Street, Ste. 430 N
Indianapolis, IN 46290
$427.30
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO# Dept. INVOICE NO. ACCT #!TITLE AMOUNT Board Members
1120 I 12835 1 102 390.11 I $427.30 1 hereby certify that the attached invoice(s), or
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
JAN 3 0 Z 11
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund