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Home My WebLink About214086 10/23/2012 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: $1,138.26 10330 N MERIDIAN ST SUITE 340 CHECK NUMBER: 214086 INDIANAPOLIS IN 46290 CHECK DATE: 10/23/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 13026 1, 138 . 26 SPECIAL DEPT SUPPLIES St. Vincent Hospital & Healthcare Center, Inc. Invoice Attn:Jeremy Zimmerman 10330 N.Meridian, Suite 430 DATE INVOICE# Indianapolis, IN. 46290-1024 10/15/2012 13026 BILL TO Carmel Fire EMS Attn: Accounts Payable 2 Carmel Civic Square Carmel, IN 46032 TERMS Due on receipt DESCRIPTION AMOUNT EMS Supplies purchased Sept. 2012 billed in Oct. 2012 1,138.26 Medical Supplies: $ 0.00 Transfer - Drugs: 1,13 8.26 TOTAL: $1138.26 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 $1,138.26 are paying on check/stub. Thank you!! Inquiries:Jeremy Zimmerman Payments/Credits $0.00 317.583.3223 jrzimmer @stvincent.org Balance Due $1,138.26 Control Controll Control Contro12 TotalPic TotalPicl 02-8213 Carmel Fire Department Acetaminophen Tab 325 MG TYLENOL Tab 325 MG 3000 EA 1 $0.01 02-8213 Carmel Fire Department Albuterol SULF NEB SOL(0.083%) ALBUTEROL SULFATE 0.083%NEB SOL(0.083%) 3 ML 34 $6.80 02-8213 Carmel Fire Department AMIODARONE HCL INJ 50 MG/mL AMIODARONE HYDROCHLORIDE INJ 50 MG/mL 3 ML 3 $2.37 02-8213 Carmel Fire Department Aspirin Tab Chew 81 MG ASPIRIN Tab Chew 81 MG 750 EA 72 $2.16 02-8213 Carmel Fire Department Atropine Sulfate INJ-SYRNG 1 MG/10 mL ATROPINE SULFATE INJ-SYR 1 MG/10 mL 10 ML 8 $54.24 02-8213 Carmel Fire Department CALcium CHLORide INJ-SYRNG 100 MG/mL CALcium CHLORide INJ-SYRNG 100 MG/mL 10 ML 13 $87.23 02-8213 Carmel Fire Department Dextrose INJ-SYRNG 50% DEXTROSE INJ-SYRNG 50% 50 mL 1 $8.55 02-8213 Carmel Fire Department DiphenhydrAMINE INJ 50 MG/mL DIPHENHYDRAMINE HYDROCHLORIDE INJ 50 MG/mL 1 ML 8 $4.56 02-8213 Carmel Fire Department EpiNEPHrine HCL INJ 0.1 MG/ML EPINEPHRINE HCL INJ 0.1 MG/ML 10 ML 32 $126.72 02-8213 Carmel Fire Department Epinephrine INJ 1 MG/ML EpiNEPHrine INJ 1 MG/ML 30 ML 2 $10.86 02-8213 Carmel Fire Department Glucagon INJ 1 MG GLUCAGEN DIAG. KIT INJ 1 MG 1 EA 5 $426.45 02-8213 Carmel Fire Department Glucose(Dextrose)GEL 40% GLUTOSE 15 GEL 40% 15 GM 1 $5.81 02-8213 Carmel Fire Department Lidocaine HCL INJ-SYRNG 100 MG LIDOCAINE HCL INJ-SYRNG.100 MG 5 ML 5 $11.55 02-8213 Carmel Fire Department Lidocaine HCL JELLY 2%30 GM LIDOCAINE JELLY 2%JELLY 2%30 GM 30 5 $29.25 02-8213 Carmel Fire Department Magnesium SULF INJ 500 MG/mL MAGNESIUM SULFATE INJ 500 MG/mL 10 ML 16 $45.60 02-8213 Carmel Fire Department Naloxone INJ 1 MG/ML NALOXONE HCL INJ 1 MG/ML 2 ML 20 $245.40 02-8213 Carmel Fire Department Nitroglycerin Tab 0.4 MG NITROSTAT Tab 0.4 MG 25 4 $33.04 02-8213 Carmel Fire Department Ondansetron INJ 2 mg/mL ONDANSETRON INJ 2 mg/mL 2 ML 8 $2.56 02-8213 Carmel Fire Department Ondansetron Tab ODT 4 MG ONDANSETRON Tab ODT 4 MG 30 EA 17 $2.89 02-8213 Carmel Fire Department Sodium Bicarbonate INJ 4.2% SODIUM BICARBONATE INJ 4.2% 10 ML 2 $8.66 02-8213 Carmel Fire Department SODium CHLORide iNJ 0.9% 1000 mL SODium CHLORide 0.9%INJ 0.9%1000 mL 1000 ML 25 $19.75 02-8213 Carmel Fire Department SODium CHLORide INJ 0.9%500 mL SODium CHLORide 0.9%INJ 0.9%500 mL 500 ML 5 $3.80 02-8213 Carmel Fire Department Total $1,138.26 Irescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 4n invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered, by Nhom, 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)) 13026 $1,138.26 1 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 $1,138.26 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 13026 1 102-390.11 I $1,138.26 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 OCT 22 2012 d Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund