HomeMy WebLinkAbout214323 11/07/2012 CITY OF CARMEL, INDIANA VENDOR. 357526 Page 1 of 1
ONE CIVIC SQUARE HENRY SCHEIN INC
,.� CARMEL, INDIANA 46032 DEPT CH 10241 CHECK AMOUNT $1,270.58
4,,,raM do PALATINE IL 60055-0241 CHECK NUMBER. 214323
CHECK DATE. 1117/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 4358006-01 1, 001 58 SPECIAL DEPT SUPPLIES
102 4239011 4746529-01 269 00 SPECIAL DEPT SUPPLIES
-- HSI 0lZ;ER# ORDER DIE IDUE DATE
04264423 10/15/12 11/14/129
D&B#-Ol 243-0880
WHSE DEA# RHO 162494 Fed ID- 11 3136595 CONTAINS MULTIPLE INVOICES
.......... gym.
mn
,C
ME,
This order as been processed by our MIDWEST 1) C
5315 WES" 74TH STREET
INDIANAPOLIS,IN 46268
1ARK
175712663
174288784
1 857-0670 EA BERMAN AIRWAY 70MM SZ 2 12 12 0 27 3 24 7
2 857-0680 EA BERMAN AIRWAY SOMM SZ 3 12 12 0 27 3 24 8
3 857-6255 EA BERMAN AIRWAY 90MM SZ 4 12 12 0 27 3 24 7
4 857-9780 EA BERMAN AIRWAY 100MM SZ 5 12 12 0 27 3 24 8
5 857-8871 EA NASAL AIRWAY LF 24FR 12 12 2 25 27 00 8
6 857-3847 EA NASAL AIRWAY LF 26FR 12 12 2 27 27 24 8
7 857-3190 EA NASAL AIRWAY LF 28FR 12 12 2 27 27 24 7
8 857-6066 EA NASAL AIRWAY LF 32FR 12 12 2 27 27 24 8
9 890-6800 EA SHARPS SHUTTLE SINGLE USE P2 25 25 1 57 39 25 7
10 507-8362 ZX 100/BX NACL PREFILL SYRINGE 10ML ST 3 3 38 95 116 85 8
N - PEDIGR E ITEM
DC 6380701 010
BILL TO SHIP TO INVOICE INVOICE AM ITEM STATUS KEY REM KEY
1308571 1817102 4358006-01 1001 58 B Backordered:Item will follow SK School Kit
) Discontinued:Item no longer available NC No Charge
HSI QRQER# ORDER DATE INVOICE DATE # OF BOXES :P Special Schein Free Goods
M Manufacturer will ship hern directly to you
04264423 10/15/12 10/15/12 8 11 Prescription Drug:Return Authorization Required
04 R Refrigerated Item:May be shipped separately
CUSTOMER P
PAGE $ Special Schein Pricing
U Temporarily unavailable;please reorder
T Taxable Item Continued on Next Page
MARK 1 OF 3 9
LP300
HENRY SCHEINc
SHIP TO/SOLD TO
EIS Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St
Station 46 Michael Kaufmann
Carmel IN 46032-8806
010000130857104358006110010000001001581015127 BILL TO
Carmel Fire Dept MI
2 Civic Sq
Carmel IN 46032-7543
Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1817102 1001 58
INVOICE# 11 INVOICE DATE
4358006-01 10/15/12
CUSTOMER PO
MARK
HSI ORDER# ORDER DATE DUE DATE
04264423 10/15/12 11/14/12
D&B#'01 243-0880
WHSE DEA# RHO162494 Fed ID' 11 3136595
... M g b
11 220-1652 EA COLLAR STIFNECK SELECT PEDI 50 50 5 50 275 00 7
12 153-6483 RX 250ML/BT STERILE WATER FOR IRRIG 250ML 48 48 C 1 10 52 80 4
N - PEDIGREE ITEM
ASE GOOD I EM, MAY BE SHIPPED SEPARATELY
DC 0033800 402
13 890-4524 EA KERLIX GAUZE RL STER 6PLY 4 5X4 1 200 200 C 1 30 260 00 6
ASE GOOD I CEM, MAY BE SHIPPED SEPARATELY
14 220-2270 EA THOMAS HOLDER F/ET TUBE ADULT 50 50 2 72 136 00 7
F YOU ARE ARTICIPATING IN A DISCOUNT PROGRAM (E G POIN S, GIFTS OR OTHER
PECIAL AWA DS ("DISCOUNT")) , WITH THIS PURL SE YOU HAVE EARNED A CREDIT TOWARD
GOODS OR SERVICES, RECEIVABLE OR REDEEMABLE IN ACCO DANCE WITH DISCOUNT PROGRAM
RULES UPOF DISCOUNT RECEIPT OR REDEMPTION, OU ARE RECEI ING OR WILL RECEIVE
OTICE OF THE DISCOUNT VALUE FROM TIME TO TI E, MEDICARE, MEDICAID TRI ARE OR
THER PAYER MAY REQUEST INFORMATION REGARDING SUCH V LUE PND UPON ANY S CH
REQUEST SU H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINSI THE PURCHASE THAT
EARNED SUCH VALUE ACCORDINGLY YOU SHOULD RE AIN THESE RECORDS
N - HENRY CHEIN, INC HAS PURCHASED THE SPE IFIC UNIT OF THE PRESCRIPT ON DRUG
DIRECTLY F OM THE MANUFACTURER
MERCHANDI E TOTAL 1001 58
Invoice Date + 30 days 1001 58
BILL TO SHIP TO INVOICE# INVOICE AMOUNT
ITEM STATUS KEY REM KEY
1308571 1817102 4358006-01 10 0 1 58 B Backordered:Item will follow SK School Kit
HSI ORDER# ORDER DATE NV I E DATE # OF BOXES D Discontinued:Item no longer available NC No Charge
F Special Schein Free Goods
10/15/12 $ M Manufacturer will ship Item directly to you
04264423 10/15/12
P Prescription Drug:Return Authorization Required
U T MER PO p E R Refrigerated Item:May he shipped separately
$ Special Schein Pricing
U Temporarily unavailable:please reorder
MARK 2 OF 3 T Taxable Item Continued on Next Page
LP300
M HENRY SCHEIN;'o
EMS SHIP TO/SOLD TO
Carmel Fire Department MI
135 Duryea Road, Melville, NY 11747 INVOICE 540 W 136 St
Station 46 Michael Kaufmann
Carmel,IN 46032-8806
01000013085710435800611,0010000001001581015127 BILL TO
Carmel Fire Dept MI
2 Civic Sq
Carmel, IN 46032-7543
Carmel Fire Dept BILL To I SHIP To I INV�100158
2 Civic Sq
Carmel, IN 46032-7543 1308571 1817102
INVOICE# INVOICE DATE
4358006-01 10/15/12
CUSTOMER PO
MARK
Please detach here and mail the above with your payment ---
HSI ORDER# I ORDER DATE DUE DATE
04264423 10/15/12 11/14/12
D&B#O1 243-0880
WHSE DEA# RHO 162494 Fed ID 11 3136595
... ........... . ........................ „
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following a dress
ENRY SCHEI INC
EPT CH 10211
ALATINE I 60055-0241
BILL To SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 1817102 4358006-01 10 O 1 58 H Backordered:Item will follow SK School Ku
D Discontinued:Item no longer available NC No Charge
HSI ORDER# ORDER ATE INVOICE DATE # OF BOXES F Special Schein Free Goods
M Manufacturer will ship Item directly to you
04264423 10/15/12 10/15/12 8 P Prescription Drug,Return Authorization Required
R Refrigerated Item:May be shipped separately
CUSTOMER PO# PAGE $ Special Schein Pricing
U Temporarily unavailable,please reorder
MARK 3 OF 3 T Taxable Item
LP300
!2 HENRY SCHEWK
EMS
make E>very(-,,sfo: -o rnaint<—pr€c,,�s°or the durat:or of a Payment by CHECK orbythe HENRYSCHEIN CREDIT CARD,
cata:oci, %oov,--,P, we reserve[:n?J&soo make orice adlustMen:s VISA,MASTERCARD DISCOVER and AUERICAN EXPRESS
response ,,manufant,:revs pace changes
Guaranteed Satisfaction vrsa
If 1,sou have tried a oroduC,a,:d it is d,-fec,.ive r does �otoertorn, or
vve-vvik orov:de a credit,refund,w exchange it syuor
y Avai:ab:c.to licensed practifior,:o-s:r.[!,e U A: :rroices are
c�cojce simpov'al 0.--jr custor%-. servi�le deparr—er,vithi.r,30 days
Pavab:;(-jvith:r-30 days.
o' ecijot If the merc-andise'o arrange or the return. Fc a
,01,arrant,y,rpr)air or it vl— ,�-ero sev sonitathing yaU aia not )rae
sinipi•call; Rx Products & Controlled Substances
Matrx Medical 1-800-845-3550
R e u I a I i o: o q j L I S to 1 i Mh'Ile s a,:e;f Rx and.,o r ro;I I,,d
substances oriv m -egistered, icensed health;rare professionals,
I-'you are a-gew cus�-cmer oe'have r&,,e:tly moved,please fu. :s?l
us�odth a copy y of your LJI'Mated state regstra.-Jon. F-c-r nor:r,)Iled
substarlces,f,:rnish a copy of ,,our DEA certificate,veerify;ng yot
shipping address, Class 11 drums can be orderoo only by—ail,
International Orders
Please Note.
Wo proudly ser,,,haalt',:, re )rof(,:,,;k%naIsand governmonts
t-rouqhout f:i�,,vor:d. o pace o,-,J?rs or or ':q, :es on export
c:edit.but will be repa:ed or roplaco;d in acc-ordanc&,,,:,h terms arse or-.6fions.olease con act nou. Ir em-atonal
manutaolurer warranties,Be!ore ooening ha~dpiecesor
eauipment,',V0 S::QQn.St that you.heck he shipping cor.-ainer -800-845-335550
arms packing list to 'er:",that YOU'laVe'eCeiwPC exactlyprhat
you ordered.Opened Computer Software is not returnable. Prescription Drug Returns Instructions
Other restrictions may also apply
A 9e: 1rn Aut„orization is Required or all`rescpfion Drugs .&'1PI'v call
our Custonlpr Servic?Depat-ment 1-800-844-3550
HSI ORDER 4 ORDER DATE IDUE DATE
04265093 10/15/12 1 11/14/12
D&B#-01 243-0880
WHSE DEA# RHO162494 Fed ID- 11 3136595
4p, r7
..............
;BOLL,
rhis order has been processed by our MIDWEST 1) C
5315 WES" 74TH 3TREET
INDIANAP LIS,IN 46268
V[ARK 317-27 .-2663
1 499-6926 PU EA SALT AIRWAY 10 10 C 20 28 202 80 1
CASE GOOD IFEM MAY BE SHIPPED SEPARATELY
2 644-3135 5/BX QUIKCLOT 25GM 2 2 33 10 66 20 2
F YOU ARE DARTICIPATING IN A DISCOUNT PROGRAM (E G , POINIS, GIFTS OR OTHER
PECIAL AWAZDS ("DISCOUNT")) , WITH THIS PURC SE YOU HAVE EARNED A CREDI" TOWARD
GOODS OR S]RVICES RECEIVABLE OR REDEEMABLE IN ACCOZDANCE WITH DISCOUNT PROGRAM
RULES UPG1 DISCOUNT RECEIPT OR REDEMPTION, 'IOU ARE RECEIIING OR WILL RECEIVE
\JOTICE OF TIE DISCOUNT VALUE FROM TIME TO TI E, MEDECARE MEDICAID TRI ARE OR
DTHER PAYER MAY REQUEST INFORMATION REGARDING SUCH VALUE, PND UPON ANY STCH
REQUEST SU-H VALUE MUST BE DISCLOSED AS A DI COUNT AGAINS I THE PURCHASES THAT
EARNED SUCH VALUE ACCORDINGLY YOU SHOULD RE"AIN THESE RECORDS
MERCHANDI E TOTAL 269 00
Invoice Date + 30 days 269 00
BILL TO SHIP TO INVOICE# INVOICE AMOUNT ITEM STATUS KEY r—K-E—M_KEY
1308571 1308572 4746529-01 269 00 13 Backordered:Item will follow SK School Kit
HSI ORDER# ORDER DATE INVOICE DATE # OF BOXES Discontinued:Item no longer available NC No Charge
Special Schein Free Goods
M Manufacturer will ship Item directly to you
04265093 10/15/12 10/15/12 2 11 Prescription Drug,Return Authorization Required
CUSTOMER PO# R Refrigerated Item:May be shipped separately
PAGE# $ Special Schein pricing
U Temporarily unavailable,please reorder
MARK 1 OF 2 T Taxable Item Continued on Next Page
LP300 j
HENRY SCHEINO
E � SHIP TO/SOLD TO
OICE Carmel Fire Dept Head Quarters MI
135 Duryea Road, Melville, NY 11747 2 civic Sq
Carmel IN 46032-2584
0100001308571047465291100100000002690010151127 BILL TO
Carmel Fire Dept MI
2 Civic Sq
Carmel IN 46032-7543
Carmel Fire Dept BILL To I SHIP To I INVOICE AMOUNT
2 Civic Sq
Carmel, IN 46032-7543 1308571 1 1308572 269 00
INVOICE# INVOICE DATE
4746529-01 10/15/12
CUSTOMER PO
MARK
Please detach here and mail the above with your payment
HSI ORDER# I ORDER DATE IDUE DATE
04265093 10/15/12 11/14/12
D&B#O1 243-0880
WHSE DEA# RHO162494 Fed ID- 11 3136595
:. W . .m < ::. :Y .. ,.... ..�.... .•., �"y� tit {"a. ,.
i �
LEASE NOTE NEW REMIT TO ADDRESS
Please remi payments only to the following address
ENRY SCHEIi INC
EPT CH 10211
ALATINE, I 60055-0241
B LL To SHIP TO INVOICE#INVOICE INVOICE AMOUNT ITEM STATUS KEY REM KEY
1308571 1308572 4746529-01 269 00 H Backordered:Item wiufollow SK school Kit
D Discontinued:Item no longer available NC No Charge
HSI RD R ORDER ATE INVOICE DATE: F B XE P Specal Schein Free Goods
0 4 2 6 5 0 9 3 10/15/12 10/15/12 2 P M Manufacturer will ship Item directly you
Prescription Drug,Return Authorization Required
CUSTOMER PO# PAGE# R Refrigerated Item:May be shipped separately
$ Special Schein Pricing
U Temporanly unavailable:please reorder
MARK 2 OF 2 T Taxable Item
LP300
r
A HENRY SCREW`{:
EMS
Payment by CHECK or by the HENRY SCHEIN CREDIT CARD
caia:na. I�,e reserve the right to make pride andjustMent's
VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS
fesporse to manufactzers orice.changes
Guaranteed Satisfaction vrsn
or
If vou have t•lpd aOroduc�'a!:d it is delec,,ive of does 1.ot.,c)ertorn-
satisrac,'-';rily we�,il:Proi,:de a credit,refund,of ex:hange-it s Vour
Availabie to licensed Pracfi1:(,;r:e,cz:r-t:�,e U S A. jc,o�s are
cnojce Sim piv call our customer S,-. ice deoadrner',!'hin 30 days
ot pavabo',xitf,-ir.30 days
: 1�n arrange-or the ret-irn. F0 a
14,arrantv ';.clair or it von ,,vero sert something !ou aid riot orjat;:
--pl,.,rall:
Rx Products & Controlled Substances
Matra Medical 1-800-845-3550
Regulations-oquirel US to ling: --ie saieut Rx anc roi°rolled
.ubstarces o?-:y to registered, icpnsedhealthcare p,ofessionals.
I`you are a qew customer or have reue'tly moved,please fu :s!i
us odtl- a co-DV Of'."our updated state registration. F6•�Oruolled
bubstances,tarnish acopy of your DEA ceiiqikafe,,Aerif'y:ng yot'r
shipping address. Class 11 dru=s ran be orderoc only b' ail.
y
International Orders
Please Note
prrudly serve healt'are xafes�ionials and gowrnments
UnMe.i avfinfluerel:1 led'o'r Of t'Ulf 0
r 'i
credit.but vvill be r;;pa't_'d&replaced in accord"ance..,wh terms ai1c, C. ions.Tease ou. k-'erraJonal'L—)epainient:
manufactu.)r waurant::.,,.Botore ooening ha.:dpeceS or -800-845-35 05,
equipment,ere&,:west licit you;heck )e si;ppnq con,ainer
and plaok:ng list to vi�—f!V
I tria,ycai :ave rp.-cei'ea exactly ,,,,hat Prescription Drug Returns Instructions
you ordered,Opened Computer Software is not returnable.
Other restrictions may also apply
A Return A0,orization is ReqUired.,or all 'escriprion r"rUgs C,�:Pl'v.,-all
-ompr Serdcp Depar ment
our 1-80(0 8aD-3550
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))
4746529-01 $26900
4358006-01 $1 001 58
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
Henry Schein
IN SUM OF $
Dept Ch 10241
Palatine, IL 60055
$1,27058
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO ACCT#/TITLE I AMOUNT Board Members
1120 4746529-01 102-390 11 j $26900 1 hereby certify that the attached invoice(s), or
1120 4358006-01 102-39011 $1,001 58 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
V -- 5 2012
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund