216886 01/29/2013 CITY OF CARMEL, INDIANA VENDOR: 360209 Page 1 of 1
ONE CIVIC SQUARE ST VINCENT HOSPITAL CHECK AMOUNT: $1,542.42
CARMEL, INDIANA 46032 ATTN:J ZIMMERMAN,ACCT REPTNG
s+° 10330 N MERIDIAN ST SUITE 340 CHECK NUMBER: 216886
"OM` INDIANAPOLIS IN 46290
CHECK DATE: 1/29/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 13096 1, 542 .42 SPECIAL DEPT SUPPLIES
St. Vincent Hospital &Healthcare Center, Inc. Invoice
Attn:Jeremy Zimmerman
10330 N. Meridian,Suite 430 DATE INVOICE#
Indianapolis,IN.46290-1024
1/16/2013 13096
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. 2012 billed in Jan. 2013 1,542.42
Medical Supplies: $
Transfer- Drugs: 1,542.42
TOTAL: $1,542.42
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 $1,542.42
are paying on check/stub. Thank you!!
Inquiries:Jeremy Zimmerman Payments/Credits $0.00
317.583.3223
jrzimmer @stvincent.org Balance Due
$1,542.42
t.°. :.
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Control Controll Control Contro12 TotalPic TotalPicl
02-8213 Carmel Fire Department Acetaminophen Tab 325 MG TYLENOL Tab 325 MG 3000 EA 13 $0.13
02-8213 Carmel Fire Department ADENOSINE INJ 6 MG ADENOSINE INJ 6 MG 2 ML 4 $11.24
02-8213 Carmel Fire Department Albuterol SULF NEB SOL(0.0133%) ALBUTEROL SULFATE 0.083%NEB SOL(0.083%) 3 ML 68 $13.60
02-8213 Carmel Fire Department AMIODARONE HCL INJ 50 MG/mL AMIODARONE HYDROCHLORIDE INJ 50 MG/mL 3 ML 24 $18.96
02-8213 Carmel Fire Department Aspirin Tab Chew 81 MG ASPIRIN Tab Chew 81 MG 750 EA 180 $5.40
02-8213 Carmel Fire Department CALcium CHLORide INJ-SYRNG 100 MG/mL CALcium CHLORide INJ-SYRNG 100 MG/mL 10 ML 1 $6.71
02-8213 Carmel Fire Department Dextrose-DOPamine INJ 400 MG/250 mL DEXTROSE/DOPamine HCL INJ 400 MG/250 mL 250 ML 2 $12.70
02-8213 Carmel Fire Department Dextrose INJ-SYRNG 50% DEXTROSE INJ-SYRNG 50% 50 mL 17 $145.35
02-8213 Carmel Fire Department DiphenhydrAMINE INJ 50 MG/mL DIPHENHYDRAMINE HYDROCHLORIDE INJ 50 MG/mL 1 ML 1 $0.70
02-8213 Carmel Fire Department EpiNEPHrine HCL INJ 0.1 MG/ML EPINEPHRINE HCL INJ 0.1 MG/ML 10 ML 2 $7.92
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 FentaNYL INJ 100 MCG/2 mL FENTANYL CITRATE INJ 100 MCG/2 mL I 2 ML 8 $5.52
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 HYDROXOCOBALAMIN KIT INJ 5 gm CYANOKIT INJ 5 gm 5 GM 1 $715.00
02-8213 Carmel Fire Department Ipratropium SOL 0.02% IPRATROPIUM BROMIDE SOL 0.02% 2.5 ML 30 $4.50
02-8213 Carmel Fire Department Lidocaine HCL INJ-SYRNG 100 MG LIDOCAINE HCL INJ-SYRNG 100 MG 5 ML 1 $2.31
02-8213 Carmel Fire Department Lidocaine HCL JELLY 2%30 GM LIDOCAINE JELLY 2%JELLY 2%30 GM 30 3 $17.55
02-8213 Carmel Fire Department Naloxone INJ 1 MG/ML NALOXONE HCL INJ 1 MG/ML 2 ML 5 $61.35
02-8213 Carmel Fire Department Nitroglycerin Tab 0.4 MG NITROSTAT Tab 0.4 MG 25 3 $24.78
02-8213 Carmel Fire Department Ondansetron INJ 2 mg/mL ONDANSETRON INJ 2 mg/mL ' 2 ML 16 $5.12
02-8213 Carmel Fire Department Ondansetron Tab ODT 4 MG ONDANSETRON Tab ODT 4 MG 30 EA 26 $4.27
02-8213 Carmel Fire Department Sodium Bicarbonate INJ 4.2% SODIUM BICARBONATE INJ 4.2% 10 ML 4 $17.32
02-8213 Carmel Fire Department Sodium Bicarbonate INJ 7.5% SODIUM BICARBONATE INJ 7.5% 50 ML 2 $13.62
02-8213 Carmel Fire Department SODium CHLORide INJ 0.9%'1000 mL SODium CHLORide 0.9%INJ 0.9%1000 mL 1000 ML 14 $11.06
j $1,542,42
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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
$1,542.42
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1120, I 13096 1 102-390.11 I $1,542.42 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 2 8 ton
Fire Chief
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
13096 $1,542.42
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