223655 08/27/2013 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: $1,135.49
��• 10330 N MERIDIAN ST SUITE 430
CHECK NUMBER: 223655
INDIANAPOLIS IN 46290
CHECK DATE: 8127/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
102 4239011 13240 1, 135 .49 SPECIAL DEPT SUPPLIES
St. Vincent Hospital & Healthcare Center, Inc. Invoice
Attn:Jeremy Zimmerman
10330 N. Meridian,Suite 430 DATE INVOICE#
Indianapolis,IN.46290-1024
8/13/2013 13240
BILL TO
Carmel Fire EMS
Attn: Accounts Payable
2 Carmel Civic Square
Carmel, IN 46032
TERMS
Due on receipt
DESCRIPTION AMOUNT
EMS Supplies purchased July 2013 1,135.49
Medical Supplies: $121.88
Transfer - Drugs: 1,013.61
TOTAL: $1,135.49
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 $1135.49
are paying on check/stub. Thank you!! '
Inquiries:Jeremy Zimmerman Payments/Credits $0.00
317.583.3223
jrzimmer @stvincent.org Balance Due $19135.49
Depatmental Transfer of Supplies date submissed 08/02/13
Requesting Department: Carmel Fire Dept Supplying Department ER
Cost Center 8213 Cost Center 27230
ITEM# I QUANTITY UNIT COST TOTAL COST
Alcohol preps 9219 $2.67 $0.00
An iocath 18g 1266 15 $1.50 $22.50
An iocath 20g 1264 19 $1.50 $28.50
An iocath 22g 1262 $1.50 $0.00
An iocath 24g 1261 $1.55 $0.00
Basin kidney shaped 103021 $0.08 $0.00
Basin round 10297 $0.31 $0.00
Cold paks 45779 $0.57 $0.00
EKG Electrodes 72104 $3.12 $0.00
Emesis Bags (per pack) 118984 $11.52 $0.00
EZ-10 Adult Needles ($495.00/box of 5) $99.00 $0.00
Foam -Quikcare 5033 $2.67 $0.00
Guaze, 2 x 2 Cotton bail 9170 $1.88 $0.00
Gauze Kerlex 9217 $0.67 $0.00
Gloves -Med 985 $5.41 $0.00
Gloves-Large 9861 $5.41 $0.00
Gloves -Xlar e 34059 $5.95 $0.00
IV Adapter, Luerlock 1260 $0.15 $0.00
IV Dial a flow 17477 $3.15 $0.00
IV Extension 19" 1223 $1.91 $0.00
IV Lock with Ext 1221 23 $1.87 $43.01
IV Start Kits (100/bx) 786631 5 $1.00 $5.00
IV Start Kits Sobraview(100/bx) 1165701 5 $2.66 $13.30
IV Tubing 15 tt 486 5 $1.17 $5.85
Kerlix 4.5"x6pl 201627 $0.73 $0.00
Razor, disposeable 910 1 $0.12 $0.12
Normal Saline 1000 cc bags/ca 446 $9.48 $0.00
Scapel#11 LUM1948 $1.30 $0.00
Sharps Container 236361 $4.59 $0.00
Sterile H2O bottle 384 $0.71 $0.00
Suction Canister&top 3634 $3.26 $0.00
Suture Kit 1 $1.09 $0.00
Syringe w/Needle 1 ml 2028 $0.07 $0.00
Syringe w/Needle 3 ml 2014 $0.05 $0.00
Syringe w/Needle 5ml 2030 $0.10 $0.00
Syringe w/Needle 10 ml 2031 30 $0.12 $3.60
,Syringe w Saline 3ml 105371 $0.28 $0.00
Syringe w/Saline10ml 37350 $0.32 $0.00
30 ml saline vials s(per box) 330 $9.63 $0.00
Tape 2"(6 rolls/box) 159 $1.00 $0.00
Tape 1" 158 $0.50 $0.00
Tape 2"cloth adh 181 $1.29 $0.00
Tape Trans ore 1/2" $1.28 $0.00
Ultra Trak Ultimate Test Control $83.30
Ultra Trak Ultimate Test Strips/10 BX $330.00 $0.00
Warm paks 3416 $1.46 $0.00
Wound Cleanser 17344 $5.04 $0.00
Suction Canister&top 3634 $3.26 $0.00
Yankauers 93771 $0.34 $0.00
Ambu Bag w/mask-Adult 18696 $8.60 $0.00
Ambu Bag w/mask- Peds 37012 $15.00 $0.00
Ambu Bag w/mask- Infant cs/10 15071 $16.00 $0.00
CPAP mask $50.00 $0.00
Lg Bitrac Full Face Mask $29.00 $0.00
ET Tube St lette 71E11 $0.00
Wipes Disenfect 1 211901 1 $11.52 $0.00
Grand Total $121.88
Approved by date
Control Controll Control Contro12 TotalPic TotalPicl
02-8213 Carmel Fire Department Acetaminophen Tab 325 MG TYLENOL Tab 325 MG 3000 EA 12 $0.12
02-8213 Carmel Fire Department ADENOSINE INJ 6 MG ADENOSINE INJ 6 MG 2 ML 13 $34.97
02-8213 Carmel Fire Department Albuterol SULF NEB SOL(0.033%) ALBUTEROL SULFATE 0.083%NEB SOL(0.083%) 3 ML 28 $5.32
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 1 $7.69
02-8213 Carmel Fire Department CALcium CHLORide INJ-SYRNG 100 MG/mL CALcium CHLORide INJ-SYRNG 100 MG/mL 10 ML 1 $7.29
02-8213 Carmel Fire Department Dextrose-DOPamine INJ 400 MG/250 mL DEXTROSE/DOPamine HCL INJ 400 MG/250 mL 250 ML 4 $26.72
02-8213 Carmel Fire Department Dextrose INJ-SYRNG 50% DEXTROSE INJ-SYRNG 50% 50 mL 11 $94.05
02-8213 Carmel Fire Department DiphenhydrAMINE INJ 50 MGImL DIPHENHYDRAMINE HYDROCHLORIDE INJ 50 MG/mL 1 ML 11 $7.70
02-8213 Carmel Fire Department EpiNEPHrine HCL INJ 0.1 MG/ML EPINEPHRINE HCL INJ 0.1 MG/ML 10 ML 18 $77.40
02-8213 Carmel Fire Department Epinephrine INJ 1 MG/ML EpiNEPHrine INJ 1 MG/ML 30 ML 5 $12.70
02-8213 Carmel Fire Department FentaNYL INJ 100 MCG/2 mL FENTANYL CITRATE INJ 100 MCG/2 mL 2 ML 18 $13.50
02-8213 Carmel Fire Department Glucagon INJ 1 MG GLUCAGEN DIAG.KIT INJ 1 MG 1 EA 5 $515.80
02-8213 Carmel Fire Department Glucose(Dextrose)GEL 40% GLUTOSE 15 GEL 40% 15 GM 3 $17.43
02-8213 Carmel Fire Department Haloperidol Lactate INJ 5 MG/ml- HALOPERIDOL LACTATE INJ 5 MG/mL 1 ML 1 $0.81
02-8213 Carmel Fire Department Lidocaine HCL INJ-SYRNG 100 MG LIDOCAINE HCL INJ-SYRNG 100 MG 5 ML 5 $21.50
02-8213 Carmel Fire Department Magnesium SULF INJ 1000 MG/2 mL MAGNESIUM SULFATE INJ 1000 MG/2 mL 2 ML 17 $9.18
02-8213 Carmel Fire Department Magnesium SULF INJ 500 MG/mL MAGNESIUM SULFATE INJ 500 MG/mL 10 ML 15 $42.75
02-8213 Carmel Fire Department MIDAZOLAM INJ 10 MG/2 mL MIDAZOLAM HCL INJ 10 MG/2 mL 2 ML 3 $2.52
02-8213 Carmel Fire Department Naloxone INJ 1 MG/ML NALOXONE HYDROCHLORIDE INJ 1 MG/ML 2 ML 3 $39.18
02-8213 Carmel Fire Department Nitroglycerin Tab 0.4 MG NITROSTAT Tab 0.4 MG 25 1 $8.73
02-8213 Carmel Fire Department Ondansetron INJ 2 mg/mL ONDANSETRON INJ 2 mg/mL 2 ML 14 $4.48
02-8213 Carmel Fire Department Ondansetron Tab ODT 4 MG ONDANSETRON Tab ODT 4 MG 30 EA 17 $2.72
02-8213 Carmel Fire Department Sodium Bicarbonate INJ 4.2% SODIUM BICARBONATE INJ 4.2% 10 ML 3 $14.16
02-8213 Carmel Fire Department Sodium Bicarbonate INJ 7.5% SODIUM BICARBONATE INJ 7.5% 50 ML 1 $6.81
02-8213 Carmel Fire Department SODium CHLORide INJ 0.9%1000 mL SODium CHLORide 0.9%INJ 0.9%1000 mL 1000 ML 29 $22.91
02-8213 Carmel Fire Department SODium CHLORide INJ 0.9%50 mL SODium CHLORide 0.9%INJ 0.9%50 mL 50 ML 5 $10.45
02-8213 Carmel Fire Department SODium CHLORide INJ 0.9%500 mL SODium CHLORide 0.9%INJ 0.9%500 mL 500 ML 6 $4.56
$1,013.61
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
$1,135.49
ON ACCOUNT OF APPROPRIATION FOR
Carmel Fire Department
PO#/Dept. INVOICE NO. ACCT#!TITLE AMOUNT Board Members
1120 I 13240 1 102-390.11 I $1,135.49 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
AUG 2 6 2013
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))
13240 $1,135.49
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