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Home My WebLink About227738 1/8/2014 CITY OF CARMEL, INDIANA VENDOR: 357526 Page 1 of 1 ONE CIVIC SQUARE HENRY SCHEIN INC CHECK AMOUNT: $922.14 CARMEL, INDIANA 46032 DEPT CH 10241 PALATINE IL 60055-0241 CHECK NUMBER: 227738 CHECK DATE: 1/8/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 102 4239011 122688-01 922 . 14 SPECIAL DEPT SUPPLIES i .............. .. ....... .. ................. ........... ....... ..... ............ .......... ........................ ....... ......... ................ ..... . ................ . ...... ..... .. ........ . ...... ......... ............... ............. ...... .... ...... . . 4 857-8871 EA NASAL AIRWAY LF 24FR 20 20 2.37 47.40 4 5 499-5080 EA STYLET W/DISTAL TIP 14FR 12 12 1.60 19.20 4 6 499-6393 EA EASY GRIP BVM ADULT 12 12 C 11.00 132.00 3 ASE GOOD I EM, MAY BE SHIPPED SEPARATELY. 7 602-5401 3/PK GLUTOSE GEL LEMON 15GM/TB 10 10 * 10.65 106.50 4 HE PRICES 3TATED ABOVE MAY REFLECT A DISCOUN OR BE SUBJECT TO A REBATE YOU UST FULLY D ACCURATELY REPORT THIS STATED ISCOUNP PRICE, OR IF APPLI ABLE, Y NET PRI ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEDICARE, MEDICAID, RICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESI BY ANY SUCH PROGRAM. IT ISYOUR ESPONSIBILITY TO REVIEW ANY AGREEMENT 0 OTHE DOCUMENTS APPLICABLE TO THESE P ICES TO DETERMINE IF THEY ARE SUB ECT TO A REB TE. THE FEDE L BILL To SHIP TO INVOICE#INVOICEINVOICE AMOUNT ITEM STATUS KEYREM KEY B-Backordered:Item will rollow SK.school Ki 1308571 1817102 t 12 2 6 8 8—01 9 2 2 .14 D-Discontinued:Item no longer available NC-No Charge F-Special Schein Free Goods ORDERORDER# ORDER DATE INVOICE DATE # OF BOXES M-Manufacturer will ship Item directly to you P-Prescription Drug:Return Authorization Required 15133067 12/20/13 12/20/13 4 R -Refrigerated❑em:May he shipped separately $ -Special Schein Pricing CUSTOMERPO# P AQE# T-Taxable Item U-Temporarily unavailable:please reorder MARK 1 OF 2 Item has MSDS Continued on Next Page.......... ........................... . ...... .................. -A HENRY SCHEIN EMS Y k. .............. .................... ..... ........ We make every effort lo mainta::-prices for the durafion of a Payment byCHECK or by the HENRYSCHEIN CREDIT CARD, ratasr g, : ,mere r,,we reserve the rioN to make price adjustments':l VISA,MASTERCARD,DISCOVER and AMERICAN EXPRESS response to manufacturers`price changes GuaranteedSatisfaction- If youhave tried ao)roducz and it is defective orive or does notoerfor YD. 'M( , satisfactorily,we-vvill provide a credit,refund,or exchange-it's your cha,ic,e. Sinin Call our cuslom-er service deparlfnen, A!;4hin 30 dallis Avai:ab'o to licensed practitionersin.tho U.S.A"invoices are I payable within 30 days, of rec,eipt of the rnen--har6se to arrange for the re'urn. For a ,Werrant,reinair or if yo were sem soniething you did not Order, s,, lplv call; : Rx Products & Controlled Substances: Matrx Medical 1-800-845-3550 RPgLJIati0:`S require us to limit the&lk6,of Rx and clontroked substances only o?eg:Ste.red,licensed healthcare,professionals, 11 you are a new customer or have recentki moved,olease. us with a copy of your uprated s'ate reg'siration. For controlled substances,furnish a copy of your DEA certificate,verityingyour shipping address, Class II dru'as Can be ordered only by--aii, International Orders: Please Note: We proudly serve healthcare professionals and governments Opened handpieces and equiprnemrnay not be returned'or Iy .prof11 1 . .. r% : : : M throughouttneworid, credit;t: :Ql be repared for replaced in accordance wilh es o expo terms arld conditions;pleasecomact our IMlern0onal Depa..Irnent manufacturer warranfles.Before opening handpiece—s or. 8CAUipment,we suggest t�,atyou check the sh'pp:ng con-miner y and L-,aP1k:-ng list to verify that you have recd ved exactly iihat you ordered,Opened Computer Software is not returnable, Prescription Drug Returns Instructions: Other restrictions may also apply, A Return Authorization is Required for all Prescripbon DrUgs.S:fllply Call our Customer Service.Department tP 1800-845-3550 ............. ................ ;hgn� q A N, i '.1W Ni A 4 LP300 vu-,j HENRY SCHEIN" C SHIP TO/SOLD TO: EMSCarmel Fire Department MI 135 Duryea Road, Melville, NY 11747INVOICE 540 W 136th St Station 46 Michael Kaufmann Carmel,IN 46032-8806 010000130857100122688110010000000922141220131 BILL TO: Carmel Fire Dept MI 2 Civic Sq Carmel, IN 46032-7543 Carmel Fire Dept BILL TO I SHIP TO INVOICE AMOUNT 2 Civic Sq Carmel, IN 46032-7543 1308571 1817102 922.14 INVOICE# INVOICE DATE 122688-01 12/20/13 CUSTOMER PO - MARK Pleace lej eh hire and mail the ahove.with vmu navment. ORDER# ORDER DATE DUE DATE 15133067 12/20/13 1 01/19/14 D&B#:01-243-0880 WHSE DEA# RHO 162494 Fed ID: 11-3136595 _.....,..... .<,_.� .r::::�:::::..f ...,-!r.t •1 s:iiF3- (� ';�:y;;;;>. . ,s::iiii�i€� ..r:S:if ................... ba. . ... ......... w...... ..lsh.b.S "..'. `� o: :Y,.. ..... ,...r, rs':::::.........k ...:.:............. ... .:: ..:.,.. :ma E ... .. ........::::e:�:G :�......:.............. t2Y::.....-:..-:.::a. �...........di>G.:.:: �� OVERNMENTI POSES CERTAIN RESTRICTIONS ON, AND REQUI ES PU LIC REPORTING OF, RANSFERS 0 VALUE TO A PRACTITIONER. IF YOU ARE PART CIPAT NG IN A PROMOTIONAL ISCOUNT PROGRAM (E.G. POINTS, DISCOUNT REDEM TIONS OR OTHER SPECIAL AWA DS) , ITH YOUR P RCHASES YOU MAY EARN POINTS/CREDI S REDEEMABLE FOR CERTAIN GOODS OR ERVICES, Ii ACCORDANCE WITH DISCOUNT PROGRAM RULES. UPON IISCOUNT RECEIPT BY EDEMPTION F YOUR EARNED POINTS/CREDITS, YOU ARE RE'EIVINC OR WILL RECEIVE OTICE OF TIE DISCOUNT VALUE. ACCORDINGLY, YOJ SHOULD RETAIN THESE RECORDS. N - HENRY 3CHEIN, INC. HAS PURCHASED THE SPE IFIL UNIT OF THE PRESCRIPTION DRUG DIRECTLY F OM THE MANUFACTURER. ---------- --------------------------------- ------ ----- ------------- ------- ---------- --------------------------------- ------ ----- ------------- ------- MERCHANDI E TOTAL 922.14 Invoice Date + 30 days 922.14 lease remi payments only to the following a dress: ` enry Schei , Inc. ept CH 102 1 alatine, I 60055-0241 BILL TO SHIP TO INVOICEINVOICE# INVOICE AMOUNT ITEM STATUS KEY REM KEY 1308571 181710 2 122688-01 922 .14 B Backordered:Item will follow SK-School lett D-Discontinued:Item no longer available NC-No Charge RDER ORDER DATE INVOICE ATE XE P_Special Schein Free Goods D1-Manufacturer will ship Item directly to you P-Prescription Drug;Return Authorization Required 1513 3 0 6 7 12/20/13 12/20/13 4 R-Refrigerated Item:May be shipped separately $ -Special Schein Pricing CUSTOMER PO PAGE T-Taxable Item MARK 2 F 2 U-Temporarily unavailable:please reorder * -Item has MSDS _5— VOUCHER NO. WARRANT NO,. ALLOWED 20 Henry Schein IN SUM OF $ Dept Ch 10241 Palatine, IL 60055 $922.14 ON ACCOUNT OF APPROPRIATION FOR Carmel Fire Department PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members 1120 I 122688-01 1102-390.11 I $922.14 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 �g Fire Chief Title Cost distribution ledger classification if claim paid motor vehicle highway fund ORDER# ORDER DATE IDUE DATE 15133067 12/20/13 01/19/141 D&,B#:01-243-0880 WHSEDEA# RH0162494 Fed ID: 11-3136595 rhis order has been processed by our MIDWEST D.C. 5315 WES'" 74TH 3TREET INDIANAP LIS,IN 46268 1 338-2276 PU 100/CA EXTENSION SET STD BORE UL 2 2 C 232.52 465.04 2 CASE GOOD IFEM, MAY BE SHIPPED SEPARATELY. 2 231-8865 RX 100/BX SALINE FLUSH SYRINGE 0.9% 10ML 2 2 37.00 74.00 4 v1N - PEDIGRE ITEM. .ITDC:6380701)011 3 360-1359 EA SAM SPLINT ORANGE/BLUE 36X4.25 12 12 6.50 78.00 4 4 857-8871 EA NASAL AIRWAY LF 24FR 20 20 2.37 47.40 4 5 496-5080 EA STYLET W/DISTAL TIP 14FR 12 12 1.60 19.20 4 6 499-6393 EA EASY GRIP BVM ADULT 12 12 C 11.00 132.00 3 CASE GOOD ICEM, MAY BE SHIPPED SEPARATELY. 7 602-5401 3/PK GLUTOSE GEL LEMON 15GM/TB 10 10 10.65 106.50 4 ----------- ---------==_====== ======= FHE PRICES TATED ABOVE MAY REFLECT A DISCOUN" OR BE SUBJECT TO A REBATE YOU 14UST FULLY �D ACCURATELY REPORT THIS STATED DISCOUNC PRICE, OR IF APPLI(ABLE, kNY NET PRI-ING, AFTER GIVING EFFECT TO ANY REBATES, TO MEEICARE, MEDICAID, rRICARE AND ANY OTHER FEDERAL OR STATE PROGRAM UPON ZEQUESl BY ANY SUCH IROGRAM. IT ISYOUR ZESPONSIBILITY TO REVIEW ANY AGREE ENTS O[ OTHE DOCUMENTS AP LICABLE TO THESE PZICES TO DETERMINE IF THEY ARE SUB ECT TO AREB TE. THE FED =- - - '7 BILL To SHIP TO INVOICEINVOICE AMOUNT ITEM STATUS KEY r—TENT-KEY B-nackordered:item will follow SK-School Kit 1308571 1817102 122688-01 922 .14 1)-Discontinued:item no longer available NC-No Charge F-Special Schein Frec Goods ORDER# ORDER DATE INVOICE DATE # OF 13OXES M-Manufacturer will ship Item directly to you P Prescription Drug:Return Authorization Required 15133067 12/20/13 12/20/13 4 R Refrigerated Item:May be shipped separately $ Special Schein pricing CUSTOMER PO4 PAGE# T Taxable Item U-Temporarily unavailable:please reorder MARK 1 OF 2 -Item has MSDS Continued on Next Page..........