HomeMy WebLinkAboutInv# 1155988253 - CONCENTRA MEDICAL CENTERS - 12/14/2022Concenitra'
INVOIGE
Occupational Health Centers
Remit To: of the Southwest, p.A.
PO Box 82549
Hapeville, cA 30354-0549
_ Tax ld: i5-2ot4l2l _ (B0o) 686-0468Account: N33-7242003529 lnvoice Date: tt/2t/2022 - LL/27/2022lnvoice: 1155988253 Balance: $93. O0 Date Printed: tI/28/2022
Bill To: Ciry of Dania Beach
Attn: Linda Gonzalez
100 W Dani-a Beach Blvd
Dania, EL 33004-3643
Name /Date PO Number
Location: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
PLEASE RETURN TH!S PORTION WITH YOUR REMITTANCE.
ssN /
Birth date
Charge
Description
Charge Pmts /Amount Adjmnts
The Eollowing Services Performed at CMC - MIA Ft Lauderdale
LI/21/2022 McNeaI, Gregory XXX-XX-5509 Hep B Vacc-1st In;
xx/Xxlxxxx Hep B Recombivax (3 shots) #1 93.00
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Balance Due: $93.00
Occupationaf Health CentersRemitTo: of tire Southwest, P.A. we appreciate your buslness. you can now pay onl-ine atAccount: N33-7242003529 httpi-://payments.concentra.com/. onfine payients must belnv Date: 17/27/2022 - ll/2I/2022 made via credit card. please contact our centraf BusinessOffice at 800-686-0468 for addltional information.
Page: l/7
AA/EEoEmproyer PAYMENT DUE UPON RECEIPT