HomeMy WebLinkAboutInv# 1156038512 - CONCENTRA MEDICAL CENTERS - 01/06/2023Concenifra'
INVOICE
Occupational Health Centers
Remit TO: of the Southwest, p . A.
PO Box 82549
Hapeville, cA 30354-0549Tax ld: 15-2014828 _ (BbO) 686-0468Account: N33-t242003529 lnvoice Date: n/22/2022 - 72/22/2022lnvoice: 1156038512 Balance: $93. OO Date Printed: t2/26/2022
Bill To: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
Name /
Date PO Number
Location: Citv of Dania Beach
Attn: Linda Gonzalez
100 [,] Dania Beach B]-vd
Dania, FL 33004-3643
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN /
Birth date
Charge
Description
Charge Pmts /Amount Adjmnts
The Eo1lowing Services Performed at CMC - MIA Et Lauderdale
L2/22/2022 McNeal, Gregory xxx-Xx-5509 Hep B Vacc-2nd lnj
xxlxxlxxxx Hep B Recombivax (3 shots) #2 93.00
Bafance Due: $93.00
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occupational HeaIth CentersRemitTo: of t'he Southwest, P.A. We appreciate your business. You can now pay onflne at
Accountl N33-1242003529 https: //payments. concentra. com/ . online payments must be
lnv Date: \2/22/2022 - L2/22/2022 made via credit card. Please contact our Centraf Business
office at 800-686-0468 for addi-tional information.
Page: l/l
AAlEEoEmproyer PAYMENT DUE UPON RECEIPT