CHECKS 38833-38850.pdf - Kerr County
CHECKS 38833-38850.pdf - Kerr County CHECKS 38833-38850.pdf - Kerr County
I 1 I IHS Date Issued 02 23 2011 Page 1 Explanation of Benefits Kerr County Indigent Health Care Provider University Health System 4502 Medical Drive San Antonio TX 78229 Tax ID 74 6002164 Vendor 2758 NPI Alt 1 We Have Received the Charges Listed Below Participant Expense Type FR TO 1 Charge Disallowed Src Covered 1 pd InvI 1 02 2011 1441 62 I 836 14 1 04 I 605 48 1 42 1 8 IHospital Outpatient 1 1 Comments 1344654241 1100015 2758 8 Batch Dt 02 28 2011 1 Patient ID Alt I IHospital Outpatient 1100015 27588 1 19 2011 I 445 00 I 258 10 I 04 I 186 90 42 I 8 1 Comments 1343156431 Batch Dt 02 28 2011 1 1 Patient ID I Alt I Summary of Benefits 1886 62 1094 24 792 38 Participant Name Client No Prgm Check Amount Check No Batch Date Indigent 186 90 NA 02 28 2011 792 38
KERR COUNTY 700 Main Room BA106 KERRVILLE TX 780285495 01 3447 VALERO MARKETING SUPPLY CO 038845 02 28 2011 DATE INVOICE PO DESCRIPTION AMOUNT 02 23 2011 201102231398 10 21288 3738 FUEL1 10210 896 56 CHECK TOTAL 896 56 PAY KERR COUNTY 700 Main Room BA106 SECURITY STATE BANK TRUST KERRVILLE TX 780285495 KERRVILLE TX 78202 TREASURER FUND EIGHT HUNDRED NINETY SIX 56 100 DOLLARS TO THE VALERO MARKETING SUPPLY CO DATE 038845 AMOUNT 02 28 2011 896 56 VOID AFTER 90 DAYS KERR COUNTY 700 Main Room BA106 KERRVILLE TX 780285495 VALERO MARKETING SUPPLY CO P O BOX 300 AMARILLO TX 79105 0300
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- Page 105 and 106: ACCT 1003978477 KERR COUNTY DISTRIC
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I<br />
1<br />
I<br />
IHS<br />
Date Issued 02 23 2011 Page 1<br />
Explanation of Benefits<br />
<strong>Kerr</strong> <strong>County</strong> Indigent Health Care<br />
Provider<br />
University Health System<br />
4502 Medical Drive<br />
San Antonio TX 78229<br />
Tax ID 74 6002164<br />
Vendor 2758<br />
NPI<br />
Alt<br />
1 We Have Received the Charges Listed Below<br />
Participant Expense Type FR TO 1 Charge Disallowed Src Covered 1 pd InvI<br />
1 02<br />
2011 1441 62 I 836 14 1 04 I 605 48 1 42 1 8<br />
IHospital Outpatient 1 1 Comments 1344654241<br />
1100015 2758 8<br />
Batch Dt 02 28 2011 1 Patient ID<br />
Alt<br />
I<br />
IHospital Outpatient<br />
1100015 27588<br />
1 19 2011 I 445 00 I 258 10 I 04 I 186 90 42 I 8<br />
1 Comments 1343156431<br />
Batch Dt 02 28 2011 1 1 Patient ID I<br />
Alt<br />
I<br />
Summary<br />
of Benefits<br />
1886 62 1094 24 792 38<br />
Participant Name Client No Prgm Check Amount Check No Batch Date<br />
Indigent 186 90 NA 02 28 2011<br />
792 38
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