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Home My WebLink About05-13-09NOTICE OF CLAIM (Filed Pursuant to 20 Pa.C.S. § 3532) Gp ~::~ -~ i!,S_r ~,Ji =~ r~ ~1 -,;~ -;, -a --3 COURT OF COMMON PLEAS OF COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF DALE M HOERNER No. 21-2008-0061 To the Clerk of the Orphans' Court Division: Enter the claim of CONTINUING CARE Rx :-~ -~c ~.,.: rv -,,- DECEASED (Claimant) amount of $ 1,113.05 ,against the above entitled Estate. in the The Decedent, who resided at CHURCH OF GOD, 801 N HANOVER ST, CARLISLE, PA 17013 died on 08-31-2007 (Street Address) Written notice of (Date of Death) said claim was given to SHAUN E O'TOOLE ESQ (Personal Representative or his/her counsel) at 2813 NORTH SECOND ST, HARRISBURG, PA 17110 on OS-11-2009 (Andress) (Date) STAN BORTNER (Claimant's Counsel) (Supreme Court LD. No.) 5775 ALLENTOWN BLVD SUITE 101 (Address) HARRISBURG PA 17112 TOLL FREE 877-372-2279 EXT 328 ("Telephone) CONTINUING CARE Rx (Claimant) 5775 ALLENTOWN BLVD SUITE 101 (Street Address) HARRISBURG PA 17112 (City, State, Zip) Form OC-07 rev. 10.13.06 CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 ** S T A T E M E N T Statement Date: 4/30/09 Page: 1 Account #: 100031218 COG DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Date -------- Description ------------ --------- Qty Amount -- Previous Balance ---------------- ----- ---------- 1,322.96 8/06/07 DOC#99126716 PAYMENT - THANK YOU 707,82_ 8/23/07 DOC#99129693 PAYMENT - THANK YOU 615.14- 8/05/07 RX# 4807727 TRiam/HCTZ 37.5/25 CAP 1 2.58 8/06/07 RX# 4809745 TRiam/HCTZ 37.5/25 CAP 1 2.58 8/07/07 RF 4445629 MIACALCIN NASAL SPRAY 3.7 1 107.47 8/07/07 RF 4782283 ALBUTEROL 0.083%NEB(2.5MG 1 16.00 8/07/07 RX# 4806223 TRiam/HCTZ 37.5/25 CAP 4 2.82 8/08/07 RX# 4814397 FUROSEMIDE 40MG TABS UD 1 2.55 8/09/07 RF 4445606 AVODART 0. 5MG SOFTGEL 30 90.18 8/09/07 RF 4676821 traMADol W /APAP 37.5/325M 30 21.10 8/09/07 RF 4706668 traZODone 50MG TABLET 15 3.40 ** continued on next page ** CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 Name: DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 COPAY COPAY COPAY COPAY COPAY COPAY COPAY COPAY COPAY Statement date: 4/30/09 Account #: 100031218 COG CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 ** S T A T E M E N T Statement Date: 4/30/09 Page: 2 Account #: 100031218 COG DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Date Description Qty Amount -------- 8/09/07 ---- RF -------- 4730616 ---------------------------- ICAPS AREDS FORMULA TR TA ---- - 30 --------- 4.38 8/09/07 RX# 4786025 ASPIRIN EC 81MG TAB 30 1.95 COPAY 8/09/07 RX# 4786026 COLCHICINE 0.6MG TAB 30 4.90 COPAY 8/09/07 RX# 4786027 DESMOPRESSIN 0.2MG TABLET 30 91.00 COPAY 8/09/07 RX# 4786028 DETROL LA 2MG CAPS 30 108.14 COPAY 8/09/07 RX# 4786029 DOXAZOSIN MESY 8MG TAB 30 6.10 COPAY 8/09/07 RX# 4786030 GABAPENTIN 100MG CAP 180 24.10 COPAY 8/09/07 RX# 4786031 GEMFIBROZIL 600MG TAB 30 10.30 COPAY 8/09/07 RX# 4786032 OMEPRAZOLE 20MG CAPSULE 60 47.50 COPAY 8/09/07 RX# 4786033 SIMVASTATIN lOMG TAB 30 7.00 COPAY 8/09/07 RX# 4786035 VITAMIN B-12 1000MCG TAB 30 1.95 8/09/07 RX# 4814937 FUROSEMIDE 40MG TAB 60 5.50 COPAY ** continued on next page ** CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 Name: DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Statement date: 4/30/09 Account #: 100031218 COG CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 ** S T A T E M E N T Statement Date: 4/30/09 Page: 3 Account #: 100031218 COG DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Date -------- Description ------------ -------------------- Qty 8/13/07 RX# 4824370 -------- CEFUROXIME AXETIL 250MG T ---- 20 8/13/07 RX# 4824443 MIRTAZAPINE 15MG TAB 26 8/20/07 RX# 4842078 ALOE VESTA 3 PROTECT DINT 1 8/20/07 RX# 4843514 AVELOX 400MG TAB 7 8/20/07 RX# 4843515 PROTONIX 40MG TAB 38 8/20/07 RX# 4843519 AVODART 0.5MG SOFTGEL 19 8/20/07 RX# 4843520 MIACALCIN NASAL SPRAY 3.7 1 8/20/07 RX# 4843521 ALBUTRL/IPRATRP INH SOLN 1 8/20/07 RX# 4843523 GEMFIBROZIL 600MG TAB 38 8/20/07 RX# 4847620 PROTONIX 40MG TAB UD 1 8/21/07 RX# 4844504 ALOE VESTA 3 PROTECT DINT 1 8/21/07 RX# 4844991 GEMFIBROZIL 600MG TAB 18 ** continued on next page ** CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 Name: DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Amount 13.70 COPAY 9.26 COPAY 7.20 80.46 COPAY 154.01 COPAY 57.84 COPAY 107.47 COPAY 59.74 COPAY 12.38 COPAY 6.00 COPAY 7.20 7.18 COPAY Statement date: 4/30/09 Account #: 100031218 COG CONTINUING CARE RX 28 S SECOND ST NEWPORT PA 17074 ** S T A T E M E N T Statement Date: 4/30/09 Page: 4 Account #: 100031218 COG DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Date Description Qty Amount -------- 8/21/07 ---- RX# -------- 4848874 ---------------------------- PROTONIX 40MG TAB UD ---- - 1 --------- 6.00 COPAY 8/22/07 RX# 4849498 LORazepam 0.5MG TAB 30 4.60 COPAY 8/27/07 RX# 4858247 MORPHINE SULF 20MG/ML SOL 1 15.53 COPAY 8/27/07 RX# 4861681 mORPHINE SULF 5MG SYR-PYX 1 2.98 COPAY Ending balance - Pay this amount ---------> 1,113.05 Past Due Past Due Past Due Current 31-60 days 61-90 days 90+ days ----------- ----------- ----------- ----------- .00 .00 .00 1,113.05 QUESTIONS PLEASE CALL 1-800-675-2279 EXT:1304 -------------------------------------------------------------------------------- Please cut here and remit this portion with payment Remit to: CONTINUING CARE RX 5775 ALLENTOWN BLVD SUITE 101 HARRISBURG, PA 17112 Name: DALE HOERNER LARRY HOERNER PO BOX 1507 HEDGEVILLE, WV 25427 Statement date: 4/30/09 Account #: 100031218 COG Ending balance: 1,113.05 Amount enclosed: oNriMVrNG A 5775 Allentown Blvd. Suite 101 Harrisburg, PA 17112 Phone: 717-810-1950 Fax: 717-810-1952 May 11, 2009 Cumberland County Register of Wills Glenda Farner Strasbaugh Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate# 21-2008-0061 DALE M HOERNER Dear Register of Wills: Enclosed is the $10.00 Fee to file a claim against the Estate of Dale M Hoerner, Estate# 21-2008-0061. Also attached is an invoice showing unpaid charges for the month of August 2007 that total the claim due of $1,113.05. Continuing Care Rx provided the necessary medications for Mr. Hoerner while he was a resident of the Church of God Skilled Nursing Facility in Carlisle, Pa. A copy of this claim is being sent to the Attorney of the Deceased, Shaun O'Toole, at the same time this claim is being mailed. I can be reached toll free at 877-372-2279 Ext 328 extension 328. Thank you. 'Z.s Stan Bonner Internal Credit and Collections CC: Shaun O'Toole Specialist in Comprehensive Pharmaci~ Services