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Attachment B: Sample Invoice <br />Lew Davis, MHA, PhD <br />BTR Executive Director <br />Cell: 704-909-8025 <br />lewisdavis1961@gmail.com <br />ze-e rr tr e, L f <br />Cabarrus County Opiate Abatement <br />2025-2026 Opiate Settlement Grant Fund <br />Correspondence: <br />Bridge To Recovery, Inc. <br />2111 Stafford Street Ext. <br />Monroe, NC 28110 <br />Invoice #: X-XXXX Invoice Date: XXXX <br />Indicate Patient # on Payment: <br />Q"Diagnosis: Opiate Use Disorder <br />Q'Cabarrus County Resident/Homeless <br />ZTotal charge not duplicated by other funds. <br />Total Charge: Pay This Amount <br />$X,XXX.XX <br />Admit Date <br />Discharge Date <br />Total Days <br />$105.00 (per day) <br />Total Charge <br />XX-XX-XXXX <br />XX-XX-XXXX <br />XX <br />$105.00 x XX = <br />$X,XXX.XX <br />Attestation: All services were provided in accordance with the contractual agreement. <br />Lew Davis, MHA, PhD <br />(LCMHC, QS, LCAS, CCS, MAC, NCC) <br />BTR Executive Director <br />Page139 <br />