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P6082028001
1 OF 2
Electronic Service Requested
6171 0.0248
ENV 6171
ADAFADTDDTDDTTFATAATTFTAAAFATDFDFTDAADFFFDTADTDATDFAAAFDAAFTDTDDD
WEST CAYUGA MEDCN PC
257 W CAYUGA ST
PHILADELPHIA, PA 19140-2439
Authorized Signature
202312288800
L6082028000
Index_2023320025479_81-3661898_1939355501_014891_Page001
202312288800
Date: 12/07/2023
Provider Number: S1953807
Explanation of Payment:
Paid to: WEST CAYUGA MEDCN PC Check Date: 12/07/2023
Check No: 1357989 Amount: $103.72
Interested in secure direct deposits using electronic funds transfer (EFT) and electronic remittance advice (ERA) to replace paper check and EOPs?
To learn more, visit: www.ibxtpa.com/providers
ENV 6171 2 OF 2