Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Far West Division | ||
| Site/Hospital | Good Samaritan | ||
| Billing | Delivery | ||
| Name | Elizabeth.Cabada@hcahealthcare.com | Name | Jessica Madison |
| George.Greene1@healthtrustpg.com | Jessica.Madison@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 2425 Samaritan Dr |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | San Jose |
| State | TN | State | CA |
| ZIP | 37203 | ZIP | 95124 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 2 | $30.76 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 3 | $29.76 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 1 | $4.46 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $29.77 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $92.61 |
| S13107 | Brayden Adult Airway Valve Assembly | 1 | $3.75 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 2 | $3.32 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 2 | $6.06 |
| Sub-Total | $200.49 | ||