Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | Terre Haute Regional MC | ||
| Billing | Delivery | ||
| Name | Luke.Routzon@hcahealthcare.com | Name | Lori Magee |
| George.Greene1@healthtrustpg.com | Lori.Magee@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3901 S. 7th St |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Terre Haute |
| State | TN | State | IN |
| ZIP | 37203 | ZIP | 47802 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 6 | $59.52 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $92.61 |
| $0.00 | |||
| Sub-Total | $152.13 | ||