Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | TriStar Division | ||
| Site/Hospital | TriStar CCA | ||
| Billing | Delivery | ||
| Name | Carlos.Reyes@hcahealthcare.com | Name | Dr. Carlos Reyes |
| George.Greene1@healthtrustpg.com | Carlos.Reyes@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | ATTN: Dr. Carlos E Reyes |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | 1100 Charlotte Ave |
| Address Line 3 | Suite 1100 | Address Line 3 | Suite 600 |
| City | Nashville | City | Nashville |
| State | TN | State | TN |
| ZIP | 37203 | ZIP | 37203 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 1 | $4.46 |
| S13107 | Brayden Adult Airway Valve Assembly | 15 | $56.25 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $29.77 |
| Sub-Total | $90.48 | ||