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HCA Order Form
Division Continental Division
Site/Hospital HCA Healthcare Center for Clinical Advancement
Billing Delivery
Name Scott.Bartholomew@HealthONEcares.com Name Scott Bartholomew
Email George.Greene1@healthtrustpg.com Email scott.bartholomew@hcahealthone.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 1650 S. Potomac Street
Address Line 2 Clinical Education Financial Reporting Address Line 2 Room 308
Address Line 3 Suite 1100 Address Line 3
City Nashville City Aurora
State TN State CO
ZIP 37203 ZIP 80012
Items to Order
Code Description Quantity Total ($)
A99003 Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 10 $153.80
S17011 Brayden Baby/Infant Artificial Lung Air Guide 20 $33.20
$0.00
  Sub-Total $187.00