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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 |
| George.Greene1@healthtrustpg.com | 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 | ||
Innosonian, Inc
Innosonian, Europe