Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Central West Texas Division | ||
| Site/Hospital | Institute for Learning | ||
| Billing | Delivery | ||
| Name | James.Marion@stdavids.com | Name | James Marion |
| George.Greene1@healthtrustpg.com | james.marion@stdavids.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 1201B W. Louis Henna Blvd. |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 200 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Austin |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 78681 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 5 | $15.15 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 5 | $49.60 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 2 | $30.76 |
| Sub-Total | $95.51 | ||