Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Carolina Division | ||
| Site/Hospital | Mission Hospital: Main Campus | ||
| Billing | Delivery | ||
| Name | Thomas.Edwards4@HealthTrustWS.com | Name | Thomas Edwards |
| George.Greene1@healthtrustpg.com | Thomas.Edwards4@HealthTrustWS.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 1 Hospital Drive Suite 6200 |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Asheville |
| State | TN | State | NC |
| ZIP | 37203 | ZIP | 28801 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 10 | $30.30 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 6 | $92.28 |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 1 | $7.75 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 6 | $59.52 |
| Sub-Total | $189.85 | ||