Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | South Atlantic Division | ||
| Site/Hospital | Summerville HHCCA | ||
| Billing | Delivery | ||
| Name | karie.thurston@hcahealthcare.com | Name | Ellen Perriello |
| George.Greene1@healthtrustpg.com | ellen.perriello@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | HCA Center for Clin Advancement |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | 201 Sigma Drive, Suite 200 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Summerville |
| State | TN | State | SC |
| ZIP | 37203 | ZIP | 29486 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 6 | $9.96 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 6 | $59.52 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 6 | $18.18 |
| $0.00 | |||
| Sub-Total | $87.66 | ||