Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Texas Division | ||
| Site/Hospital | NTXD HHCCA | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Marlo Cooper or Dave Owen |
| George.Greene1@healthtrustpg.com | marlo.cooper@medicalcity.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3401 Dallas Tollway |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 900 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Frisco |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 75034 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 12 | $184.56 |
| A17001 | Brayden Baby/Infant Cotton Diaper | 12 | $198.48 |
| A17002 | Brayden Baby/Infant Blanket | 12 | $198.48 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 12 | $19.92 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 12 | $36.36 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $185.22 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 12 | $119.04 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 6 | $24.84 |
| $0.00 | |||
| $0.00 | |||
| Sub-Total | $966.90 | ||