Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | Portsmouth Regional Hospital | ||
| Billing | Delivery | ||
| Name | Luke.Routzon@hcahealthcare.com | Name | Bri Pickle |
| George.Greene1@healthtrustpg.com | bri.pickle@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 100 Eileen Dondero Foley Ave |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Clinical Education |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Portsmouth |
| State | TN | State | NH |
| ZIP | 37203 | ZIP | 03801 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| [980] | Brayden Baby/Infant Artificial Lung Air Guide | 10 | $16.60 |
| [980] | Brayden Baby/Infant Replacement Lung (single) | 5 | $49.60 |
| [980] | Brayden Baby/Infant Face Shield Membrane (Pack of 10) | 1 | $6.62 |
| [980] | $0.00 | ||
| Sub-Total | $72.82 | ||