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HCA Order Form
Division East Florida Division
Site/Hospital Westside Regional Med Ctr
Billing Delivery
Name rellie.lorenzo@hcahealthcare.com Name Rellie Lorenzo
Email George.Greene1@healthtrustpg.com Email rellie.lorenzo@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 261 N University
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Plantation
State TN State FL
ZIP 37203 ZIP 33324
Items to Order
Code Description Quantity Total ($)
[980] Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 1 $15.38
  Sub-Total $15.38