Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Florida Division | ||
| Site/Hospital | Fort Walton Beach Med Ctr | ||
| Billing | Delivery | ||
| Name | dan.fran@hcahealthcare.com | Name | Nsg. Education (928-B) – Janna Boswell & Casey Harris |
| George.Greene1@healthtrustpg.com | Casey.Harris@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 1000 Mar Walt Dr |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Fort Walton Beach |
| State | TN | State | FL |
| ZIP | 37203 | ZIP | 32547 |
| 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 Adult Airway Valve Assembly | 3 | $11.25 |
| [980] | Brayden Adult Lung Kit Version A04 (Pack of 24) | 1 | $49.61 |
| [980] | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 3 | $46.14 |
| Sub-Total | $173.20 | ||