Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Florida Division | ||
| Site/Hospital | Lake Nona Hospital | ||
| Billing | Delivery | ||
| Name | dan.fran@hcahealthcare.com | Name | Dan Franceschini |
| George.Greene1@healthtrustpg.com | Dan.Fran@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 6400 Sanger Rd. |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Orlando |
| State | TN | State | FL |
| ZIP | 37203 | ZIP | 32827 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| [980] | Brayden Baby/Infant Artificial Lung Air Guide | 10 | $16.60 |
| [980] | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 2 | $15.50 |
| [980] | Brayden Adult Airway Filter (Pack of 24) | 2 | $8.92 |
| [980] | Brayden Baby/Infant Replacement Airway Tube (single) | 5 | $15.15 |
| [980] | Brayden Adult Face/Mouth Connector | 6 | $15.90 |
| [980] | Brayden Adult Lung Kit Version A04 (Pack of 24) | 1 | $49.61 |
| [980] | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $29.77 |
| [980] | Brayden Baby/Infant Replacement Lung (single) | 3 | $29.76 |
| Sub-Total | $181.21 | ||