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HCA Order Form
Division West Florida Division
Site/Hospital HCA Center for Clinical Advancement
Billing Delivery
Name Allison.Bica@hcahealthcare.com Name Matt Moore
Email George.Greene1@healthtrustpg.com Email Charles.Moore@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 560 S. Lakewood Dr.
Address Line 2 Clinical Education Financial Reporting Address Line 2 Ste 210
Address Line 3 Suite 1100 Address Line 3
City Nashville City Brandon
State TN State FL
ZIP 37203 ZIP 33511
Items to Order
Code Description Quantity Total ($)
[980] Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 8 $123.04
[980] Brayden Baby/Infant Artificial Lung Air Guide 20 $33.20
[980] Brayden Baby/Infant Replacement Airway Tube (single) 20 $60.60
  Sub-Total $216.84