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HCA Order Form |
Division | |||
Site/Hospital | |||
Billing | Delivery | ||
Name | dan.fran@hcahealthcare.com | Name | Kristin Kadlacek |
George.Greene1@healthtrustpg.com | kristin.kadlecek@hcahealthcare.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 2nd floor computer / Education office |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | 4600 SW 46th Ct. |
Address Line 3 | Suite 1100 | Address Line 3 | |
City | Nashville | City | Ocala |
State | TN | State | FL |
ZIP | 37203 | ZIP | 34474 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
S13107 | Brayden Adult Airway Valve Assembly | 3 | $10.20 |
Sub-Total | $10.20 |