Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | South Atlantic Division | ||
| Site/Hospital | Doctors Hospital of Augusta | ||
| Billing | Delivery | ||
| Name | Susan.Burke@hcahealthcare.com | Name | Susan Burke |
| George.Greene1@healthtrustpg.com | Susan.burke@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3651 Wheeler Rd |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Att: Susan Burke Education POB 1 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Augusta |
| State | TN | State | GA |
| ZIP | 37203 | ZIP | 30909 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 10 | $40.50 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 12 | $108.00 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 20 | $55.00 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 20 | $30.00 |
| $0.00 | |||
| Sub-Total | $233.50 | ||