Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Mid America Division | ||
| Site/Hospital | Belton Regional Medical Center | ||
| Billing | Delivery | ||
| Name | Charla.Clark@hcamidwest.com | Name | Valeria Finley |
| George.Greene1@healthtrustpg.com | Valeria.Finley@hcamidwest.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 17065 S. US-71 Hwy |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Belton |
| State | TN | State | MO |
| ZIP | 37203 | ZIP | 64012 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $84.00 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 2 | $18.00 |
| Sub-Total | $102.00 | ||