Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | Chippenham | ||
| Billing | Delivery | ||
| Name | Tracy.Harrell@hcahealthcare.com | Name | Michelle Ford |
| George.Greene1@healthtrustpg.com | Michelle.Ford2@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 7101 Jahnke Rd |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Richmond |
| State | TN | State | VA |
| ZIP | 37203 | ZIP | 23225 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 3 | $27.00 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $84.00 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 3 | $8.25 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 4 | $55.80 |
| $0.00 | |||
| Sub-Total | $175.05 | ||