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HCA Order Form
Division Capital Division
Site/Hospital Johnston Willis
Billing Delivery
Name Tracy.Harrell@hcahealthcare.com Name Michelle Ford
Email George.Greene1@healthtrustpg.com Email Michelle.Ford2@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 1401 Johnston Willis Dr
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 23235
Items to Order
Code Description Quantity Total ($)
C99008 Brayden Premium Urethane Adult Lung Kit (Pack of 6) $0.00
S17011 Brayden Baby/Infant Artificial Lung Air Guide 6 $9.00
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 6 $16.50
$0.00
  Sub-Total $25.50