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HCA Order Form
Division Central West Texas Division
Site/Hospital St. David’s Medical Center
Billing Delivery
Name Robert.Williams@HCAhealthcare.com Name Bob Williams
Email George.Greene1@healthtrustpg.com Email Robert.Williams@HCAhealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 1201B W. Louis Henna Blvd.
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Austin
State TN State TX
ZIP 37203 ZIP 78681
Items to Order
Code Description Quantity Total ($)
A99003 Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 1 $14.65
C17001 Brayden Baby/Infant Replacement Lung (single) 4 $37.80
C99008 Brayden Premium Urethane Adult Lung Kit (Pack of 6) 1 $88.20
S17011 Brayden Baby/Infant Artificial Lung Air Guide 1 $1.58
$0.00
  Sub-Total $142.23