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HCA Order Form |
Division | TriStar Division | ||
Site/Hospital | TriStar CCA | ||
Billing | Delivery | ||
Name | sandra.hart@hcahealthcare.com | Name | Carlos Reyes |
George.Greene1@healthtrustpg.com | Carlos.Reyes@hcahealthcare.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 5380 Hickory Hollow Pkwy |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 200 |
Address Line 3 | Suite 1100 | Address Line 3 | |
City | Nashville | City | Antioch |
State | TN | State | TN |
ZIP | 37203 | ZIP | 37013 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 10 | $15.80 |
A99002 | Brayden Adult Compression Spring Addon | 1 | $22.70 |
C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
$0.00 | |||
Sub-Total | $126.70 |