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| HCA Order Form | 
| Division | North Florida Division | ||
| Site/Hospital | Oviedo | ||
| Billing | Delivery | ||
| Name | dan.fran@hcahealthcare.com | Name | Susan Miller – Clinical Education Team | 
| George.Greene1@healthtrustpg.com | Susan.Miller4@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 8300 Red Bug Lake Rd | 
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Clinical Education Team | 
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Oviedo | 
| State | TN | State | FL | 
| ZIP | 37203 | ZIP | 32765 | 
| Items to Order | |||
| Code | Description | Quantity | Total ($) | 
| C99007 | Brayden Adult Lung Kit Version A04 (Pack of 24) | 1 | $47.25 | 
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 4 | $37.80 | 
| Sub-Total | $85.05 | ||
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