Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Texas Division | ||
| Site/Hospital | NTXD HHCCA | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Clyde “Dave” Owen |
| George.Greene1@healthtrustpg.com | Clyde.Owen@MedicalCityHealth.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3401 Dallas Tollway |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 900 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Frisco |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 75201 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 3 | $12.75 |
| S13106 | Brayden Adult Face/Mouth Connector | 10 | $25.20 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $176.40 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 8 | $117.20 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 2 | $8.50 |
| S13107 | Brayden Adult Airway Valve Assembly | 12 | $42.84 |
| A99002 | Brayden Adult Compression Spring Addon | 3 | $68.10 |
| $0.00 | |||
| Sub-Total | $450.99 | ||