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HCA Order Form
Division West Florida Division
Site/Hospital HCA Center for Clinical Advancement
Billing Delivery
Name Charles.Moore@hcahealthcare.com Name Matt Moore
Email George.Greene1@healthtrustpg.com Email Charles.Moore@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 560 S. Lakewood Dr.
Address Line 2 Clinical Education Financial Reporting Address Line 2 Ste 210
Address Line 3 Suite 1100 Address Line 3
City Nashville City Brandon
State TN State FL
ZIP 37203 ZIP 33511
Items to Order
Code Description Quantity Total ($)
C17001 Brayden Baby/Infant Replacement Lung (single) 10 $94.50
C99008 Brayden Premium Urethane Adult Lung Kit (Pack of 6) 2 $176.40
  Sub-Total $270.90