Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Continental Division | ||
| Site/Hospital | HCA Healthcare Center for Clinical Advancement | ||
| Billing | Delivery | ||
| Name | Scott.Bartholomew@HealthONEcares.com | Name | Scott Bartholomew |
| George.Greene1@healthtrustpg.com | Scott.Bartholomew@HealthONEcares.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 333 W. Hampden Ave ? Suite 200 |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Englewood |
| State | TN | State | CO |
| ZIP | 37203 | ZIP | 80110 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 10 | $15.80 |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 2 | $14.76 |
| C99007 | Brayden Adult Lung Kit Version A04 (Pack of 24) | 0 | $0.00 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 6 | $56.70 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 3 | $8.67 |
| C99110 | Brayden Junior Replacement Face Skin Piece (single) | 1 | $14.65 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $176.40 |
| $0.00 | |||
| Sub-Total | $286.98 | ||