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 | Marlo Cooper |
| George.Greene1@healthtrustpg.com | marlo.cooper@medicalcityhealth.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3201 Dallas Parkway |
| 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 | TX | State | TX |
| ZIP | 37203 | ZIP | 75201 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $28.35 |
| C17005 | Brayden Baby/Infant Face Shield Membrane (Pack of 10) | 5 | $31.50 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 5 | $14.45 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 5 | $19.70 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 3 | $43.95 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 5 | $7.90 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 5 | $47.25 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 5 | $14.45 |
| $0.00 | |||
| Sub-Total | $295.75 | ||