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| HCA Order Form | 
| Division | TriStar Division | ||
| Site/Hospital | Parkridge Main | ||
| Billing | Delivery | ||
| Name | sandra.hart@hcahealthcare.com | Name | Beth Broadway | 
| George.Greene1@healthtrustpg.com | elizabeth.broadway@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 2205 McCallie Ave | 
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 506 | 
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Chattanooga | 
| State | TN | State | TN | 
| ZIP | 37203 | ZIP | 37404 | 
| Items to Order | |||
| Code | Description | Quantity | Total ($) | 
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 1 | $14.65 | 
| Sub-Total | $14.65 | ||
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