Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Texas Division | ||
| Site/Hospital | Medical City Fort Worth | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Christopher Rougeux / Vonnie Erwin |
| George.Greene1@healthtrustpg.com | Christopher.Rougeux@medicalcityhealth.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 900 8th Ave |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 108 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Fort Worth |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 76104 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | $0.00 | |
| A99002 | Brayden Adult Compression Spring Addon | $0.00 | |
| S13107 | Brayden Adult Airway Valve Assembly | 2 | $7.14 |
| S13106 | Brayden Adult Face/Mouth Connector | 2 | $5.04 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 1 | $4.25 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 4 | $15.76 |
| C16101 | Brayden Pro Adult Body Skin | 2 | $84.00 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 4 | $37.80 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 4 | $11.56 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 4 | $6.32 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | $0.00 | |
| $0.00 | |||
| Sub-Total | $260.07 | ||