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 / Clyde Owen |
| 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 | Texas |
| ZIP | 37203 | ZIP | 75034 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 2 | $29.30 |
| A99002 | Brayden Adult Compression Spring Addon | 2 | $45.40 |
| S13107 | Brayden Adult Airway Valve Assembly | 2 | $7.14 |
| S13106 | Brayden Adult Face/Mouth Connector | 3 | $7.56 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 2 | $8.50 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| S16402 | Brayden Pro Adult Body Skin Magnet | 6 | $23.64 |
| C16101 | Brayden Pro Adult Body Skin | 1 | $42.00 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 5 | $47.25 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 6 | $17.34 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 6 | $9.48 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | $0.00 | |
| $0.00 | |||
| Sub-Total | $325.81 | ||