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HCA Order Form |
Division | TriStar Division | ||
Site/Hospital | Centennial Med Ctr | ||
Billing | Delivery | ||
Name | sandra.hart@hcahealthcare.com | Name | Patrisha Fanter |
George.Greene1@healthtrustpg.com | Patrisha.Fanter@hcahealthcare.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 121 Hilcrest Dr |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
Address Line 3 | Suite 1100 | Address Line 3 | |
City | Nashville | City | Clarksville |
State | TN | State | TN |
ZIP | 37203 | ZIP | 37043 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $176.40 |
Sub-Total | $176.40 |