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HCA Order Form
Division North Florida Division
Site/Hospital West FL
Billing Delivery
Name dan.fran@hcahealthcare.com Name Barbara Hamilton / Brian Groat – Nursing Education Office
Email George.Greene1@healthtrustpg.com Email Barbara.Hamilton3@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 8383 N. Davis Hwy
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Pensacola
State TN State FL
ZIP 37203 ZIP 32514
Items to Order
Code Description Quantity Total ($)
S17011 Brayden Baby/Infant Artificial Lung Air Guide 5 $7.90
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 5 $14.45
$0.00
  Sub-Total $22.35