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HCA Order Form
Division Capital Division
Site/Hospital Lewis Gale Medical Center
Billing Delivery
Name Mathew.Huddleston@hcahealthcare.com Name Larry Bartley
Email George.Greene1@healthtrustpg.com Email larry.bartley@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 Attn: Larry Bartley, Clinical Education
Address Line 2 Clinical Education Financial Reporting Address Line 2 1802 Braeburn Dr.
Address Line 3 Suite 1100 Address Line 3
City Nashville City Salem
State TN State VA
ZIP 37203 ZIP 24153
Items to Order
Code Description Quantity Total ($)
C99008 Brayden Premium Urethane Adult Lung Kit (Pack of 6) 1 $88.20
C17001 Brayden Baby/Infant Replacement Lung (single) 3 $28.35
A99003 Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 1 $14.65
  Sub-Total $131.20