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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 1802 Braeburn Dr
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3 Attn: Larry Bartley, Clinical Education
City Nashville City Salem
State TN State VA
ZIP 37203 ZIP 24153
Items to Order
Code Description Quantity Total ($)
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 5 $14.45
  Sub-Total $14.45