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HCA Order Form |
Division | Mountain Division | ||
Site/Hospital | Lakeview Hospital | ||
Billing | Delivery | ||
Name | Michelle.Husberg@hcahealthcare.com | Name | Dorthe Grice |
George.Greene1@healthtrustpg.com | Dorthe.Grice@Mountainstarhealth.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 630 E. Medical Dr |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
Address Line 3 | Suite 1100 | Address Line 3 | |
City | Nashville | City | Bountiful |
State | TN | State | Utah |
ZIP | 37203 | ZIP | 84010 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
$0.00 | |||
Sub-Total | $88.20 |