Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Mountain Division | ||
| Site/Hospital | HCA Healthcare Center for Clinical Advancement | ||
| Billing | Delivery | ||
| Name | Michelle.Husberg@hcahealthcare.com | Name | Michelle Husberg |
| George.Greene1@healthtrustpg.com | Michelle.Husberg@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 180 West Election Road |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 200 |
| Address Line 3 | Suite 1100 | Address Line 3 | . |
| City | Nashville | City | Draper |
| State | TN | State | UT |
| ZIP | 37203 | ZIP | 84020 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 10 | $15.80 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 10 | $94.50 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| Sub-Total | $198.50 | ||