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HCA Order Form |
Division | Central West Texas Division | ||
Site/Hospital | Del Sol Medical Ctr | ||
Billing | Delivery | ||
Name | lisa.everett@stdavids.com | Name | Jimmy Zambrano or Elizabeth Varela |
George.Greene1@healthtrustpg.com | elizabeth.varela@hcahealthcare.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | DS Training & Development |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | 10555 Vista del Sol Suite 100 |
Address Line 3 | Suite 1100 | Address Line 3 | Building #3 |
City | Nashville | City | El Paso |
State | TN | State | TX |
ZIP | 37203 | ZIP | 79925 |
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) | 6 | $56.70 |
$0.00 | |||
Sub-Total | $144.90 |