Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Central West Texas Division | ||
| Site/Hospital | Bastrop FSED | ||
| Billing | Delivery | ||
| Name | lisa.everett@stdavids.com | Name | Kirk Sinclair |
| George.Greene1@healthtrustpg.com | Kirk.Sinclair@stdavids.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3201 HWY 71 E |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Bastrop |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 78659 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 1 | $9.45 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 1 | $7.38 |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 1 | $4.25 |
| $0.00 | |||
| Sub-Total | $109.28 | ||