Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | North Texas Division | ||
| Site/Hospital | NTXD HHCCA | ||
| Billing | Delivery | ||
| Name | marlo.cooper@medicalcityhealth.com | Name | Clyde “Dave” Owen |
| George.Greene1@healthtrustpg.com | Clyde.Owen@MedicalCityHealth.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3401 Dallas Tollway |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 900 |
| Address Line 3 | Suite 1100 | Address Line 3 | |
| City | Nashville | City | Frisco |
| State | TN | State | TX |
| ZIP | 37203 | ZIP | 75201 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C17003 | Brayden Baby/Infant Body Skin | 2 | $115.50 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 12 | $18.96 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 12 | $34.68 |
| A17001 | Brayden Baby/Infant Cotton Diaper | 2 | $31.50 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $176.40 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 12 | $113.40 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 8 | $117.20 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $28.35 |
| Sub-Total | $635.99 | ||