Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | Portsmouth Regional Hospital | ||
| Billing | Delivery | ||
| Name | Mathew.Huddleston@hcahealthcare.com | Name | Kelsey Lamers |
| George.Greene1@healthtrustpg.com | kelsey.lamers@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 100 Eileen Dondero Foley Ave. Suite 100 |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | Attn: Kelsey Lamers – Clinical Education Dept. |
| City | Nashville | City | Portsmouth |
| State | TN | State | NH |
| ZIP | 37203 | ZIP | 03801 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| C99003 | Brayden Adult Airway Filter (Pack of 24) | 1 | $4.25 |
| C99002 | Brayden Adult Airway Silicone Flap Valve (Pack of 24) | 1 | $7.38 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 3 | $8.67 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 3 | $4.74 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 3 | $28.35 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 1 | $88.20 |
| Sub-Total | $141.59 | ||