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HCA Order Form |
Division | North Texas Division | ||
Site/Hospital | NTXD HHCCA | ||
Billing | Delivery | ||
Name | marlo.cooper@medicalcityhealth.com | Name | Marlo Cooper |
George.Greene1@healthtrustpg.com | marlo.cooper@medicalcityhealth.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 3201 Dallas Parkway |
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 | TX | State | TX |
ZIP | 37203 | ZIP | 75034 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 2 | $176.40 |
2 | $0.00 | ||
S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 12 | $18.96 |
S17008 | Brayden Baby/Infant Spring | 2 | $30.46 |
S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 12 | $34.68 |
S16402 | Brayden Pro Adult Body Skin Magnet | 8 | $31.52 |
C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $28.35 |
A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 8 | $117.20 |
$0.00 | |||
Sub-Total | $437.57 |