Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | John Randolph MC | ||
| Billing | Delivery | ||
| Name | Mathew.Huddleston@hcahealthcare.com | Name | Pamela Hicks-van Haren |
| George.Greene1@healthtrustpg.com | pamela.hicksvanharen@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 411 W. Randolph Rd |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
| Address Line 3 | Suite 1100 | Address Line 3 | Attn: Pam Hicks-Van Haren, Clinical Education Department |
| City | Nashville | City | Hopewell |
| State | TN | State | VA |
| ZIP | 37203 | ZIP | 23860 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 3 | $4.74 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 3 | $28.35 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 3 | $8.67 |
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 1 | $14.65 |
| Sub-Total | $56.41 | ||