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HCA Order Form
Division South Atlantic Division
Site/Hospital Trident Medical Center
Billing Delivery
Name Susan.Burke@hcahealthcare.com Name Ruth Malone
Email George.Greene1@healthtrustpg.com Email Ruth.Malone@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 Live Oak Mental Health and Wellness
Address Line 2 Clinical Education Financial Reporting Address Line 2 3445 Ingleside Blvd.
Address Line 3 Suite 1100 Address Line 3 Att: Education/Tom Gates
City Nashville City Ladson
State TN State SC
ZIP 37203 ZIP 29456
Items to Order
Code Description Quantity Total ($)
C99007 Brayden Adult Lung Kit Version A04 (Pack of 24) 1 $47.25
S17011 Brayden Baby/Infant Artificial Lung Air Guide 5 $7.90
A17001 Brayden Baby/Infant Cotton Diaper 1 $15.75
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 5 $14.45
S16402 Brayden Pro Adult Body Skin Magnet 2 $7.88
C17001 Brayden Baby/Infant Replacement Lung (single) 3 $28.35
A99003 Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug 2 $29.30
$0.00
  Sub-Total $150.88