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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 | 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 ($) |
A99002 | Brayden Adult Compression Spring Addon | 5 | $113.50 |
S13106 | Brayden Adult Face/Mouth Connector | 5 | $12.60 |
C17003 | Brayden Baby/Infant Body Skin | 5 | $288.75 |
S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 15 | $23.70 |
C17001 | Brayden Baby/Infant Replacement Lung (single) | 20 | $189.00 |
C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 7 | $617.40 |
$0.00 | |||
A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 12 | $175.80 |
S16402 | Brayden Pro Adult Body Skin Magnet | 12 | $47.28 |
S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 14 | $40.46 |
$0.00 | |||
Sub-Total | $1,508.49 |