Innosonian, Inc
Innosonian, Europe
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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 ($) |
| [980] | Brayden Adult Compression Spring Addon | 5 | $113.50 |
| [980] | Brayden Adult Face/Mouth Connector | 5 | $12.60 |
| [980] | Brayden Baby/Infant Body Skin | 5 | $288.75 |
| [980] | Brayden Baby/Infant Artificial Lung Air Guide | 15 | $23.70 |
| [980] | Brayden Baby/Infant Replacement Lung (single) | 20 | $189.00 |
| [980] | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 7 | $617.40 |
| [980] | $0.00 | ||
| [980] | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 12 | $175.80 |
| [980] | Brayden Pro Adult Body Skin Magnet | 12 | $47.28 |
| [980] | Brayden Baby/Infant Replacement Airway Tube (single) | 14 | $40.46 |
| [980] | $0.00 | ||
| Sub-Total | $1,508.49 | ||