Innosonian, Inc
Innosonian, Europe
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| HCA Order Form |
| Division | Capital Division | ||
| Site/Hospital | Portsmouth Regional Hospital | ||
| Billing | Delivery | ||
| Name | Mathew.Huddleston@hcahealthcare.com | Name | Kelsey Lamers |
| George.Greene1@healthtrustpg.com | kelsey.lamers@hcahealthcare.com | ||
| Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 100 Eileen Dondero Foley Ave |
| Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | Suite 100 |
| Address Line 3 | Suite 1100 | Address Line 3 | Attn: Kelsey Lamers Clinical Educator |
| City | Nashville | City | Portsmouth |
| State | TN | State | NH |
| ZIP | 37203 | ZIP | 03801 |
| Items to Order | |||
| Code | Description | Quantity | Total ($) |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 3 | $4.74 |
| C17003 | Brayden Baby/Infant Body Skin | 1 | $57.75 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 5 | $14.45 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 5 | $47.25 |
| Sub-Total | $124.19 | ||