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HCA Order Form
Division West Florida Division
Site/Hospital HCA Center for Clinical Advancement
Billing Delivery
Name Abigayle.Zamor@hcahealthcare.com Name Kathryn Gleeson
Email George.Greene1@healthtrustpg.com Email Kathryn.Gleeson@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 560 S. Lakewood Dr.
Address Line 2 Clinical Education Financial Reporting Address Line 2 Ste 210
Address Line 3 Suite 1100 Address Line 3
City Nashville City Brandon
State TN State FL
ZIP 37203 ZIP 33511
Items to Order
Code Description Quantity Total ($)
C99003 Brayden Adult Airway Filter (Pack of 24) 2 $8.50
C99002 Brayden Adult Airway Silicone Flap Valve (Pack of 24) 2 $14.76
S17011 Brayden Baby/Infant Artificial Lung Air Guide 20 $31.60
C17001 Brayden Baby/Infant Replacement Lung (single) 15 $141.75
A17002 Brayden Baby/Infant Blanket 3 $47.25
  Sub-Total $243.86