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HCA Order Form
Division North Florida Division
Site/Hospital West FL
Billing Delivery
Name dan.fran@hcahealthcare.com Name Barbara Hamilton Brian Groat
Email George.Greene1@healthtrustpg.com Email Barbara.Hamilton3@hcahealthcare.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 8383 N. Davis Hwy – 7th Fl. Nsg. Edu. Team
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Pensacola
State TN State FL
ZIP 37203 ZIP 32514
Items to Order
Code Description Quantity Total ($)
S17011 Brayden Baby/Infant Artificial Lung Air Guide 5 $8.30
C17001 Brayden Baby/Infant Replacement Lung (single) 5 $49.60
  Sub-Total $57.90