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 | Clyde “Dave” Owen |
| 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 ($) |
| S16402 | Brayden Pro Adult Body Skin Magnet | 15 | $62.10 |
| A17002 | Brayden Baby/Infant Blanket | 10 | $165.40 |
| A17001 | Brayden Baby/Infant Cotton Diaper | 10 | $165.40 |
| S17008 | Brayden Baby/Infant Spring | 6 | $95.94 |
| S17013 | Brayden Baby/Infant Replacement Airway Tube (single) | 34 | $103.02 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 18 | $29.88 |
| C99008 | Brayden Premium Urethane Adult Lung Kit (Pack of 6) | 6 | $555.66 |
| $0.00 | |||
| A99003 | Brayden Power Adaptor for Adult & Baby, 110v, 8ft cord, U.S. Plug | 20 | $293.00 |
| Sub-Total | $1,470.40 | ||