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HCA Order Form |
Division | Gulf Coast Division | ||
Site/Hospital | HCA Houston Healthcare Conroe | ||
Billing | Delivery | ||
Name | sarah.prial@hcahealthcare.com | Name | Karen king |
George.Greene1@healthtrustpg.com | karen.king1@hcahealthcare.com | ||
Address Line 1 | Clinical Education Financial Reporting | Address Line 1 | 504 Medical Center Blvd |
Address Line 2 | Clinical Education Financial Reporting | Address Line 2 | |
Address Line 3 | Suite 1100 | Address Line 3 | |
City | Nashville | City | Conroe |
State | TN | State | TX |
ZIP | 37203 | ZIP | 77304 |
Items to Order | |||
Code | Description | Quantity | Total ($) |
C99007 | Brayden Adult Lung Kit Version A04 (Pack of 24) | 2 | $99.22 |
C17001 | Brayden Baby/Infant Replacement Lung (single) | 2 | $19.84 |
Sub-Total | $119.06 |