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 ($) |
| A17001 | Brayden Baby/Infant Cotton Diaper | 5 | $82.70 |
| C17001 | Brayden Baby/Infant Replacement Lung (single) | 15 | $148.80 |
| S17011 | Brayden Baby/Infant Artificial Lung Air Guide | 15 | $24.90 |
| A17002 | Brayden Baby/Infant Blanket | 10 | $165.40 |
| C17006 | Brayden Baby/Infant Double Filter (Pack of 5) | 1 | $29.77 |
| Sub-Total | $451.57 | ||