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HCA Order Form
Division Continental Division
Site/Hospital HCA Healthcare Center for Clinical Advancement
Billing Delivery
Name Scott.Bartholomew@HealthONEcares.com Name Scott Bartholomew
Email George.Greene1@healthtrustpg.com Email scott.bartholomew@healthonecares.com
Address Line 1 Clinical Education Financial Reporting Address Line 1 333 W Hampden Ave Ste 200
Address Line 2 Clinical Education Financial Reporting Address Line 2
Address Line 3 Suite 1100 Address Line 3
City Nashville City Englewood
State CO State Colorado
ZIP 37203 ZIP 80110
Items to Order
Code Description Quantity Total ($)
S17013 Brayden Baby/Infant Replacement Airway Tube (single) 20 $60.60
S17011 Brayden Baby/Infant Artificial Lung Air Guide 20 $33.20
  Sub-Total $93.80