subject_line
SUPPLY REQUEST
BLOOD - COLLECTION SUPPLIES
"Tiger Top" SST Clot Activator - 100 Units
Dark Blue/Royal Blue Top Tube - 100 Units
Lavender / Purple Top Tubes - 100 units
Light Gray Top Tube -100 Units
Red Top Tube - 100 Units
Needles (Butterfly) w/ Luer Adapter, 23G x 7.5 in - 100 per units
Needles - Safety Needles 22G x 1in - 100 per unit
Needle Holders - 100 units
URINE - COLLECTION SUPPLIES
Urine Collection Cup - 100 per unit
Urine- No Additive - Yellow Tube - 100 per unit
Tamper Proof Seal Labels - 100 per unit
CHLAMYDIA - COLLECTION SUPPLIES
Chlamydia Sterile Swab Kits / Thin Prep - 100 per unit
Chlamydia Urine Collection Kits (PCR Media) - 100 per unit
OTHER SUPPLIES
Bandages, Adhesive 3" x .75" - 1 Box
Specimen Bags - 100 per unit
Tourniquets
Specimen Shipping Boxes
Shipping Return Labels - 25 per unit
Cold Packs
Special Request/Comments:
Site Location Name:
*
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Powered by
Report abuse