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HealthEast Medical Labs Supply Request

Required Information
Facility full name:
Enter the facility's full name.
Address: Street  Suite # 
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  City  State  Zip code 
Enter the city name.
Enter the postal code for the state.
Enter your zip code.
Request completed by:
Enter the name of the person submitting the request.
Phone number:  E-mail: 
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Enter a valid e-mail address.
Blood Collection Supplies pkg. ea.
Blood Collection Tubes (100 / pkg.)
Blue Top (NaCitrate), 2.7 ml
Quantities must be numeric
Quantities must be numeric
Lavender Top (EDTA), 4 ml
Quantities must be numeric
Quantities must be numeric
Red Top, 10 ml
Quantities must be numeric
Quantities must be numeric
SST (marble top), 3.5 ml
Quantities must be numeric
Quantities must be numeric
SST (marble top), 8.5 ml
Quantities must be numeric
Quantities must be numeric
Navy - green band (NaHep) - Leads
Quantities must be numeric
  
Navy - red band (no additive)
Quantities must be numeric
  
Grey Top (NaFKOxalate) 4 ml
Quantities must be numeric
  
Microbiology Supplies pkg. ea.
Gen-Probe Swabs (50 / box)
Quantities must be numeric
Quantities must be numeric
Gen-Probe Urine Transport (50 / pkg.)
Quantities must be numeric
Quantities must be numeric
Charcoal CultureSwab
Quantities must be numeric
Regular CultureSwab (50 / pkg.)
Quantities must be numeric
Minitip CultureSwab (50 / pkg.)
Quantities must be numeric
Urea/Mycoplasma Swab (M4)
Quantities must be numeric
Stool Culture Vials (ETM) (50 / pkg.)
Quantities must be numeric
Quantities must be numeric
Stool O&P Vials (Proto-fix) (50 / pkg.)
Quantities must be numeric
Quantities must be numeric
Blood Culture Vials
Adult (Yellow and Blue)
Quantities must be numeric
Pediatric (Pink)
Quantities must be numeric
Specimen Transport Bags   bundle
Standard Biohazard Bags (100 / bundle)
Quantities must be numeric
STAT Biohazard Bags (100 / bundle)
Quantities must be numeric
Small Courier Transport Bags (50 / bundle)
Quantities must be numeric
Large Courier Transport Bags (50 / bundle)
Quantities must be numeric
Yellow Biohazard Bags (50 / bundle)
Quantities must be numeric
Other (item name) unit (pkg., bundle, ea.)  qty  
Lab Testing Patient Info Brochure (25 / pkg)
Quantities must be numeric

Quantities must be numeric

Quantities must be numeric
General Supplies pkg. ea.
Serum Transfer Tubes (100 / pkg.)
Quantities must be numeric
Quantities must be numeric
Disposable Pipettes (500 / box)
Quantities must be numeric
Quantities must be numeric
Sterile Urine Containers (75 / bag)
Quantities must be numeric
Quantities must be numeric
Boricon Urine Containers (50 / pkg.)
Quantities must be numeric
Quantities must be numeric
24 Hour Urine Containers
No preservative
Quantities must be numeric
  
Preservative
25 ml 50% Acetic Acid
Quantities must be numeric
  
20 ml 6 N HCl
Quantities must be numeric
5 g NaCO3
Quantities must be numeric
10 g Boric Acid
Quantities must be numeric
Syringe Caps
Quantities must be numeric
Forms & Printer Supplies pkg. ea.
Supply Order Form
Quantities must be numeric
ABN Form (stack of approx 100)
Quantities must be numeric
Quantities must be numeric
Printer Toner
Brother Toner TN540
Quantities must be numeric
Quantities must be numeric
Brother Toner TN550
Quantities must be numeric
Quantities must be numeric
Brother Toner TN650
Quantities must be numeric
Quantities must be numeric
Savin Fax Toner T116/Ricoh 1160
Quantities must be numeric
Quantities must be numeric
LabWorks Printer Paper (3 reams)
Quantities must be numeric
Quantities must be numeric
LabWorks Printer Labels (roll)
Quantities must be numeric
  
Name / DOB Labels (roll)
Quantities must be numeric
Cytology, Pathology & Hematology Supplies pkg. ea.
Plastic Slide Holders
Quantities must be numeric
Conventional PAP Kits (25 / box)
Quantities must be numeric
Quantities must be numeric
SurePath Vials with Brush & Spatula (25 each/pkg.)
Quantities must be numeric
Quantities must be numeric
SurePath Vials with Brooms (25 each/ pkg.)
Quantities must be numeric
Quantities must be numeric
PAP Question Pads - Blue (50 sheets / pad)
Quantities must be numeric
Quantities must be numeric
Frosted End Slides (100 / box)
Quantities must be numeric
  
Plain End Slides (100 / box)
Quantities must be numeric
  
10% Formalin Containers, 60 ml (12 / pkg.)
Quantities must be numeric
Quantities must be numeric
Cytology brushes for colposcopy (100/box)
Quantities must be numeric
Quantities must be numeric
Requisitions unit (pkg., bundle, ea.) qty
Full Page LTCF (100/pack)
Quantities must be numeric
Custom (50/pack)
Quantities must be numeric

Quantities must be numeric
Additional comments
 
 
 
 
 
 
 
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