ADC Supply Order Form
Name
*
First Name
Last Name
FOR HEMODIALYSIS DIALYSIS MACHINE ORDER ONLY
Nipro
Supplies
Facility Account# Location (Ship To)
Riverview Regional Medical Center 600 S 3rd St,Dialysis Dept.Gadsden, AL 35901-10003069
None
Bicarbonate
Bicarbonate (BC+201)($25.00)
Nipro
Dialyzers and Lines
ELISIO® 15H Dialyzer(DD+ELISIO-15H) ($198.00)
Nipro
ELISIO® 17H Dialyzer(DD+ELISIO-17H)($218.40)
Nipro
ELISIO® 19H Dialyzer(DD+ELISIO-19H)($243.60)
Nipro
Cellentia®17-H Dialyzer (DD+CT17H)($384.00)
Nipro
Blood Lines (BL+A209Y/V803)
Nipro
Acids
1K 2.5CA (AC+202)
Nipro
2K 2.5CA (AC+200)
Nipro
3K 2.5CA (AC+203)
Nipro
2K 2.0CA (AC+201)
Nipro
1K0.0Ca (AC+220)
Nipro
0K0.0Ca (AC+213)
Nipro
CitricAcid (CA-50L)
Nipro
Needles
Needles 15G (1FT+152530TP)
Nipro
Needles 16G (FT+162530TP)
Nipro
Needles 17G (FT+172530TP)
Nipro
Transducers (TPSURE+1)
Nipro
Fresenius
Supplies
Facility Account# Location (Ship To)
*
195805- RIVERVIEW REGIONAL MEDICAL CENTER
None
Bicarbonate
Bicarbonate (08-CL024-0)
Fresenius
Acids
1K 2.5CA (08-1251-1)
2K 2.5CA (08-2251-0)
3K 2.5CA (08-3251-9)
2K 2.0CA (08-2201-5)
1K0.0Ca (08-1001-0)
Dialyzers and Lines
Dialyzer F180 (0500318E)
Fresenius
Dialyzer F160 (0500316E)
Fresenius
Blood Lines 03-2722-9
Fresenius
Hypoallergenic F180 0500318N
Fresenius
Bleach and Vinegar
Bleach (28-1335-3)
Fresenius
Vinegar (28-0527-3)
Fresenius
Needles
Needles 15G (820-2531-33)
Needles 16G (820-2632-33)
Needles 17G (820-2717-33)
Disposables
Transducers (04-9500-2)
Fresenius
Catheter Caps (09-0125-0)
Fresenius
Recirculators (04-9502-8)
Fresenius
Potassium 11.5 G (27-0380-9)
Fresenius
Under Pads (16-7200-0)
Fresenius
Calcium 5.7G (27-0060-7)
Fresenius
Note: Special Request
FOR PERITONEAL DIALYSIS ORDER ONLY
Solutions
Biofine 1.5% 5L (077-50621)
Fresenius
Biofine 2.5% 5L (077-50622)
Fresenius
Biofine 4.25% 5L (077-50624)
Fresenius
DEFLEX 1.5% 2L (054-20221)
With Drain
DEFLEX 2.5% 2L (054-20222)
With Drain
Cycler Lines
Liberty cycler integrated set (050-87216A)
Fresenius
Liberty Drain set (026-20226A)
Fresenius
stay•safe catheter extension set with Luer-Lock, 12-inch (050-95004)
Fresenius
Other
Stay•Safe cap (050-95012)
Fresenius
ExSept First aid Antiseptic (23-2501-0)
Fresenius
Alcavis 50 Disinfectant (23-1501-8)
Fresenius
Note: Special Request
RPC
Supplies
Zip Code
*
Please Select
Riverview Medical: 35901
Test Strips
E-Z Chek® Residual Chlorine Test Strips (K100-0101B)
Water Hardness Test Strips (K100-0102)
Ultra-Low™ Total Chlorine Test Strips (K100-0118)
Micro-X® Peroxide / Peracetic Acid Residual Test Strips (K100-0100)
Phoenix Meter Solutions
CalRite 7.0 pH Buffer Solution (S-0011)
CalRite 14.0 mS NaCl Conductivity Solution (S-0024)
CalRite ProbeRite® Sensor Cleaning Solution (S-0043)
Submit
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