Supplies Order Form

Please place your order using the form below. Be sure to include all of the requested contact information as well as the quantity number of items you wish to purchase. Once we receive your request you will receive an order number and invoice for purchases.
Contact Information
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 Order Form Sections
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Personal Protection Items
Stock Number: Product Description: Packaging: u/m: Order Qty.
2101DNurse Cap, 21" White5/100/cscs
2141DIsolation Gown, Fluid Res, Full Bk, Yellow50/cscs
2201DFace Mask w.Ear Loops12/50/cscs
2205DFace Mask Surgical w/Ties6/50/cscs
2131DShoe Cover, Non-Conductive150/cscs
2132DShoe Cover, Non-Conductive, Non-Skid150/cscs
2326DLatex Exam Gloves, Small10/100/cscs
2327DLatex Exam Gloves, Medium10/100/cscs
2328DLatex Exam Gloves, Large10/100/cscs
2329DLatex Exam Gloves, X-Large10/100/cscs
2336DLatex P/F Exam Gloves, Small10/100/cscs
2337DLatex P/F Exam Gloves, Medeium10/100/cscs
2338DLatex P/F Exam Gloves, Large10/100/cscs
2339DLatex P/F Exam Gloves, X-Large10/100/cscs
2601DVinyl Exam Gloves, Small10/100/cscs
2602DVinyl Exam Gloves, Medium10/100/cscs
2603DVinyl Exam Gloves, Large10/100/cscs
2604DVinyl Exam Gloves, X-Large10/100/cscs
2611DVinyl P/F Exam Gloves, Small10/100/cscs
2612DVinyl P/F Exam Gloves, Medium10/100/cscs
2613DVinyl P/F Exam Gloves, Large10/100/cscs
2614DVinyl P/F Exam Gloves, X-Large10/100/cscs
Antiseptic/Infection Control
Stock Number: Product Description: Packaging: u/m: Order Qty.
1103DAlcohol Prep Pads, Medium10/200/cscs
1206DPVP Scrubstick 3's10/25/cscs
1216DLemon/Glycerin Swabstick 3's10/25/cscs
PQ55172DSani-Cloth Super, Large12/160/cscs
PQ08472DSani-Cloth HB, Large12/160/cscs
PQ89072DSani-Cloth Plus, Large12/160/cscs
PQ20372DSani-Dex ALC Handwipes, Canister12/135/cscs
Wound Care
Stock Number: Product Description: Packaging: u/m: Order Qty.
3102DStretch Gauze Bandage
Roll, N/S, 2"		8/12/cscs
3103DStretch Gauze Bandage
Roll, N/S, 3"		8/12/cscs
3104DStretch Gauze Bandage
Roll, N/S, 4"		8/12/cscs
3112DStretch Gauze Bandage
Roll, Ster., 2"		8/12/cscs
3113DStretch Gauze Bandage
Roll, Ster., 3"		8/12/cscs
3114DStretch Gauze Bandage
Roll, Ster., 4"		8/12/cscs
3161DKrinkle Gauze Roll, Ster.100/cscs
3162DKrinkle Gauze Roll, N/S100/cscs
3242DGauze Sponge N/S, 4x4, 8 ply20/200/cscs
3342DGauze Sponge Sterile 2's, 4x4, 8 ply24/25/cscs
3354DGauze Pad Sterile, 4x4, 12 ply12/100/cscs
3501DAbdominal Pad, 5x9, 1/pouch, Ster.20/20/cscs
3521DWound Closure Strips, Ster., 1/8"x3", 5/pch4/50/cscs
3523DWound Closure Strips, Ster., 1/4"x3", 3/pch4/50/cscs
3552DSurgical Tape (Paper), 1"x10yds12/12/cscs
3553DSurgical Tape (Paper), 2"x10yds12/6/cscs
3554DSurgical Tape (Paper), 3"x10yds12/4/cscs
3562DSurgical Tape (Cloth), 1"x10yds12/12/cscs
3563DSurgical Tape (Cloth), 2"x10yds;12/6/cscs
3564DSurgical Tape (Cloth), 3"x10yds.12/4/cscs
3572DSurgical Tape (Transparent), 1"x10yds.12/12/cscs
3573DSurgical Tape (Transparent), 2"x10yds.12/6/cscs
3574DSurgical Tape (Transparent), 3"x10yds.12/4/cscs
3602DAdhesive Bandage, Sheer Strips, 1"x3", Ster.24/100/cscs
3612DAdhesive Bandage, Fabric, 1"x3", Ster.24/100/cscs
3663DElastic Bandage, 3", Latex Free5/10/cscs
3664DElastic Bandage, 4", Latex Free5/10/cscs
Nursing
Stock Number: Product Description: Packaging: u/m: Order Qty.
4302DCotton Tip Applicator, 6", N/S10/10/100/cscs
4305DCotton Tip Applicator, 6", Ster10/100/2's/cscs
4312DTongue Depressor, N/S, 6"10/500/cscs
4314DTongue Depressor, Ster, 6"10/100/cscs
4242DPaper Souffle Cups, 3/4 oz.20/250/cscs
4252DMedicine Cup, polyethylene, 1 oz50/100/cscs
4255DDrinking Cup, plastic, 5 oz.25/100/cscs
4257DDrinking Cup, plastic, 7 oz.25/100/cscs
4259DDrinking Cup, plastic, 9 oz.25/100/cscs
4260DFlex Straws, plastic, 7 3/4"25/400/cscs
4401DPoly Bib, 15"x20" w/3" Pocket4/500/cscs
4405DPaper/Poly Lab Bibs, 16"x33" w/Ties300/cscs
4406DPaper/Poly Lab Bibs, 16"x33" Overhead300/cscs
4512DInstant Cold Pack, 5"x9"24/cscs
4531DPlastic Pitcher, 32 oz., w/Handle & Lid, Mauve4/25/cscs
4541DService Trays, 10"x6" Mauve100/cscs
4551DDenture Cups w/ Clear Imprinted Lid5/50/cscs
4571DEmesis Basin, 500cc, Graduated, Mauve5/50/cscs
4582DWash Basin, Rectangular, 8 qt., Mauve2/25/cscs
4591DMale Urinal w/Lid, 32 oz., Graduated2/25/cscs
4592DBedpan, Fracture, Mauve4/12/cscs
4593DBedpan, Stackable, Mauve2/25/cscs
Patient Care
Stock Number: Product Description: Packaging: u/m: Order Qty.
4250DRazors, Twin Blade30/10/cscs
4861DToothbrushes, Adult 30 Tuft10/144/csbx
4862DToothbrushes, Adult 46 Tuft10/144/csbx
4872DTootpaste, 1.5 oz. tube12/12/cscs
4885DAdult Combs, 7" Black120/12/csbx
4888DAdult Combs, Black, Lg Handle24/12/csbx
4889DAdult Combs, Assorted, Lg Handle24/12/csbx
4891DClippers, Fingernail24/24/csbx
4892DClippers, Toenail12/12/csbx
Diabetic Supply
Stock Number: Product Description: Packaging: u/m: Order Qty.
00GM100MGlucometers1/ea.ea
00GM100STest Strips, 20/50/cs50/bxbx
1103D Alcohol Prep Pads, Medium10/200/cscs
00200LANSafety Lancet, GlucoPro200/bxbx
00100LANSafety Lancets, Bulls Eye100/bxbx
00150LANSafety Lancets, Smiths150/bxbx
00CTRL02Control Solution, Two Levels2/pkpk
Urological
Stock Number: Product Description: Packaging: u/m: Order Qty.
10SGDTUrological Test Strips, 10SG100/bxbx
4271DUrinary Drainage Bag, St., 2000ml Bag20/cscs
4932DFoley Catheters, Latex, Silicone Coated, 5cc, 12FR10/cscs
4934DFoley Catheters, Latex, Silicone Coated, 5cc, 14FR10/cscs
4936DFoley Catheters, Latex, Silicone Coated, 5cc, 16FR10/cscs
4938DFoley Catheters, Latex, Silicone Coated, 5cc, 18FR10/cscs
4940DFoley Catheters, Latex, Silicone Coated, 5cc, 20FR10/cscs
4942DFoley Catheters, Latex, Silicone Coated, 5cc, 22FR10/cscs
4944DFoley Catheters, Latex, Silicone Coated, 5cc, 24FR10/cscs
4946DFoley Catheters, Latex, Silicone Coated, 5cc, 26FR10/cscs
4948DFoley Catheters, Latex, Silicone Coated, 5cc, 28FR10/cscs
4950DFoley Catheters, Latex, Silicone Coated, 5cc, 30FR10/cscs
4952DFoley Catheters, Latex, Silicone Coated, 30cc, 12FR10/cscs
4954DFoley Catheters, Latex, Silicone Coated, 30cc, 14FR10/cscs
4956DFoley Catheters, Latex, Silicone Coated, 30cc, 16FR10/cscs
4958DFoley Catheters, Latex, Silicone Coated, 30cc, 18FR10/cscs
4960DFoley Catheters, Latex, Silicone Coated, 30cc, 20FR10/cscs
4962DFoley Catheters, Latex, Silicone Coated, 30cc, 22FR10/cscs
4964DFoley Catheters, Latex, Silicone Coated, 30cc, 24FR10/cscs
4966DFoley Catheters, Latex, Silicone Coated, 30cc, 26FR10/cscs
4968DFoley Catheters, Latex, Silicone Coated, 30cc, 28FR10/cscs
4970DFoley Catheters, Latex, Silicone Coated, 30cc, 30FR10/cscs
4925DUrethral Cath Tray, w/gloves & 14FR catheter20/cscs
4926DFoley Insertion Tray, Ster. (w/out catheter)20/cscs
Incontinent Care
Stock Number: Product Description: Packaging: u/m: Order Qty.
3101TQDisposable Washcloths, 9"x13", w/aloe12/50/cscs
2708TSUnderpads, 23"x36", NO SAP6/25/cscs
2675TSUnderpads, 23"x36"6/25/cscs
2677TSUnderpads, 28"x30"10/10/cscs
2760TSBooster Pad, 4.25"x12"8/25/cscs
2190TQBariatric XL plus TQ Brief (64"-96")4/8/cscs
2604TSAdult Disposable Underwear, Small4/22/cscs
2605TSAdult Disposable Underwear, Medium4/20/cscs
2606TSAdult Disposable Underwear, Large4/18/cscs
2607TSAdult Disposable Underwear, X-Large4-14/cscs
2620TSAdult Disposable Briefs, Small10/10/cscs
2624TSAdult Disposable Briefs, Medium8/12/cscs
2634TSAdult Disposable Briefs, Large6/12/cscs
2635TSAdult Disposable Briefs, X-Large8/8/cscs
2805TBAdult Disposable Underwear, Medium4/20/cscs
2806TBAdult Disposable Underwear, Large4/18/cscs
2807TBAdult Disposable Underwear, X-Large4/14/cscs
2724TBAdult Disposable Briefs, Medium8/12/cscs
2734TBAdult Disposable Briefs, Large6/12/cscs
2735TBAdult Disposable Briefs, X-Large8/8/cscs
Respiratory Care
Stock Number: Product Description: Packaging: u/m: Order Qty.
1115HUCrush Resistant Tubing, 7 ft.50/cscs
1119HUCrush Resistant Tubing, 25 ft.25/cscs
1120HUCrush Resistant Tubing, 50 ft.25/cscs
64041GFConcentration Mask w/7ft. Tubing50/cscs
1820HUNasal Cannula w/7ft. Tubing50/cscs
1821HUNasal Cannula50/cscs
1083HUAerosol Mask50/cscs
185OHUDual Lumen Cannula25/cscs
0224CHOximizer, Pendant Style1/ea.ea
64060GFNon-Rebreather Mask w/7ft Tubing50/cscs
3230HUHumidifier Bottles, Refillable, 4 PSI50/cscs
3260HUHumidifier Bottles, Refillable, 6 PSI50/cscs
1885HUMicro-Mist Nebulizer Kit, Mask1/ea.ea
1883HUMicro-Mist Nebulizer Kit, Mouthpiece1/ea.ea
4602DTrach Kit w/14FR Suc. Catheter, Ster.50/cscs
4814DSuction Catheters, 14FR, Ster.50/cscs
1680HUCor-A-Flex Tubing, Trach Tubing, 6ft Section1/ea.ea
1642HUOxygen Bleed-In Adapter (cor-a-flex)1/ea.ea
1650HUIn-Line Water Trap (cor-a-flex)1/ea.ea
1770HULarge Volume Neb Bottle (cor-a-flex)1/ea.ea
1075HUTrach Mask (cor-a-flex)1/ea.cs
1220SAGStraight Connector (for oxygen tubing)1/ea.ea
0749YAGY-Connector (for oxygen tubing)1/ea.ea
2555HUNipple and Nut (oxygen tubing adapter)1/ea.ea
006EVOGray Corrugated Tubing, 6ft.1/ea.ea
50216EVOSuction tubing, 72", w/connectors1/ea.ea
50014EVOSuction Tubing, compressor to jar1/ea.ea
61012EVOSuction Cannisters1/ea.ea
66080AGCylinder Wrench1/ea.ea
2540AGOxygen Regulator Seals (nylon)25/bgbg
86065AGOxygen Regulator Seals (brass)1/ea.ea
0799AGHumidifier Bottle Adapter w/tube (Invacare)1/ea.ea
143AGFRAir Sep Filter, Black, Small Particle1/ea.ea
1107AGFRInvacare P5 Filter, Foam, Small Particle1/ea.ea
910BFAGInvacare Compressor Filter, P51/ea.ea
11FAGInvacare Filter, Foam, Small Particle1/ea.ea
900BFAGInvacare Compressor Filter1/ea.ea
100HCFAGRespironics Filter1/ea.ea
168CFAGRespironics Filter, Foam Pre-Filter1/ea.ea
691WCFAGRespironics Cabinet Filter, Foam, Tabs1/ea.ea
601FAGRespironics Cabinet Filter, Foam, No Tabs1/ea.ea
500BFAGRespironics Bacteria Filter1/ea.ea