CLIENT SUPPLY ORDER FORM
Date
CLIENT SUPPLY CALL CENTER…………………….. 866-344-5178
CLIENT SUPPLY FAX NUMBER ………………….. 800-522-4601
Please allow 3-5 buisness days for delivery
Quest Diagnostics Incorporated
Contact/Client Name
Address
900 Buisness Center Drive
Phone Number
Horsham, PA. 19044
Qnty
Ordr'd
Units
E-mail
Client Number
ID
Description
Item
num
Qnty
Ordr'd
Units
ID
BLOOD COLLECTION TUBES
*PK/100
T47
Serum Separator Tube
*PK/100
T04
Lavender Top Tube - EDTA
EACH
T62
Lavender Top Tube - 10ml
EACH
T09
EACH
T07
EACH
T11
EACH
Description
Item
num
EACH
C01
Culture Swab, Copan Blue Gel Aero/Ana
4ml 141997
EACH
M10
Virapap Kits (HPV)
10ml 159861
EACH
M30
Red Top Tube - Plain/No Preservative
10ml 53712
EACH
Blue Top Tubes - Sodium Citrate
4.5ml 38417
EACH
Tan Top Tube (Hemogard)
3ml 141847
T88
Gray Top Tube (Sodium Floride/Potassium Oxalate)
EACH
T11
EACH
EACH
Units
ID
Description
Item num
CYTOLOGY AND HISTOLOGY COLLECTION
TRANSPORTATION MEDIA
7.5ml 170739
Qnty
Ordr'd
141902
EACH
A32
Prostate Biopsy Kit pk14
141881
3113
EACH
A35
Prostate Biopsy Kit pk 8
165640
VCM Viral Culture Green Legion/Skin/Other
142060
EACH
A34
Bone Marrow Biopsy Kit
143878
M31
VCM Viral Culture Green Nasopharygeal
142059
EACH
U07
Biopsy Bottle w/ Formalin
60ml
135749
M32
VCM Viral Culture Green Female/Cervical
142057
EACH
U45
Biopsy Bottle w/ Formalin
120ml
135751
EACH
M33
VCM Viral Culture Green Male/Urethral
142058
EACH
U26
Biopsy Bottle w/ Formalin
20ml
165943
4ml 141882
*PK/10
F04
InSure Fecal Immuno
129031
EACH
P16
Cytology Solution
30ml
Navy Blue Top Tube - EDTA
6ml 38416
*PK/10
M01
Affirm Vaginosis Testing
141900
*PK/25
P04
Kit, ThinPrep Coll Vial w Brooms
141767
T13
Navy Blue No Additive
7ml 38427
EACH
F02
Parasitology, Kit, Total Fix
170511
*PK/25
P03
Kit, ThinPrep Coll Vial w Brush/Spatula
141768
T24
Yellow-Top ACD Solution B
6ml 53725
EACH
F01
Stool C&S Transport Media
141856
*PK/25
P15
SurePath Kit Vial w Brooms
165886
EACH
T05
Green Top Sodium Heparin
10ml 180824
EACH
U05
Stool Container White
168680
*PK/25
P14
SurePath Kit Vial w Brush & Spatula
165885
*PK/100
S08
Transfer Tubes (Select Cap Below)
49867
EACH
U14
Sputum Collection Container
127553
*PK/25
P13
SurePath Brooms Only
141917
*PK/100
A37
Purple Caps (Plasma)
134480
EACH
M04
Aptima, sureswab
141905
*PK/25
P12
SurePath Brushes/Spatulas Only
141918
EACH
M03
Aptima, Probe Male/Female Combo
141880
3.5ml 130058
EACH
M02
Aptima, Urine Male/Female Combo
141879
EACH
G01
Glucose, Orange 50GM
141928
3ml 141912
EACH
A03
Urea Breath Tech Kit
155155
EACH
G10
Glucose, Lemon lime 75GM
141933
EACH
G11
Glucose, Fruit Punch 100GM
158822
PEDIATRIC BLOOD COLLECTION TUBES
*PK/100
T26
Serum Separator Tube
EACH
T10
Red Top Tube - Plain/No Preservative
*PK/100
T30
Blue Top Tubes - Sodium Citrate
EACH
T43
Gray Top Tube (Sodium Floride/Potassium Oxalate)
2.7ml 141876
3ml 38431
NEEDLES
8oz
URINE COLLECTION
48880
MISCELLANEOUS
EACH
U36
Pain Management Cups
154873
*500/PK
R79
Paper w/o Logo 8 ½ x 11 Green Stripe
153296
*PK/25
U13
Urinalysis Vial w/ Preservative 10ml
134626
*500/PK
R09
Printer Paper w/ Quest Logo_ 8 ½ x 11
141849
BX/48
N14
Needles, Multidraw 21 G 1 1/4" Safety
141999
EACH
U11
4 oz Sterile Container
4oz
170551
*100/PK
B01
Specimen Bags Routine
142696
BX/48
N13
Needles, Multidraw 22G 1 1/4" Safety
141994
EACH
C11
Urine C&S Kit Plastic
5ml
141974
*100/PK
B25
Specimen Bags (Electronic )
142689142689
EACH
N07
Needle Holders (single use)
151539
*PK/100
U15
Urine Collection Cups (Uricups)
177111
EACH
EACH
U01
24Hr Urine Container (Select Preservative Below)
156874
EACH
EACH
C06
Bactec, Aerobic Blood Culture Bottle
56471
*BG/5
A17
Boric Acid (use 4 tab/24hr container)
101533
ROLL
EACH
C07
Lytic, Anerobic Blood Culture Bottle
141845
EACH
U29
6N HCL (25ml)
159972
EACH
C08
Bactec, Pediatric Blood Culture Bottle
BLOOD CULTURES
Toner(Please Specify name & model #)
Drum (Please Specify name & model #)
R07
Labels Dymo/CC Link
56987
56308
OTHER ITEMS :
REQUISTIONS - Please Specify
8/12/2016