GML Online Supply Order Form

Enter amounts after the items you wish to order and submit electronically.

Client Name: Internal Zip (GHS Sites):
Address:          Suite, Apt #:
City:                 State: Zip code:
Contact Name: Phone Number:
ITEM
AMOUNT
ALIQUOT TUBES AND CAPS
(PKG OF 100)
BAG, GREEN REFRIGERATE BIOHAZARD BAG, 6 X 9
(EACH)
(PKG OF 100)
BAG, GREEN REFRIGERATE BIOHAZARD BAG, 12 X 15
(EACH)
(PKG OF 100)
BAG, BLUE FROZEN BIOHAZARD BAG, 6 X 9
(EACH)
(PKG OF 100)
BAG, BLUE FROZEN BIOHZARD BAG, 12 X 15
(EACH)
(PKG OF 100)
BAG, YELLOW ROOM TEMPERATURE BIOHAZARD BAG, 6 X9
(EACH)
(PKG OF 100)
BAG, YELLOW ROOM TEMPERATURE BIOHZARD BAG, 12 X15
EACH
(PKG OF 100)
BLOOD BANK ARM BANDS
(EACH)
BLOOD BANK TRANSFUSION QUESTION LABELS
(EACH)
BACTEC BLOOD CULTURE BOTTLES
(SET)
BACTEC AEROBIC BLOOD CULTURE BOTTLES (for Pediatric patients)
(EACH)
BRUSH, CYTOLOGY
(PKG OF 100)
CONTAINER, STERILE SPECIMEN (90 ML)
(EACH )
(PKG OF 100)
DAU TEMPERATURE STRIPS
PKG OF 100)
   
CULTURE SWABS
WHITE (MRSA / VRE / GRPB STREP)
(EACH)
ESWAB (BACTERIAL & FUNGAL)
(EACH)
(PKG)
GREEN (NPG OR MALE URETHRAL)
(EACH)
BLUE (GROUP A STREP COMBO)
(EACH)
(BOX)
 
CYTOLOGY FIXATIVE
(EACH)
CYTOLOGY PRESERVATIVE TUBES
(EACH)
DRUGS OF ABUSE COLLECTION KITS
(EACH)
FORMALIN, 40 ML
(EACH)
BOX)
CASE)
FORMALIN, 20 ML
(EACH)
BOX)
CASE)
GEN PROBE GC/CHLAMYDIA COLLECTION KITS
UNISEX SWAB (URETHRAL/ENDOCERVICAL)
(EACH)
(BOX)
GEN PROBE URINE COLLECTION KIT
(EACH)
(BOX)
 
LABELS:SPECIMEN IDENTIFICATION
LANCETS
(EACH)
MICHEL'S SOLUTION
(EACH)
NEEDLES
ECLIPSE BLOOD COLLECTION NEEDLE 22 x 1-1/4
(EACH)
(BOX OF 100)
ECLIPSE BLOOD COLLECTION NEEDLE 21 x 1/1/4
(EACH)
(BOX OF 100)
BD SAFETY-LOK BUTTERFLY COLLECTION W/HOLDER 23 GAUGE
(EACH)
(B0X OF 50)
NEEDLE PROS/BARRELS
(EACH)
 
PAP SMEAR KIT
(PKG of 25)
PIPETTE, TRANSFER 3 ML.
(BOX OF 500)
REQUISITIONS:
CLINICAL CUSTOMIZED
(EACH)
CYTOPATHOLOGY
(EACH)
SURGICAL PATHOLOGY
(EACH)
SLIDES, SUPERFROST 3" X 1"
(BOX of 100)
SLIDE MAILERS MAILERS:
(PKG OF 20)
STOOL TRANSPORT VIALS (CULTURE/GIARDIA EIA)
(EACH)
(BOX)
STOOL, FOBT KIT
(EACH)
(BOX OF 25)
STOOL, FOBT ENVELOPES
(EACH)
(PKG OF 25)
STOOL TRANSPORT VIALS (O&P)
(EACH)
(BOX)
SURE PATH ® PAP COLLECTION VIALS & BROOMS
(PKG OF 25)
SURE PATH ® PAP COLLECTION VIALS & BRUSHES/SPATULAS
(PKG OF 25)
THIN PREP® PAP COLLECTION VIALS & BRUSHES/SPATULAS
(PKG OF 25)
THIN PREP® PAP COLLECTION VIALS &BROOMS
(PKG OF 25)
TOOTHBRUSH FOR FUNGAL CULTURE
(EACH)
TOURNIQUETS
(EACH)
TUBES, BLOOD COLLECTION
ACD SOLUTION A, YELLOW, 8.5 ML
(EACH)
ACD SOLUTION B, YELLOW, 6 ML
(EACH)
BLUE, LIGHT (COAGULATION) 2.7 ML
(EACH)
(PKG OF 100)
BLUE, TRACE ELEMENT, 6 ML (SERUM)
(EACH)
BLUE, TRACE ELEMENT PLUS K2EDTA, 6 ML (PLASMA)
(EACH)
GRAY, 3 ML
(EACH)
(PKG OF 100)
GREEN LITHIUM HEPARIN 3 ML
(EACH)
(PKG OF 100)
GREEN SODIUM HEPARIN 3 ML
(EACH)
(PKG OF 100)
GREEN SODIUM HEPARIN 10 ML
(EACH)
(PKG OF 100)
LAVENDER (EDTA) 2 ML
(EACH)
(PKG OF 100)
LIGHT GREEN LITHIUM HEPARIN PLASMA SEPARATOR TUBE 3ML
(EACH)
PINK (EDTA - BLOOD BANK) 6 ML
(EACH)
(PKG OF 100)
RED (PLAIN) 6 ML
(EACH)
(PKG OF 100)
GOLD (SERUM SEPARATOR) 3.5 ML
(EACH)
(PKG OF 100)
TB GOLD KIT
(EACH)
TUBE, OTHER - SPECIFY:
TUBES, BLOOD COLLECTION - MICROTAINERS
AMBER (BILIRUBINS)
(EACH)
(PKG OF 50)
RED (PLAIN)
(EACH)
(PKG OF 50)
GREEN (LITHIUM HEPARIN)
(EACH)
(PKG OF 50)
YELLOW (SERUM SEPARATOR)
(EACH)
(PKG OF 50)
LAVENDER (EDTA)
(EACH)
(PKG OF 50)
URINALYSIS TRANSPORT TUBE, 8 ML
(EACH)
URINE COLLECTION HAT
(EACH)
URINE CULTURE COLLECTION KIT (CUP AND WIPE)
(EACH)
URINE CULTURE TRANSPORT KIT (STRAW AND TUBE TOGETHER)
(EACH)
(PKG OF 50)
URINE ALIQUOT TUBE (RANDOM), 15 ML
(EACH)
(PKG of 50)
URINE ALIQUOT TUBE (24 HOUR), 50 ML
(EACH)
(PKG of 25)
URINE
PLAIN CONTAINER (24 HOUR)
(EACH)
ACID ADDED CONTAINER (24 HOUR)
(EACH)
OTHER
(EACH)
URINE CULTURE TRANSPORT TUBE
(EACH)
URINE TRANSFER STRAW
(EACH)
URORISK KIT
(EACH)
URINE STRAINER
(EACH)
 
UNIVERSAL TRANSPORT MEDIA (UTM)
(EACH)
VIROLOGY/CHLAMYDIA TRANSPORT CONTAINERS
(EACH)
OTHER:

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