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Request Supplies

Order what you need, when you need it. Supplies are an important part of our process, enabling us to provide consistent, dependable service.

Requestor Information

First Name: *

Last Name: *

Suffix: select... Sr. Jr. III IV Esq. MD PhD RN

Company / Practice: *

Position / Profession: *

Phone: *

Phone Location: * select... Office Surgery Ctr.

Email: *

Email Location: * select... Office Surgery Ctr.

Shipping Address: *

Shipping Address 2:

City: *

State: * select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip: *

Attention: *

Your Miraca Life Sciences Laboratory: select... Dallas/Irving TX Boston/Newton MA Phoenix AZ N/A

Laboratory Supplies

Prefilled NBF, 20 ml (96/cs): select... 1 2 3 4 5

Qty.

Prefilled NBF, 40 ml (96/cs): select... 1 2 3 4 5

Qty.

Prefilled NBF, 60 ml (96/cs): select... 1 2 3 4 5

Qty.

Prefilled NBF, 120 ml (96/cs): select... 1 2 3 4 5

Qty.

Prefilled NBF, 240 ml (96/cs): select... 1 2 3 4 5

Qty.

Biopsy Pads - Blue (1000/pk): select... 1 2 3 4 5

Qty.

Biopsy Pads - White (1000/pk): select... 1 2 3 4 5

Qty.

Slide holder containers (10/pk): select... 1 2 3 4 5

Qty.

Slides (50/box): select... 1 2 3 4 5

Qty.

Cytology Vials (10/pk): select... 1 2 3 4 5

Qty.

Prefilled Bouin's Fixative (1 bottle): select... 1 2 3 4 5 6 7 8 9 10

Qty.

Carbofix Cytology Fixative (4 fl oz): select... 1 2 3 4 5

Qty.

Urine Cytology / UroVysion FSH: select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Qty.

Prostate Biopsy Kit (8 vial): select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Qty.

Prostate Biopsy Kit (16 vial): select... 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

Qty.

Miraca Life Sciences General Requisitions (100/pk): select... 1 2 3 4 5

Qty.

Miraca Life Sciences Derm Requisitions (100/pk): select... 1 2 3 4 5

Qty.

Miraca Life Sciences GI Requisitions (100/pk): select... 1 2 3 4 5

Qty.

Miraca Life Sciences Urologic Pathology Requisitions (100/pk): select... 1 2 3 4 5

Qty.

Miraca Life Sciences Podiatry Requisitions (100/pk): select... 1 2 3 4 5

Qty.

Biohazard Transport Bags (100/pk): select... 1 2 3 4 5

Qty.

Brochures - Patient Guide to Billing - English (50/pk): select... 1 2 3 4 5

Qty.

Brochures - Patient Guide to Billing - Spanish (50/pk): select... 1 2 3 4 5

Qty.

Printer Supplies

Ink Cartridge - HP Officejet Pro K550 Color Printer (C8157A) COLOR: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K550 Color Printer (C8157A) BLACK: select... 1 2

Qty.

Ink Cartridge - HP Business Inkjet 1200 Printer series COLOR: select... 1 2

Qty.

Ink Cartridge - HP Business Inkjet 1200 Printer series BLACK: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940XL (C4906AN) BLACK : select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940XL (C4907AN) CYAN : select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940XL (C4908AN) MAGENTA: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940XL (C4909AN) YELLOW: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940 (C4900A) BLACK/YELLOW: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro 8000 - HP 940 (C4901A) MAGENTA/CYAN: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 XL (C9396AN) BLACK: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 XL (C9391AN) CYAN: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 XL (C9392AN) MAGENTA: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 XL (C9393AN) YELLOW: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 (C9381A) BLACK/YELLOW: select... 1 2

Qty.

Ink Cartridge - HP Officejet Pro K5400 - HP 88 (C9381A) MAGENTA/CYAN: select... 1 2

Qty.

Dymo Labels - 350 labels/roll (2 rolls/box) : select... 1 2

Qty.

UPS Shipping Supplies

UPS Next Day Air Boxes - Small (20/case): select... 1 2 3 4 5

Qty.

UPS Next Day Air Boxes - Medium (20/case): select... 1 2 3 4 5

Qty.

UPS Next Day Air Boxes - Large (20/case): select... 1 2 3 4 5

Qty.

Lab pack bags (50/pack): select... 1 2 3 4 5

Qty.

Return Service Labels & UN3373 Shipping Labels (25/pack): select... 1 2 3 4 5

Qty.

Comments / Notes: