GML Online Supply Order Form

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

Client Name: Internal Zip (GHS Sites):
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ITEM
AMOUNT
ABSORBENT PADS
(BAG OF 500)
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)
BACTEC BLOOD CULTURE BOTTLES
(SET)
BACTEC AEROBIC BLOOD CULTURE BOTTLES (for Pediatric patients)
(EACH)
BLOOD CULTURE, MALE LEUR ADAPTER
(EACH)
CONTAINER, STERILE SPECIMEN (90 ML)
(EACH ) (PKG OF 100)
DAU TEMPERATURE STRIPS
(PKG OF 100)
CULTURE SWAB, RED (MRSA / VRE / GRPB STREP)
(EACH)
CULTURE SWAB, ESWAB (BACTERIAL & FUNGAL)
(EACH) (PKG)
CULTURE SWAB, GREEN (NPG OR MALE URETHRAL)
(EACH)
CULTURE SWAB, BLUE (GROUP A STREP COMBO)
(EACH) (BOX)
CYTOLOGY FIXATIVE SPRAY BOTTLE
(EACH)
CYTOLOGY PRESERVATIVE TUBES
(EACH)
DRUGS OF ABUSE COLLECTION KITS
(INCLUDES CHAIN OF CUSTODY FORM, GREEN DAU LABEL, AND DAU CUP)
(EACH)
FORMALIN, 40 ML
(EACH) BOX) CASE)
FORMALIN, 20 ML
(EACH) BOX) CASE)
GEN PROBE UNISEX SWAB (URETHRAL/ENDOCERVICAL)
(EACH) (BOX)
GEN PROBE URINE COLLECTION KIT
(EACH) (BOX)
LABELS:SPECIMEN IDENTIFICATION
LANCETS
(EACH)
MICHEL'S SOLUTION
(EACH)
NEEDLE, ECLIPSE BLOOD COLLECTION NEEDLE 22 x 1-1/4
(EACH) (BOX OF 100)
NEEDLE, ECLIPSE BLOOD COLLECTION NEEDLE 21 x 1/1/4
(EACH) (BOX OF 100)
NEEDLE, BD SAFETY-LOK BUTTERFLY COLLECTION W/HOLDER 23 GAUGE
(EACH) (B0X OF 50)
NEEDLE PROS/BARRELS
(EACH)
PIPETTE, TRANSFER 3 ML.
(BOX OF 500)
REQUISITION: CLINICAL CUSTOMIZED
(EACH)
REQUISITION: CYTOPATHOLOGY
(EACH)
REQUISITION: SURGICAL PATHOLOGY
(EACH)
SLIDES, SUPERFROST 3" X 1"
(BOX of 100)
SLIDE 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)
TOOTHBRUSH FOR FUNGAL CULTURE
(EACH)
TUBES, BLOOD COLLECTION, ACD SOLUTION A, YELLOW, 8.5 ML
(EACH)
TUBES, BLOOD COLLECTIONM, ACD SOLUTION B, YELLOW, 6 ML
(EACH)
TUBES, BLOOD COLLECTION, BLUE, LIGHT (COAGULATION) 2.7 ML
(EACH)
(PKG OF 50)
TUBES, BLOOD COLLECTION, BLUE, TRACE ELEMENT, 6 ML (SERUM)
(EACH)
TUBES, BLOOD COLLECTION, BLUE, TRACE ELEMENT PLUS K2EDTA, 6 ML (PLASMA)
(EACH)
TUBES, BLOOD COLLECTION, GRAY, 3 ML
(EACH) (PKG OF 50)
TUBES, BLOOD COLLECTION, GREEN LITHIUM HEPARIN 3 ML
(EACH) (PKG OF 100)
TUBES, BLOOD COLLECTION, GREEN SODIUM HEPARIN 3 ML
(EACH) (PKG OF 100)
TUBES, BLOOD COLLECTION, GREEN SODIUM HEPARIN 10 ML
(EACH)
TUBES, BLOOD COLLECTION, LAVENDER (EDTA) 3 ML
(EACH)
(PKG OF 50)
TUBES, BLOOD COLLECTION, LT GREEN LITHIUM HEPARIN PLASMA SEPARATOR TUBE 3ML
(EACH)
TUBES, BLOOD COLLECTION, PINK (EDTA - BLOOD BANK) 6 ML
(EACH) (PKG OF 50)
TUBES, BLOOD COLLECTION, RED (PLAIN) 6 ML
(EACH) (PKG OF 50)
TUBES, BLOOD COLLECTION, GOLD (SERUM SEPARATOR) 3.5 ML
(EACH) (PKG OF 50
TUBES, TB GOLD KIT
(EACH)
TUBE, BLOOD CULTURE DECANT (EACH) PKC OF 100
   
TUBE, OTHER - SPECIFY:
TUBE RACK, DISPOSABLE
(PKG OF 100)
TUBES, MICROTAINER, AMBER (BILIRUBINS)
(EACH) (PKG OF 50)
TUBES, MICROTAINER, RED (PLAIN)
(EACH) (PKG OF 50)
TUBES, MICROTAINER, GREEN (LITHIUM HEPARIN)
(EACH) (PKG OF 50)
TUBES, MICROTAINER YELLOW (SERUM SEPARATOR)
(EACH) (PKG OF 50)
TUBES, MICROTAINER, LAVENDER (EDTA)
(EACH) (PKG OF 50)
URINALYSIS TRANSPORT TUBE, 8 ML
(EACH) (PKG OF 100)
URINE,PLAIN CONTAINER (24 HOUR)
(EACH)
URINE, ACID ADDED CONTAINER (24 HOUR)
(EACH)
OTHER
(EACH)
URINE CULTURE TRANSPORT TUBE
(EACH) (PKG OF 100)
URINE TRANSFER STRAW
(PKG OF 100)
URORISK KIT
(EACH)
URINE STRAINER
(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)
UNIVERSAL TRANSPORT MEDIA (UTM) WITH SWAB
(EACH) (BOX OF 50)
UNIVERSAL TRANSPORT MEDIA ONLY (NO SWAB)
(EACH) (BOX OF 50)
VIRAL TRANSPORT MAILERS
(EACH)
OTHER:

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