McKesson/Masimo/HemoCue Hematology Supply Order Form

Only approved WIC agencies that contract with the Washington State Dept. of Health may use this order form to order clinic Hematology orders.

The Washington State WIC Program only pays for items listed on this order form.

We place orders every Friday if received by COB on Thursday. Orders usually arrive 11-14 days after we place them.

Send a copy of the packing slip or confirmation within 3 days of receiving your order
to WICHematology@doh.wa.gov Fax # 360-236-2320

All comments received, including attachments and other supporting materials, are part of the public record and may be subject to public disclosure under RCW 42.56 (Public Records Act).

1. Clinic Information (Required)
Contact Email Address
Contact Phone Number
Contact First and Last Name
Agency Name
Clinic Name
Clinic Shipping Address (No PO Boxes)
City, State, Zip Code
• Please beware - Some items may have an Expiration Date.
• Please order accordingly to your clinic caseload, clinic need and for a limited timeframe.
2. McKesson Hematology Supplies: (Send packing slip to State WIC office within 3 days)
191089
Alcohol Prep Pads
200 per box (2” x 2”, 2 ply, sterile, 70% isopropyl alcohol)
box
373772
Gauze Pads
200 per box (2” x 2”, 8 ply, non-sterile)
box
464083
Large Adhesive Bandages
100 per box (3/4” x 3”- Sterile)
box
668783
Medium Adhesive Bandages
100 per box (5/8” x 2 ¼ “- Sterile
box
448626
Small Adhesive Bandages
100 per box (3/8 x 1 1/2” - Sterile
box
840311
Small Safety Depth Lancet
100 per box (1.5mm Depth, 28 Gauge, push button activation)
box
511848
Large Surgilance Safety Depth Lancet
100 per box (2.2 mm Depth, 21 Gauge, push button activation)
box
586912
Sharps Containers 1.7 Quart size
20 per box
box
3. Masimo Hematology Supplies: (Send packing slip to State WIC office within 3 days)
852975
Pulse CO-Oximeter Pronto
(Battery Operated, Mfr# 9167) One Each.
each
854273
Pediatric Hemoglobin Sensor #3421
(400 SPHB Tests)
each
854272
Adult Hemoglobin Sensor #3420
(400 SPHB Tests)
each
4. HemoCue Hematology Supplies: (Send packing slip to State WIC office within 3 days)
478707
201+ HemoCue Analyzer - Mft#121721
(1 per box)
each
462624
HemoCue Hard Shell Carry Case for 201+ HemoCue Analyzer
(1 per box)
box
1129466
HemoCue 12volt Power Supply Adapter for 201+ HemoCue Analyzer
(1 per Box)
box
462626
HemoCue Analyzer Cleaners - Mft # 139123 (5 packs per Box)
box
696015
HemoCue HB 201+ Cuvette Holder Mft# 131717 (1 per box)
box
554387
201+ Microcuvette - Mft # 111716
Stable for 3 months after opening.
200 per box 4 vials per box/ 50 cuvettes per vial
box
1220109
Hemocue Mfr# 111732 Microcuvette HemoCue
Hb 201 Hemoglobin For HemoCue
Photometers 100 Tests 10 μL Microcuvette, Hemoglobin 201
individually wrapped (100/BX)
box