McKesson/Masimo/HemoCue Hematology Supply Order Form

Only approved WIC agencies that contract with the Washington State Department 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

Information collected via this form may be subject to release in accordance with RCW 42.56 (Public Records Act).

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.

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
1217991	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
855064	Sharps Containers 1 Quart size Base (6-1/4Hx 4-1/4W x4-1/4D inch) Vertical entry .25 Gallon	each

Masimo Hematology Supplies: (Send packing slip to State WIC office within 3 days)

868866	Handheld Pulse Pronto Co-Oximeter (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

HemoCue Hematology Supplies: (Send packing slip to State WIC office within 3 days)
*Only order the 301 Microcuvettes for the 301 Analyzers

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 # 111731 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
1249026	Analyzer, Hemocue Hb301 (1 per box) (wic)d/s *This replaces the 201 Analyzers	each
1257876	Microcuvettes, F/hb301 Analyzer (75 EA/VL, 4VL/BX) (wic) D/s (1 per box) *Only order for 301 Analyzers	box