North Campus Lab Supply Orders

Complete the form below to order specimen collection supplies. By completing this form, you agree these are supplies to be used only for specimens that will be submitted to ProMedica Laboratories. When completing this form, please ensure that all information is current and accurate.

Please make sure to use the official/formal name of the physician practice that is tied with your office's Concordance number.

*Required

Physician Practice

Street Address

City

State

Contact Name

Phone

Account Number

Postal Code

Email Address

General Supplies

M4RT (Viral Swab - Herpes, etc.) - Each

Each

Cobas PCR Female Dual Swab kit (CGS) pink instructions - Each

Each

Cobas PCR Urine kit (CGU) yellow instructions - Each

Each

XPERT Swabs – Molecular Vaginitis Panel (MVP); Trichomonas (female) - Each

Each

XPERT Trichomonas Urine - Each

Each

Mycoplasma & Ureaplasma Viral Transport Media - Each

Each

ROM Plus Test - Each

Each

C & S Cary Blair Vial - Each

Each

Protocol Parasitology System (O & P) - Each

Each

PINWORM Collection Tube - Each

Each

A.C.T.I. - Each

Each

FIT Sample Collection Device - Each

Each

FIT Personal Pack (patient take home kit) - Each

Each

Navy/Lavendar Stripe EDTA - Each

Each

Navy/Red Stripe Serum - Each

Each

Blood Culture Bottles

Blood Culture Kits (includes Anaerobic & Aerobic bottle) – Each

Each

Also, please fill out the amount of the adapters you want with your blood culture kits below. Here is some more information on the different adapters to help you choose.

Male Adapter

Female Adapter

Female Adapters – Each

Each

Male Adapters – Each

Each

Cytology / Pathology

Prostate Kits - Each

Each

Fetal Fibronectin Kits - 4/Box

Boxes

Formalin Jars 20ml - Each

Jars

Formalin Jars 60ml - Each

Jars

Formalin Jars 90ml - Each

Jars

Formalin Jars 120ml - Each

Jars

Cytolyte 30 Ml - Each

Each

Thin Prep Brush Kit (Includes Vials, Brushes & Scrapers) - 25/Pack

Packs

Thin Prep Broom Kits (Includes Vials And Brooms) - 25/Pack

Packs

Slides - 72/Box

Boxes

Slide Holder - 50/Bag

Bags

Fixative Spray - Each

Each

Cytobrush Plus GT (OB/GYN Offices) - 10/Bag

Bags

Chocolate Agar Plates - Each

Each

Blood Agar Plates - Each

Each

Potato Slant - Each

Each

Enriched Thio Broth Tube - Each

Each

Glucola 50g - Pack

Packs

Glucola 75g - Pack

Packs

Glucola 100g - Packs

Packs

Forms

Clinical Requisitions - Each

Each

Pathology Requisitions - Each

Each

Specimen Labels - 30/Sheet

Sheets

Pathology Specimen Tracking Courier Log - 100/Pack

Packs