Coloplast Urostomy Pouch Assura® 12995 One-Piece System 10-3/4 Inch Length Convex 1-1/8 Inch Stoma Drainable Nutritionals and Feeding Supplies Manufacturer # 262837 Country of

Manufacturer # 262837 Country of Origin China Application Dressing Change Tray Contents 1 (1) 3-1/2 X 4-1/2 Inch Tegaderm™ Dressing with Tape

(3) Bug Repellent Wipes

Manufacturer # 411640 Brand Little Ones® Manufacturer ConvaTec Country of Origin Dominican Republic Application Ostomy Pouch Capacity Small Color Teddy Bear Design Drain Type Closed End FSA Eligible - Buy UOM Yes FSA Eligible - Primary UOM Yes FSA Eligible - Sell UOM Yes HCPCS A4419 Length 6 Inch Length Stoma Opening Size 1/5 to 1-1/4 Inch Stoma System Type Two-Piece System UNSPSC Code 42312104

(2) Diotame

Manufacturer # 3512V Country of Origin Mexico Additive Without Additive Application Urinary Drain Bag Drain Tube Type Clamp Fastening Type Hanger / Hook and Loop Strap Graduations Graduated HCPCS A4357 (Disclaimer) Is_Active_Vendor Y Is_DSCSA N Is_Discontinued N Is_Medical_Device Y Lot_Tracking_Flag N Material Vinyl On_Allocation N Privacy Option Without Privacy Cover Sample Port Type Blunt Cannula Sterility Sterile Supplier_ID 488147 Tubing Length 40 Inch Tubing UNSPSC Code 42142704 Valve Type Anti-Reflux Valve Volume 2000 mL

Coloplast Urostomy Pouch Assura® 12995 One-Piece System 10-3/4 Inch Length Convex 1-1/8 Inch Stoma Drainable Nutritionals and Feeding Supplies Manufacturer # 262837 Country ofUOM BOX 10 UNITS PER BOX Features Urostomy pouch with belt loops Standard wear adhesive Convex skin barrier for retracted stomas Odor proof film Anti Reflux Valve Manufacturer # 12995 Brand Assura Manufacturer Coloplast Country of Origin Hungary Application Urostomy Pouch Barrier Style Convex Barrier Type Standard Wear Color Transparent Drain Type Drainable FSA Eligible Buy UOM Yes FSA Eligible Primary UOM Yes FSA Eligible Sell UOM Yes HCPCS A4392