Vendor Application

If your company serves the healthcare industry and is interested in becoming a AHP contracted Vendor, we welcome your application. AHP is dedicated to completing a thorough review and interview process to ensure prospective Vendors can provide our Members with value contract pricing and relationship support.

**Disclaimer of Application: Please note this application serves as a process to identify Vendors for potential business relationships for AHP’s Members. This application and processes shall not be interpreted or construed, by either party, as entering into an agreement or contract of any type.

Organization*

First Name*

Email Address*

Title*

Address Line 1*

State*

Products and/or Services Offered*

( EMR, medical equip, pharma, therapy, office supplies, etc. )

Last Name*

Phone*

Website*

City*

Zip/Postal Code*

Tell us about your organization and areas of expertise*

What is your Organization's Service Area Coverage (ie. regional, state, national)?

Are you a member of other group purchasing organizations?*

Do you currently have relationships with any Senior Healthcare Facilities or Physician Groups? If so, please provide references

Feel free to upload a company brochure.

Maximum size 10MB (jpg, jpeg, png, gif, pdf files only)

If a member referral, please indicate the organization and name below.

Are you human?*

This field should be left blank

Get in Touch!