New User Form

Become a Member of U.S. Physician's Purchasing Group (USPPG) Today!

To join and start enjoying discounts on all your future vaccine and medical supply purchases, please complete the electronic membership application below and submit it to us. Remember, membership is FREE!

Upon application approval, you will be emailed a confirmation and secure password.

*All fields are required.

Electronic Application Form

Practice Name: *

Practice Specialty:

Physician First Name: *

Physician Last Name: *

Title (MD, DO, etc.): *

Main Office Address 1: *

Main Office Address 2:

City: *

State: *

Zip Code: *

Email: *

Phone: *

Fax:

Office Manager Name: *

Office Manager Email: *

Please list all other Physician Names associated with this practice/business:

Choose a User Name: *

How did you hear about USPPG?:

Offer:

We would like to receive all pricing and rebate updates and other USPPG information by email.

AS A MEMBER OF USPPG, I AGREE TO KEEP ALL PRICING AND CONTRACT INFORMATION CONFIDENTIAL

Furthermore, I recognize that the purchasing programs offered by USPPG may include an administrative fee paid by the contracted vendors to. Such USPPG compensation may be a fixed amount or a percentage of the value of purchases made by your Practice from a vendor, but in no case shall it exceed three percent (3%) without appropriate notification to your Medical Practice.

Furthermore, I understand that each vendor's (manufacturer or distributor) contract requires that I expressly designate my intention to purchase products under the terms of the USPPG agreement by signing the vendor's Contract Designation Form. Membership in USPPG does not automatically provide access to USPPG'S vendor contracts. I agree to review each vendor's Contract Designation Form that I intend to use and abide by any conditions contained therein.

USPPG represents and warrants that its Group Purchasing Program and related activities comply with applicable state and Federal laws, including the relevant provisions of the Federal "Safe Harbor" regulations found at 42 CFR 1001. Your Medical Practice, by executing this Agreement, agrees to disclose and appropriately reflect any discount or reduction in price received in any cost report submitted to any governmental programs, including but not limited to, the Medicare and Medicaid programs. This Group Purchasing Program Membership Agreement shall remain in effect for one year from the date of signature unless terminated by either party upon thirty (30) days advance written notice. Unless otherwise notified, this agreement shall renew for additional one-year periods on the anniversary date each year hereafter.

Agreement2: *

I agree to Terms of Agreement

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Become a Member of U.S. Physician's Purchasing Group (USPPG) Today!

Electronic Application Form