Supplier Form

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Supplier Form

Step 1: General Information

If you have been given a System ID by your Negotiator, enter this number here, (Example CTR####).

Step 2: Company Information

Click the drop-downs to complete the mailing and physical address fields.



Note that if you enter a DBA Name, additional response fields will appear. For reference, the DBA name associated with your Tax ID will populate in the top right section of each screen as you move forward.

When you make a selection from the Diversity list, a date field will open. Hover over the date field to see the drop-down completion arrows.

Step 3: Company Information (cont.)

Be sure to click the drop-down icon for correct response options.



The option No is the default response regarding OIG (Office of Inspector General) and GSA (Government Services Administration). However if the negative response is inaccurate, you must check Yes. Either response does not impact your ability to move forward in the questionnaire.

Step 4: Products/Services

Select the categories that your company offers. This may include products, equipment, or services. You can select multiple categories or subcategories, but you must select at least one category. If you do not see a category listed that is applicable for your business or offering, notify HealthTrust Customer services and provide that information.

Expanding the parent category will allow you to select one or multiple sub-categories. If you select the parent category, the system will automatically select all the sub-categories beneath it.

Step 5: Previous Company Details

Complete only if you are submitting a change due to a merger or acquisition (the form will open by checking the box).

Clicking the box next to Will any catalog numbers change will prompt a message telling you that later in the process you will be required to submit new catalog information.

Step 6: Purchasing/Remit Information

Click here to see this section of the form. Select Yes or No as appropriate. If No is selected, explain in the field provided.

Steps 7: Contacts

The fields shown here will be required for the contact types listed below.

Contact Types and Definitions

Contact types to include here are:

  • Primary Contact – Main person to whom HealthTrust membership should direct any contract questions.
  • Secondary Contact – Secondary person to whom HealthTrust membership should direct any contract questions.
  • Contract Manager Contact (National Account Rep) – Person with whom HealthTrust will use when sending approval and rejection email notification for batches of price changes, item adds, and/or item expires.
    • Pharmacy – Please provide the contact information for the person with whom HealthTrust will use when sending approval and rejection e-mail notification for batches of price changes, item adds, and/or item expires.
    • Distributors – Please provide the contact for the person with whom HealthTrust will use when sending price files.
  • EDI Information Contact – Person members should direct questions regarding the set-up of EDI transactions.
  • Customer Service Contact – Contact to whom members should communicate issues or ask questions. This could be a main toll-free number and does not have to have a name or address.
  • Financial Contact – In some instances, it will be necessary for HealthTrust to cut checks back to the vendor. Provide the information for the contact to whom HealthTrust should send these checks.
  • Source Advertising Contact – Person that would like to receive communications regarding opportunities to advertise in HealthTrust’s quarterly magazine, The Source.
  • Primary Pharmacy Contact – Person to whom HealthTrust membership should direct any pharmacy contract questions.

Finish & Review

Review your entries from the above steps.



At any time during or at the end of the form completion process, you may return to a previous screen to correct or update an entry by clicking the Previous button on the bottom left.

Upon submission, this message will appear on your screen.

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*“New technology” is classified as a product that, as compared to existing products:

  • Offers significant technological advancements,
  • Improves clinical outcomes or patient care in a significant way (i.e., documented reduction in procedure times, outcomes, lengths of stay, readmissions, infection rates), or
  • Streamlines work processes and/or the economics of facility operations in a significant way (i.e., increase or decrease expenses in supply chain or resource utilization).

Demonstration of the above through independent, peer-reviewed publication(s) is beneficial, but not required.*

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