Vendor Registration

During the registration process Materials Management will review/check the following:

Applicable policies
Campus map, if appropriate
Information regarding patient safety and infection control
Information regarding confidentiality
Need for a business associate agreement
Information regarding parking
Information regarding identification badges
JCAHO requirements, as determined by the Licensing/ Accreditation Department
Office of Inspector General's list of excluded individual/entities check
Bio-medical equipment preventive maintenance/quality checks
Other policies, standards or documents applicable to the vendor considering the service or product provided; the entity, division, or department with whom the vendor is working; the request of ACHS Personnel; or other written arrangements between ACHS and the vendor.

Upon acceptance of your registration, an email will be sent back to you with a sign-on password that will give you access to detailed information regarding compliance, legal, procurement, insurance, and other applicable requirements.

Any questions should be directed to Luis Soto, Director of Materials Management 727-767-4957 or sotol@allkids.org.

Register Now:

Comany Name *

Local Representative Name *

Local Representative Email Address *

Federal Tax ID Number

Local Representative Phone Number *

Local Representative Fax Number

Local Representative Address Line 1 *

Local Representative Address Line 2

Local Representative City *

Local Representative State *

Local Representative Postal Code *

Corporate Address Line 1 *

Corporate Address Line 2

Corporate Address City *

Corporate Address State *

Corporate Address Postal Code *

Regional Director or Vice President Name

Director/VP Phone Number

Director/VP Fax Number

Is your company a participant in these Group Purchasing Organizations?

Med Assets

Premier

As a vendor are you certified or classified as the following:

Minority Business Enterprise (MBE)

Small Business Enterprise (SBE)

Veteran Owned (VET)

Woman Business Enterprise (WBE)

Describe your Product Line and or Give Examples

Are your products DEHP and Latex Free?

If your products are not Latex and DEHP free, please provide additional information

* Required

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Vendor Registration

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