Vaccine and Vendor Forms

Vendor Forms

To participate in any of the discount programs offered through Premier, Inc (Including, but not limited to: McKesson, Staples, Warehouse Direct, COTG, Sprint, Verizon, and/or AT&T) please submit the following:

  • CCPAPP-Premier ProviderSelect:MD Application - to be completed by all practices electing to participate in any of the Premier discount programs. Please allow up to 2 weeks for your application to be processed by Premier. Your practice will receive a Premier Member ID/Entity Code from CCPAPP once your application has been processed and membership has been activated.

Please note that if you are participating in the McKesson agreement, you may begin to receive discounted pricing right away upon enrollment in Premier; however, it may take up to 8 additional weeks for your practice to receive all discounted medical-surgical supplies pricing to take effect. Pricing must be activated by each product supplier and the activation time-frame is dependent on how quickly each supplier responds to CCPAPP's request. Some products will take longer than others for the pricing to take effect.

  • CCPAPP-Premier Discounts Form - to be completed by all practices electing to join Premier (please be sure to complete the above-referenced ProviderSelect:MD Application) but opting out of the McKesson agreement.

Please note that additional steps may be required to participate in a Premier discount program. Please contact the vendor directly to ensure you are linked to the Premier pricing. For discounts with the cell phone service companies, please refer to the instructions found on the Cell Phone & Other Discounts page.

If your practice would like to participate in the McKesson agreement through Premier, but does not have an active ordering account, you must complete and submit the following to McKesson:

To participate in all other vendors, please contact them directly using the CCPA Purchasing Partners Vendor Contact Reference Guide found on our Vendor Partners Listing page

Updates to Your Practice? 

Please help us keep our membership information current by providing us with any updates regarding the address, phone, fax, and staff/physicians at your office(s). Members may update information by logging in to our site and clicking on the Membership tab underneath My Account or by returning our Update to Existing Practice or Physician Information Form.