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The parties expressly agree to enter into this Acknowledgement of Confidentiality and Non-disclosure Obligations in electronic format, to be bound by the terms thereof as expressed electronically, and to the use of an electronic signature process as the parties’ intent to be bound by such terms. You may be provided a paper copy of the Acknowledgement of Confidentiality and Non-disclosure Obligations upon written request by contacting CCPA Purchasing Partners.

The undersigned, a prospective business associate ("Prospect") of CCPA Purchasing Partners, LLC ("CCPA PP"), is reviewing potential business opportunities and/or is considering entering into an agreement with CCPA PP and accordingly has or may have access to vendor pricing and other proprietary information.

For the benefit of CCPA PP in the administration of the above-referenced arrangements, the undersigned hereby affirms that Prospect will not disclose to any third party any of the following information:

(i) Proprietary business information, not available to the general public, which is obtained by the Prospect; or

(ii) The specific vendor pricing provided for under the agreement between CCPA PP and Prospect The Prospect agrees to indemnify, defend, and hold harmless CCPA PP and its employees, officers and directors from and against any claim (including the costs of the investigation and defense thereof and any damages assessed) arising from or out of any breach by the Prospect of this agreement.

Business Name:
* First Name:		Field 'First Name' is blank
* Last Name:		Field 'Last Name' is blank
Title:
* Email Address or Fax Number of where you would like this pricing sent:		Field 'Email Address or Fax Number' is blank
* Phone Number (Format: 123-456-7890):		Field 'Phone Number' is blank Field 'Phone Number' is invalid
Sample Pricing Requested:	COTG (Xerox/HP copiers, printers, multi-functional devices) LB Medwaste Services (medical waste disposal) McKesson (medical-surgical supplies) MedImmune (Flumist vaccine) Medix (temporary staffing) Merck (vaccines) Access (document storage, scanning) Pfizer (Trumenba, meningococcal group B) Sanofi Pasteur (vaccines including Influenza) Staples (office supplies) Summit Technologies (IT support) USPAY (electronic payments) Warehouse Direct (office supplies)
McKesson provides sample pricing that is tailored to various physician specialties. If your practice is interested in this vendor, please indicate the specialty(ies) of the physician(s) in your office:	1000 characters left
	4/24/2024 5:59:39 PM