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Begin our membership application process today!

Contact Us                                                                                                        

Kena Norris
Executive Director

312.227.7406
knorris@ccpapp.org

Priya Stemler
Director of Operations

312.227.7437
pstemler@ccpapp.org

Paresh Patel
National Sales Manager

312.227.7436
papatel@ccpapp.org

Jennifer Jackson
Sr. Administrative Assistant
312.227.7442
jdjackson@ccpapp.org
 
Sonia Perez Gandara
Member Relations Specialist

312.227.7508
sgandara@ccpapp.org

General Inquiries:
312.227.7444
info@ccpapp.org
 
 

Vaccine Forms

To participate in CCPAPP's Vaccine Contracting Program, please submit the items below. Please note that you must be a member of CCPAPP to participate in our vaccine or vendor program. To become a member, please visit our Join page.

CCPAPP Vaccine Contracting Compliance Form - to be completed if your practice would like to participate in CCPAPP's Merck, Sanofi Pasteur, Pfizer, and/or AstraZeneca contract(s).This form allows you to select one contract option. Please ensure the form is signed and dated.

Depending on which vaccine contract(s) your practice elects, please submit the following:

Pfizer:

  • Pfizer New Ordering Account Application - to be completed if your practice would like to set up a direct ordering account with Pfizer.  Direct ordering is necessary for participation in discount pricing for Trumenba (Meningicoccal Group B Vaccine).

Sanofi Pasteur:

  • Sanofi Pasteur New Customer Form - to be completed only if your practice does not have an existing Sanofi Pasteur Account. If you have an existing Sanofi Pasteur account, please indicate your Sanofi account/customer number on the CCPA Purchasing Partners Vaccine Contracting Compliance form and complete the Sanofi Pasteur General Information Form noted below.
  • Sanofi Pasteur General Information Form - to be completed by practices electing the Sanofi Pasteur agreement that have an existing account/customer number. Please also indicate your account number on CCPAPP's Vaccine Contracting Compliance form where indicated.

Merck:

  • Merck Application for Direct-Purchase Account - to be completed only if your practice does not have an existing Merck Account. Please submit the following with your Application: Copy of State Medical License(s) and DEA Certificate(s). If you have an existing Merck account, you do not need to complete a new application. Simply indicate your Merck account number on the CCPA Purchasing Partners Vaccine Compliance Commitment form.
  • Merck Request to Modify an Existing Direct-Purchase Account - to be completed if your practice does have an existing Merck Account and would like to make the following account modifications: add/delete a permanent shipping location, update current shipping/billing address, update office delivery times, and other modifications.

AstraZeneca/MedImmune:

Please note that the timeframe for being linked to our vaccine contracts is 5 business days for existing accounts and 7-10 business days for new accounts.

 

 

 

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