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Letter of Participation
1. Group Designation and Term. The undersigned Member recognizes and designates New Source Ambulatory, LLC ("New Source") as a group purchasing organization and its purchasing agents for the purpose of negotiating vendor pricing on Member's behalf. Member hereby designates New Source as its primary group purchasing organization, and New Source hereby grants Member access to New Source's vendor pricing contracts, as the same maybe published from time to time. This letter of participation is valid for a period of one year, unless terminated by either party within ten (10) days of notice to the other. If not sooner terminated, it will automatically extend at the end of each one year term for a successive one year term.
2. Administrative Fees and Reporting. New Source is permitted by law to be paid by vendors with whom it has negotiated contract pricing. An administrative fee not to exceed 3% of the amount of sales by those vendors accessed by each New Source member. New Source will report to each member at least annually the amount of such fees paid to New Source in respect of purchases made by that member.
3. Confidentiality. The undersigned, member, McKesson Medical-Surgical and New Source each agree to keep confidential terms of this agreement and the vendor pricing, and terms negotiated on member's behalf by New Source, and agree that they will not disclose such pricing and terms to any third paty without prior consent of New Source.
Member Information
Facility Name:
Signature:
Date:
Print Name of Contact:
Facility Street Address:
Facility City, State and Zip Code:
Phone:
Fax:
Email:
DEA Number:
or
HIN Number:
or
Medical License Number:
5605 Glenridge Drive, NE - Suite 870 Atlanta, GA 30342 1-888-906-4217 678-623-3938 (Fax)
Online Acceptance via E-Signature allows you to immediately accept or decline this offer of participation. You will be allowed to electronically sign these actions, allowing your enrollment into a GPO to be faster and more efficiently processed. If you like a paper copy of this agreement, please contact our office.
If you prefer to accept your awards manually, please contact our office via email or phone, and we would be happy to work with you.
