Program Enrollment

Address: 3330 Cumberland Blvd, Suite 500, Atlanta, GA 30339
Telephone: 770-953-3026
Fax: 770-771-5945

Program Enrollment

Current Members do not need to fill out the below form. Instead, please email a member of our Team for assistance.

Enrolling with HPS is easy. If you have any questions or need assistance, please email enrollment@healthcareprocurement.com or call our support team at 770-953-3026.

To enroll, complete and submit the form below, choose the programs you are interested in, and sign the online member disclosure agreement. Fields with a are required.

Upon completion, a member of the HPS team will contact you to review your selections and provide next steps to get you connected to confirmed programs.

Thank you for choosing HPS as your preferred GPO!

Business Information

Business Name:

Primary Facility Address - commercial business location, PO Boxes & residential addresses not accepted
Street:
City:
State:
Zip Code:

Billing Address - if different than Primary Facility Address
Street:
City:
State:
Zip Code:

Primary Phone Number: (###-###-####)
Website Address:
Class of Trade:
If "Other", please specify:
Number of Employees:
Number of Locations:

Contact Information

Contact Name
Contact Title
Contact Phone Number (###-###-####)
Primary Email Address (example@domain.com)
Who is your current GPO?
How did you hear about HPS?

Program Participation

Reference Laboratory Services

Who is your current provider of lab services?


What is your account number with the current provider?


Please provide the name of your current lab service representative.

Please provide the phone number of your current lab service representative. (###-###-####)

Please provide the email address of your current lab service representative. (example@domain.com)


Expected annual lab volume (in dollars):

What is your current EMR platform?

Do you have an in-house phlebotomist?
Yes No
What is your practice specialty (if more specific than Class of Trade provided)?

Disclosure Agreement

I have read and understand the HPS Member Disclosure Agreement. By entering my name in the signature box below, I acknowledge receipt and accept the terms of this Agreement as a condition of participation.

Signature:

Related Links

HPS KEY PARTNERS
We Partner with Thousands of Clinical and Non-clinical Companies

Program Enrollment

Related Links

HPS KEY PARTNERSWe Partner with Thousands of Clinical and Non-clinical Companies

HPS KEY PARTNERS
We Partner with Thousands of Clinical and Non-clinical Companies