RenalEdge GPO Enrollment Form
Name
*
First Name
Last Name
Title
*
Organization/Company
*
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Are you a
*
Dialysis Provider -interested in accessing group purchasing discounts
Vendor Partner - interested in partnering with RenalEdge to offer products/services
N/A
Enrollment in RenalEdge GPO is included with Renal Healthcare Association membership. Are you a member of RHA?
*
Yes, I am a member.
No, please send me more information.
No.
If a provider: What is your Facility Type
Independent
SDO
MDO/LDO
Hospital-Based
Other
If a provider: What are you Areas of Interest
Pharmaceuticals
Dialyzers & Consumables
Equipment
Lab Services
IT/Software
Other
Are you currently part of any other GPOs?
Yes
No
If a Vendor: What Products/Service Categories do you offer
Dialysis Equipment
Supplies & Consumables
Pharmaceuticals
Lab Testing
IT/Software Solutions
Staffing/Recruitment
Consulting/Training
Other
Do you currently have contracts with any GPOs?
Yes
No
Why are you interested in partnering with RenalEdge? (Access to independent providers, streamlined contracting, etc.)
Do you offer any of the following
National Pricing
Volume-Based Discounts
Rebates or Incentives
Custom Contracting Options
How did you hear about RenalEdge?
Any comments or questions for us?
Submit
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