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Thank you for your interest in serving North Carolina's community health centers through our Group Purchasing Organization. Before completing this application, please review the GPO Vendor Information Package.

At the end of the application, you will be prompted to pay the $175 application fee electronically by credit card or by mailing a check.

Contact:
Michael Barefoot
Vendor Service Assistant
North Carolina Community Health Center Association
919-655-0390
barefootm@ncchca.org

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* 1. Company Name

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* 2. Company Website

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* 3. Contact Person Name

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* 4. Contact Person Title

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* 5. Contact Person Email

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* 6. Contact Person Phone

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* 7. What category of goods and services does your company offer? (check all that apply)

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