In order to increase your probability of being connected based on your identified areas of interest, please select all applicable areas of strength in which you would be willing to share best practices.  Please use low, medium or high to prioritize your areas of interest for each 340B program topic. 

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* 1. Name of person completing 340B ACE Connect questionnaire:

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* 2. Role/Title:

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* 3. Are you an 340B Apexus Certified Expert (ACE)?

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* 4. Email address:

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* 5. Phone Number:

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* 6. Location (State):

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* 7. Covered Entity Type?

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* 8. 340B ID(s):

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* 16. If you’ve identified an area of strength for yourself and/or for your entity, please list examples of any specific projects that you can speak to:

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* 17. If you’ve identified an area of interest as high priority, please list specific questions that you are trying to learn more about.

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* 18. By completing this questionnaire, I consent to Apexus facilitating a 340B ACE connection whereby I may be the party sharing or receiving best practice recommendation as designed by the intent of the questionnaire.

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