Contact Person* Contact Person Title* Company Name* Year Established Telephone Number* Email* Address* City/State/Zip* Website Address* Ownership Individual Partnership Corporation Subsidiary Subsidiary of Total Annual Sales Annual Sales in US/Canada Key Product(s) Markets Served* Primary Competition* List Primary Distributors* Total Number of US Distributors* % of Sales Through Distribution % of Sales Direct to Healthcare Providers Do you currently sell directly to self-distributing IDNs? If so, which ones? Total Number of Sales Personnel* Company Reps Manufacturer Reps Is your organization interested in outsourcing its sales and/or marketing functions? Yes No Does your organization own its distribution facility(s) or do you outsource that function? Own Outsource Is your organization interested in outsourcing its distribution utilizing NDC 3PL Services? Yes No Do you have current contractual relationships with GPOs? If so, which ones? Do you currently process rebates? If so, is that internally processed or outsourced to a 3rd Party? Is your organization interested in outsourcing its contracts & rebate processing? Yes No Who directed you to NDC? What are your expectations in doing business with NDC? Additional Comments Captcha Verification Submit
