Prospective Vendor Profile
*Required Fields
 

PLEASE READ:

Thank you for your interest in becoming a potential vendor with HealthTrust. Please review our Contracting Schedule ("bid categories") prior to completing the Profile.   Vendors should review the schedule periodically for additions and/or changes.  The review process may start six to nine months prior to the expiration date of current agreements in a specific product or service category.  HealthTrust utilizes advisory boards that may, at their discretion, elect to extend a current agreement beyond its expiration date, or renew it for a new term. 

Please complete the Profile in its entirety. Please do not submit multiple profiles, and please ensure that others within your organization are not also submitting profiles for your company, which can cause delays. The Profile is a means of providing information about your company to HealthTrust. A HealthTrust representative will review your profile and contact you.  Due to the significant volume of profiles received, the review process could take up to 60 days.  If you would like to check on the progress, feel free to contact Cathy Florek, AVP Supply Chain Services, at 615.344.2966 or cathy.florek@healthtrustpg.com. 

If you are not contacted within 60 days, contact Lynn Egan, Ethics & Compliance Officer, at 615.344.3947 or lynn.egan@healthtrustpg.com.

Your submission of your company’s the profile does not guarantee that your company will be included in a bidding process.
  Company Name: *  
  Address: *  
  City: *  
  State: *  
  Zip: *  
  Telephone: *  
  Toll-Free No.:    
  Fax:     
  Your E-mail: *  
  Web Site:  *  
  Ownership Status:   Corporation
Government
 Joint Venture
Limited Liability Company
Partnership
Private
Proprietorship
Public
 
  Nature of Business    
  1)  Does your organization manufacture the product, market the product, or distribute the product for another manufacturer?    
  2) If your organization markets the product, do you have an exclusive national marketing agreement with the manufacturer?   Yes       No
  3) If your organization distributes the product, do you have an exclusive national distribution agreement with the manufacturer?   Yes       No

* If yes, with whom?

 
  If Minority Concern, Please Complete This Section:    
   A. Small Disadvantaged Business Concern:   Asian Pacific American
 Black
Hasidic Jewish American
Hispanic
Native American
Subcontinent Asian American
Not Applicable
 
  B. Certified Small Business Concern:
(As defined by the small business act)		   Yes       No
  C. Women-Owned Small Business:   Yes      No
 
  Geographic Service Area:
(Please indicate the geographic area your organization is currently serving.) 		*  
  Approximate Sales Volume for *
 Current Year's Rolling 12 Months:    
 Previous Year's Rolling 12 Months:  
   
*
 
  Information Products or Services:
(Please check all that apply) 		* Clinical Capital Equipment
Clinical Supplies
 Food Procurement & Services
 Information Technology Products & Services
 Laboratory Equipment & Supplies
 Non-Clinical Supplies
Non-Clinical Capital Equipment
Other-Products & Services (please complete below)
A. If other, does your organization provide goods or services not listed in the categories above?
Yes  No
B. If yes, please provide details:
C. What area of clinical environment (hospital, surgery center, etc.) currently uses your product?
 
  What percentage of your business is direct? *  
  What distribution channels does your company currently use?
(Please check all that apply) 		* Medical /Surgical
Pharmaceutical
 Laboratory
 Specialty
  What percentage of your business is through a distributor? *  
  How many distributors do you have?  *  
  What is the name of your National Sales Manager? *  
 

BUSINESS CLASSIFICATION DEFINITIONS

A.

 SMALL BUSINESS CONCERN: A small business concern, including its affiliates, which is independently owned and operated, is not dominant in the field of operation in which it is competing and can further qualify under the criteria concerning the type of business, number of employees, average annual receipts, or other criteria as defined by the Small Business Act and relevant regulations published. For example, all contracts of $10,000 or less, a company is determined to be small and if it does not have more than 500 employees including its affiliates.

B.

SMALL DISADVANTAGED BUSINESS CONCERN: A small concern that is at least 51% owned and controlled by socially and economically disadvantaged individuals, and whose management and daily business operations are controlled by one or more of those individuals: (A) Socially disadvantaged individuals are those who have been subjected to racial or ethnic prejudice or cultural bias because of their identity as a member of a group without regard to their individual qualities: (B) Economically disadvantaged individuals are those socially disadvantaged individuals whose ability to compete in the free enterprise system has been impaired due to diminished capital and credit opportunities compared to others in the same business area who are not socially disadvantaged. Contractors shall presume that socially and economically disadvantaged individuals include citizens of the U.S. identified below. Hasidic Jewish Americans have been classified as socially disadvantaged by the U.S. Department of Commerce Minority Business Development Agency.

  1. Black Americans
  2. Hispanic Americans
  3. Native Americans
  4. Asian-Pacific Americans
  5. Subcontinent Asian Americans
  6. Hasidic Jewish Americans

C.

 WOMEN-OWNED BUSINESS CONCERNS: A business concern that is at least 51% owned by women or women who are U.S. citizens, and who also control and operate the business. Women as a class are not considered to be socially and economically disadvantaged.