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IPS GROUP PURCHASING ORGANIZATION (IPS GPO)

  • Contact Information

  • Main Office Ship To Address

  • Vaccine Account Numbers

  • Please List All Physicians and Mid-Levels

  • First Name *Middle NameLast Name * 
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  • Please take a moment to answer the following questions. The information gathered will be reviewed by the Program Director to determine compliance with program requirements.
  • THIS AGREEMENT is between the Medical Practice named herein and Integrated Physician Solutions Group Purchasing Organization (“IPS GPO”). The Medical Practice and IPS agree to enter into an agreement in which IPS will act as a group-purchasing agent so that the Medical Practice will gain access to nationally contracted IPS pricing. For vaccine purchases, IPS will help Members retain eligibility for pricing under this agreement based upon a 90% market share with Sanofi Pasteur’s IPOL, Hib, and DTaP (Daptacel) or Tdap (Adacel), and Meningococcal vaccine (Menactra or MenQuadfi) and a 90% market share with Merck’s Pneumovax 23/Vaxneuvance, and Rotavirus (Rotateq). IPS Group Purchasing Organization may receive an administrative fee ranging from 0%-5% from the participating manufacturers as payment for administering and managing the organization and ensuring organizational compliance. Members in good standing with manufacturers are eligible to receive payment terms of net 60-90 days and a 2% prompt pay discount. Members agree to keep all IPS pricing and contract information confidential except as may be required by any governmental programs, including but not limited to, Medicare and Medicaid. Returns are the responsibility of the Member. This Agreement may be canceled through written notice, with or without cause, by either party with 30days written notice. I understand and agree that any and all vaccines purchased through IPS GPO are for my practice’s “own use” and that I will not engage in re-sale of any vaccine to any other entity or individual. I understand and agree that any dispute that may occur between the manufacturer or other supplier/vendor and the practice including billing, payments, return of product or efficacy of product will be resolved solely between the vaccine manufacturer/ supplier/vendor and the member. I agree to voluntarily participate in the IPS GPO and am authorized to contract for the Medical Practice named herein and its affiliated physicians listed. I understand that as a new member, my first vaccine order could take up to 1 week for IPS pricing to be effective with Sanofi Pasteur, and up to 3 weeks for IPS pricing to be effective with Merck.
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