Members Portal

Join USPPG

Membership is free for physician practices and pharmacies. Fill in the form below and USPPG staff will review your application within 1 to 2 business days.

Fields marked with an asterisk are required. Already a member? Sign in

Your details

Title

First name *

Last name *

Email address *

Mobile phone

Your position

Practice

Organization or practice name *

Member type *

Street address *

Suite, floor or unit

City *

State *

ZIP code *

Practice phone

Contact phone

Licensing and tax IDs

Enter a DEA number or a HIN number. At least one is required.

DEA number

HIN number

Tax ID (TIN or EIN) Needed to receive rebate payments.

State license number

License expiration

Distributors

Primary distributor

Alternative distributor

Benefits you're interested in (optional)

Tick any contracts you'd like to join. You can also request them after your account is approved.

USPAY Moderna CLS Seqirus Medico-Mart, Inc. GSK Portfolio GSK Flu GSK Portfolio + Rotarix Add On + Arexvy Add On GSK Portfolio + Arexvy Add On GSK Portfolio + Rotarix Add On GSK Bexsero Only GSK Pharmacy Portfolio + Flu Pfizer COVID-19 Vaccines Pfizer Abrysvo (RSV) Penbraya Pfizer Portfolio Vaccines Pfizer Prevnar Pfizer Trumenba

W-9 form

A completed W-9 is needed to receive rebate payments. You can still join USPPG without one, you just won't be eligible for rebates. Download a blank W-9 (PDF)

I will email my W-9 to usppg@usppg.org I choose not to submit a W-9 and understand I won't receive rebates

Signature

Your signature is used on your GPO participation agreement and W-9. Please review both forms before signing.

GPO agreement (PDF) W-9 form (PDF)

Type your full name

Preview

Your Signature

Sign with your mouse or finger.

Please provide your signature before submitting.

Questions? Email usppg@usppg.org