Vaccine & Vendor Forms

Vaccine Forms

Merck:

Merck Application for Direct-Purchase Account– Please complete to open a new Merck direct purchase account.
Merck Request to Modify an Existing Direct-Purchase Account – Please complete to add/delete a permanent shipping location, update current shipping/billing address, update office delivery times, and other modifications.

Sanofi Pasteur:

Sanofi Pasteur New Customer Form - Please complete to open a new Sanofi Pasteur direct purchase account.
Sanofi Pasteur General Information Form - Please complete to participate in the CCPAPP-Sanofi Pasteur Vaccine Contract.

Pfizer:

Pfizer Prime Contracts Registration Instructions - Please self-register on the Pfizer Prime Contracts website to join the Prevnar and/or TRUMENBA contract(s).

AstraZeneca:

AstraZeneca - FluMist orders must be placed through McKesson or another authorized distributor for AstraZeneca.

Vendor Forms

CCPAPP-Premier ProviderSelect:MD Application - Please complete if your practice is electing to participate in any of the Premier discount programs. Your practice will receive an email with your Premier Member ID/Entity Code from CCPAPP once your application has been processed and membership has been activated.

Updates to Your Practice?

To make account updates such as adding new physicians, changes to address(es), email, and/or contact information, please visit the Member Login Page to access your account.

“Our medical group of 8 internists were able to reduce our overall costs significantly. Through our membership, we were able to save on vaccines, medical supplies, office supplies, and medical waste disposal. I would highly recommend CCPAPP!”

Vandy Jain, MD

Skokie, IL

“Our PHO, has utilized CCPAPP for over five years. They have given wonderful customer service by answering our questions and providing advice that has enabled our member practices to run smoother and more efficiently.”

Jeanette Werling, Executive Director

Cedar Rapids, IA

“We have been members of the CCPAPP since 2006. Our savings have allowed us to reduce our overhead for vaccines, office supplies, and IT services. The vendors we have chosen are professional and courteous.”

Sue Wallenberg, Office Manager

Darien, IL