– This is the MediGroup/MedAssets Participation Agreement. It is required that the customer sign this document in order to be enrolled into the program. It is important that this document with our logo be signed as opposed to a MedAssets PA that does not have the MediGroup logo to ensure they are enrolled into the MediGroup program. Please note: this document must be very legible. There can not be any missing lines due to faxing.

– Wholly owned addendum acknowledges the customer’s satellite facilities that receive supply shipments. In order for all the locations to receive the same contract pricing, all the locations, including address, phone and fax must be included in the open space. If there are too many satellite facilities to fit in the open space provided then they may type “see attached” in the open space and include the satellite facilities on an Excel spreadsheet. This form must be signed on the bottom left side by the facility representative. If the facility only has one bill to and ship to account then we do not need this document.

– This document is for facilities that want to access the MediGroup/MedAssets pharmaceutical contract portfolio. Please note that only authorized MediGroup/MedAssets pharmaceutical distributors will be able to access pharmaceutical contract pricing on member facilities behalf. This form must be copied onto the facility’s letterhead prior to being filled out. A copy of their DEA license is also required when submitting the GPD form.

All of these forms should be printed, completed, and submitted to MediGroup.

Fax: 866-633-4769
Mail: 1630 S. 5th St. Ste. 334 St. Charles, MO 63301
Attention: Membership Coordinator