AKDHC, LLC Vendor Engagement Policy

Arizona Kidney Disease and Hypertension Centers, LLC (AKDHC) maintains a policy requiring all vendors seeking to do business with our organization to complete the form below. This process helps ensure that we appropriately review and route vendor inquiries to the correct department based on current organizational needs.

Vendors who call an AKDHC office or extension directly without first completing this form will be asked to do so, as we are unable to direct or respond to unsolicited vendor calls prior to completing our internal vetting process.

Vendor/Company Information

Company Name(Required)

Business Address (Street, City, State, Zip)(Required)

Company Website(Required)

Years in Business(Required)

Primary Contact Person

Full Name(Required)

Title/Role(Required)

Email Address(Required)

Phone Number(Required)

Preferred Method of Contact(Required)

Nature of Inquiry / Purpose of Contact

Type of Service/Product Offered(Required)

Other Type of Service/Product Offered

Brief Description of Offering

Target Audience/Intended Department

Other Target Audience

Supporting Materials (PDF, 5 MB max)

Max. file size: 40 MB.

Attach Brochures or Proposal Documents

Compliance & Security Acknowledgment

Are you familiar with HIPAA compliance requirements?(Required)

Do you have a Business Associate Agreement (BAA) template available?(Required)

Can you provide references from other healthcare clients?(Required)

Additional Comments or Questions

Consent & Submission(Required)

I confirm that the information provided is accurate and complete to the best of my knowledge.