
PMPnow Vendor Connection Request
What is the name of the product?
What type is the product?
Are you in good standing with the Office of the National Coordinator Certified Health IT Product List?
If yes, has your product ever been reprimanded or removed from the Certified Health IT Product List?
What is this product used for?
What is your client base in Illinois?
How many prescribers would access the ILPMP database information?
How many dispensers would access the ILPMP database information?
What connection protocol are you interested in using?
Contact Name:
Title:
Email:
Additional notes:
Please make sure all fields with a red asterisk(*) are completed and no special characters are used (-+=><'")
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Thank you for using the ILPMP.