Interested Vendors Registration

Vendors interested in receiving notification of upcoming solicitations for treatment services must complete and submit the following registration information. As a reminder, all "Full Procurement Agency" vendors must be either nationally accredited, or are required to submit an AOC Pre-Qualification Application to the AOC within 45 days of registration. However, if a vendor is nationally accredited by The Joint Commission, COA or CARF, documentation of accreditation must be faxed to Attn: Contracts Unit at (602)452-3879 following registration.

Question Title

* 1. Vendor

Legal Name

Address

City

State

Zip Code

Phone Number

Fax Number

Email Address

Website

Type of Agency or Practice

Question Title

* 2. Contact Person (If different than above)

Name/Title:

Phone:

Email Address:

Question Title

* 3. Vendor Type

Independent Practitioner(IP)-(please skip question 4 and submit registration)

Full Procurement Agency(FP)-(please answer question 4)

Question Title

* 4. Agency(FP) Pre-Qualification:(Documentation of Accreditation must be faxed to 602-452-3879, Attention AOC Contracts Unit, within 48 hours)

The Joint Commission

COA

CARF

N/A (If N/A vendor must complete the AOC Pre-Qualification Application and submit within 60 days.)

Thank you for your interest in serving the youth and families involved in Arizona’s Juvenile Courts.