hospital Application form
Thank you for your interest in joining 340B Health!
This application is for hospitals that are not joining as part of a health system.
If your hospital is part of a health system in which there are other 340B hospitals that are not yet 340B Health members, please use the Health System Application Form. In accordance with our bylaws all 340B hospitals within a health system must have their own membership in 340B Health. You would include in the Health System application all of your system’s 340B hospitals and we will apply our significant group discount. If you are not sure if other 340B hospitals in your system are 340B Health members, please go HERE.
If your hospital is part of health system in which 340B hospitals are already 340B Health members, please contact email@example.com or 202-552-5864. Your hospital will be added to the system membership and receive the appropriate group discount.
Once your application is processed, an invoice will be sent to you. Membership benefits will begin upon receipt of dues payment.
*Required fields are indicated with an asterisks (*). If you do not have information for a required field, please enter N/A.