Give Feedback Close


Military Health System
	
	MHS Home

	
	
Main Navigation
        About the MHS
    Accessibility
            Elements of the MHS
            Our Strategy
            Our Organization
            Defense Health Networks
            Our Leaders
            Our History
            Careers
            Contact Us
                Defense Health Networks
    Atlantic
            Central
            Continental
            East
            Europe
            Indo-Pacific
            National Capital Region
            Pacific Rim
            West
            Defense Health Support Activity
                Military Health Topics
    All Topics
            DOD Cancer Clearinghouse
            Warfighter Brain Health Hub
            MHS Mental Health Hub
            Health Care Administration & Operations
            Health Readiness & Combat Support
            Centers of Excellence
            Doing Business with the Defense Health Agency
    Component Acquisition Executive
    Who We Are
            Procurement
    DHA 101
            Opportunities Gateway
    DHA Industry Day
            Forecast
            Topics of Interest
    Topics of Interest Archive
            DHA Unsolicited Proposals
            Small Business Programs
    Doing Business with DHA OSBP
            Policy & Legislation
            Resources
            Small Business News
            Events
    2024 National Small Business Conference
            National Small Business Federal Contracting Summit DC Spring 2024
            Vendor Information Form
            Education & Training
            Health Care Technology
            DHA Virtual Medical Library
            MHS Toolkits & Branding Guidance
            Privacy & Civil Liberties
            Research & Innovation
            Men's Health
            Women's Health
                News & Gallery
    Articles
            Calendar of Events
            Gallery
            Infographics
            Photos
            Videos
            In the Spotlight
            Social Media in the Military Health System
                Reference Center
    Clinical Practice Guidelines
            Congressional Testimonies
            DHA Publications Library
            Fact Sheets
            FOIA Library
            Forms & Templates
            Frequently Asked Questions
            Meeting References
            MHS Health Care Glossary
            Policies
            Presentations
            Publications
            Reports
            Technical Documents
                I Want To...
    Go to the MHS GENESIS Patient Portal
            Find Walk-in Contraceptive Services
            Go to TRICARE.mil
            Find Suicide Prevention Resources
            Veterans Health Care
            Donate Blood
            Do Business with DHA
            See TRICARE Rates & Reimbursements
            Become a TRICARE Provider
            Find a Military Hospital or Clinic
            File a Complaint
            Get Mental Health Care
            Get Copies of My Medical Records
            Submit a Media Inquiry
            Submit a Speaker Request Form
            Request a TRICARE Briefing
            Contact Us

Sitewide Search


Visit MHS on Instagram
            Visit MHS on LinkedIn
            Visit MHS on Facebook
            Visit MHS on Twitter
            Visit MHS on YouTube
            Visit MHS on GovDeliveryAbout the MHS

                    
                    Accessibility
                                        Elements of the MHS
                                        Our Strategy
                                        Our Organization
                                        Defense Health Networks
                                        Our Leaders
                                        Our History
                                        Careers
                                        Contact Us
                                    Learn More About the MHS
                
                
                Defense Health Networks

                    
                    Atlantic
                                        Central
                                        Continental
                                        East
                                        Europe
                                        Indo-Pacific
                                        National Capital Region
                                        Pacific Rim
                                        West
                                        Defense Health Support Activity
                                    View All Defense Health Networks
                
                
                Military Health Topics

                    
                    All Topics
                                            DOD Cancer Clearinghouse
                                            Warfighter Brain Health Hub
                                            MHS Mental Health Hub
                                            Health Care Administration & Operations
                                            Health Readiness & Combat Support
                                            Centers of Excellence
                                            Doing Business with the Defense Health AgencyEducation & Training
                                            Health Care Technology
                                            DHA Virtual Medical Library
                                            MHS Toolkits & Branding Guidance
                                            Privacy & Civil Liberties
                                            Research & Innovation
                                            Men's Health
                                            Women's Health
                            Recent News Articles
                                            Apr 16, 2024
                Defense Health Agency Assists European Command’s Operation Austere Challenge Conflict Exercise
                                                    Apr 15, 2024
                TRICARE Authorizes Temporary Prescription Refill Waivers for Charleston County, South Carolina, due to Flooding
                                                    Apr 15, 2024
                TRICARE Authorizes Temporary Prescription Refill Waivers for Eight Florida and Georgia Counties due to Storm Damage
        See All Topic A-Z
                
                
                News & Gallery

                    
                    Articles
                                        Calendar of Events
                                        Gallery
                                        Infographics
                                        Photos
                                        Videos
                                        In the Spotlight
                                        Social Media in the Military Health SystemUpcoming Events
                                        Apr
        18

    Acute Concussion Care Pathway: MACE 2 & PRA Training
                                                Apr
        24

    April LTES
                            Most Recent Updates
                                Articles

    Defense Health Agency Assists European Command’s Operation Austere Challenge Conflict Exercise
                Defense Health Agency Assists European Command’s Operation Austere Challenge Conflict Exercise
                    Defense Health Agency tracks fictional casualties during annual conflict computer exercise in Europe.
                                    Photos
                                        Videos
                                        Infographics
                                    Follow us on Social Media
                                        Visit MHS on Instagram
            Visit MHS on LinkedIn
            Visit MHS on Facebook
            Visit MHS on Twitter
            Visit MHS on YouTube
            Visit MHS on GovDelivery
        Read the Latest News
                
                
                Reference Center

                    

                    References by Type
                                Clinical Practice Guidelines
                                        Congressional Testimonies
                                        DHA Publications Library
                                        Fact Sheets
                                        FOIA Library
                                        Forms & Templates
                                        Frequently Asked Questions
                                        Meeting References
                                        MHS Health Care Glossary
                                        Policies
                                        Presentations
                                        Publications
                                        Reports
                                        Technical Documents
                            Most Popular References
                                    UCCI – Statement of Work (SOW) Dental Coverage for all Active Duty Service Members (ADSMs)
                                            Delta Dental – TRICARE Retiree Dental Program (TRDP) coverage Statement of Work (SOW)
                                            Sep 2006 Amendment of Solicitation/Modification of Contract
                                            CSA Program Performance Statement of Work - Bolling AFB
                                            Oct 2003 Contract #H94002-04-D-0001
                                            Government Required MTF Prime Service Areas
                                            2008 Comprehensive Interventions for Autism Spectrum Disorder
                                            OASD (HA) File 84-47
                                            Accreditation Reports and Documentation - DD Form 1423-1 Contract Data Requirements List
                                            2001-2010 Gastric Bypass and Other Weight Loss Surgery Costs
                            Recently Posted References
										Frequently Asked Questions for Identifiers
												Patient Safety Order Materials
												ePrescribing Military Pharmacies
												Slides: Getting Health Care for Foreign Force Members and Their Families
        Visit Our Reference Center
                
                
                I Want To...

                    
                    Go to the MHS GENESIS Patient Portal
                                        Find Walk-in Contraceptive Services
                                        Go to TRICARE.mil
                                        Find Suicide Prevention Resources
                                        Veterans Health Care
                                        Donate Blood
                                        Do Business with DHA
                                        See TRICARE Rates & Reimbursements
                                        Become a TRICARE Provider
                                        Find a Military Hospital or Clinic
                                        File a Complaint
                                        Get Mental Health Care
                                        Get Copies of My Medical Records
                                        Submit a Media Inquiry
                                        Submit a Speaker Request Form
                                        Request a TRICARE Briefing
                                        Contact Us
                
        
        Sitewide Search Clear Your Browser Cache This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.
  Need larger text?
 MHS Home
			
				Military Health Topics
			
				Doing Business with the Defense Health Agency
			

		Vendor Information Form
 Skip subpage navigation All Topics

            DOD Cancer Clearinghouse
            Warfighter Brain Health Hub
            MHS Mental Health Hub
            Health Care Administration & Operations
            Health Readiness & Combat Support
            Centers of Excellence
            Doing Business with the Defense Health Agency
    Component Acquisition Executive
    Who We Are
            Procurement
    DHA 101
            Opportunities Gateway
    DHA Industry Day
            Forecast
            Topics of Interest
    Topics of Interest Archive
            DHA Unsolicited Proposals
            Small Business Programs
    Doing Business with DHA OSBP
            Policy & Legislation
            Resources
            Small Business News
            Events
    2024 National Small Business Conference
            National Small Business Federal Contracting Summit DC Spring 2024
            Vendor Information Form
            Education & Training
            Health Care Technology
            DHA Virtual Medical Library
            MHS Toolkits & Branding Guidance
            Privacy & Civil Liberties
            Research & Innovation
            Men's Health
            Women's Health
 Vendor Information Form Please contact dha.smallbusinessforum@health.mil if you have any questions.
 Vendor Information Form
	* Denotes Required Field

		1. Vendor Contact Information
			1.A. Name*
			Vendor Name is required
			1.B. Company*
			Company Name is required
			1.C. Phone*
			Vendor Phone is required	
			1.D. E-mail*
			Vendor E-mail is required
			Please enter a valid e-mail address

		1.E. Were you recommended by DHA Personnel?*
		YesNo
		Selection of Recommended DHA Personnel is required

		1.E.i. Recommended by
			1.E.ii. What specific product / solution was he / she interested in

		1.F. Are you interested in participating in the DHA Industry Partnership Network (IPN)?*
		YesNo
		Selection of Interest in IPN is required

		1.G. Type of Services/Products*
		Select...IT Services or ProductsOther Services or ProductsType of Service or Product is required
		
		1.H. Company Size*
		Select...Small BusinessOther than Small BusinessCompany Size Classification is required

		
		
		
		2. Product / Service Information
		
				
				2.A. Company Classification
					Select...ManufacturerResellerValue Add Reseller2.B. Product Classification
					Select...HardwareSoftwareService
				
			
				
				Name of Product/Service
				Briefly describe the product / service offered, and what it will be used for
				2.E. Product Category
					Select...IT Infrastructure and OperationsInformation ManagementManagement and OrganizationApplication DevelopmentCustomer Intelligence and Experience ManagementTelecommunications ServicesSecurity Risk and ComplianceSourcing and ProcurementNon-Conforming Innovations2.F. Product Subcategory
					Select...

			3. Product / Service Review
			
				
				
				
				
				3.A. Is your product accredited by a DoD Agency?
					YesNo

					3.A.i. Which DoD agencies are using this product or other agency Authority to Operate (ATO) (please list)
					3.A.ii. Point of Contact for ATO Information Package
					3.A.iii. Is your product FIPS 140-2 certified?
					YesNo

					3.A.iv. Certification #
					3.A.v. Other certifications
					3.B. Is this a Cloud Service (If yes, select FedRAMP level)
					YesNo
					3.B.i. FedRAMP Level
					Select...1234563.C. Is this an Information Assurance (IA) enabled product?
					YesNo
					3.C.i. Evaluation Assurance Level (EAL)
					YesNo
					3.C.ii. Common Criteria List (CCL)
					YesNo
					3.C.iii. The Department of the Navy (DON) Application & Database Management System (DADMS)
					YesNo

					
					
					
					3.D. Is your product approved by the Joint Interoperability Test Command (JITC)
					YesNo
					3.D.i. Approval #
				
				
				
				
				
				How does this product or service align with DHA’s vision and mission?
				Please list DHA / HIT related services or products your organization currently provides
				Please explain how your company can improve/enhance DHA services
				What makes this products or service unique in the marketplace?
				3.I. Please briefly describe current uses of this product within the healthcare industry.
				
				
				
				
				Is DHA an existing customer
				YesNo
			
			
			4. Small Business Information
				4.A. Company Mailing Address*
				Company address is required for small companies
					 

				4.B. Company Web Address*
				Company URL is required for small companies
					

				4.C. Small Business Category*
				Select...Small Business (SB)Veteran Owned Small Business (VOSB)Service Disabled Veteran Owned Small Business (SDVOSB)Woman Owned Small Business (WOSB)HUBZone8(a)Company category is required for small companies
					

				4.D. DUNS*
				DUNS is required for small companies
					

				4.E. CAGE*
				CAGE is required for small companies
					

				4.F. Primary NAICS Code*
				Primary NAICS Code is required for small companies
					

				4.G. Primary Product Services Code (PSC)*
				Primary PSC Code is required for small companies
					

				4.H. Core Competencies (select all that apply)
					
					Engineering ServicesProgram Management ServicesIT Services & SupportInformation Management ServicesProfessional ServicesMedical (Q) ServicesConsulting & Analytical ServicesFinancial Management ServicesAdministrative Management ServicesHuman Resource ServicesInvestigative ServicesMedia & Communication ServicesFacilities Management ServicesTelecommunications ResellersEducational Support ServicesAcquisition Management ServicesAudio/Video Equipment & Services
				4.I. Facility Clearance
				YesNo
				4.J. Facility Clearance Level
				Select...SecretTop Secret4.K. Federal Healthcare Experience
				4.L. Contract Vehicles
 The appearance of hyperlinks does not constitute endorsement by the Department of Defense of non-U.S. Government sites or the information, products, or services contained therein. Although the Defense Health Agency may or may not use these sites as additional distribution channels for Department of Defense information, it does not exercise editorial control over all of the information that you may find at these locations. Such links are provided consistent with the stated purpose of this website.
 View the external links disclaimer
 OK Cancel
 MHS Home
                Visit MHS on Instagram
            Visit MHS on LinkedIn
            Visit MHS on Facebook
            Visit MHS on Twitter
            Visit MHS on YouTube
            Visit MHS on GovDelivery
            About the MHS
                            Accessibility
                                    Elements of the MHS
                                    Our Strategy
                                    Our Organization
                                    Defense Health Networks
                                    Our Leaders
                                    Our History
                                    Careers
                                    Contact Us
                        Defense Health Networks
                            Atlantic
                                    Central
                                    Continental
                                    East
                                    Europe
                                    Indo-Pacific
                                    National Capital Region
                                    Pacific Rim
                                    West
                                    Defense Health Support Activity
                        Military Health Topics
                            All Topics
                                    DOD Cancer Clearinghouse
                                    Warfighter Brain Health Hub
                                    MHS Mental Health Hub
                                    Health Care Administration & Operations
                                    Health Readiness & Combat Support
                                    Centers of Excellence
                                    Doing Business with the Defense Health Agency
                                    Education & Training
                                    Health Care Technology
                                    DHA Virtual Medical Library
                                    MHS Toolkits & Branding Guidance
                                    Privacy & Civil Liberties
                                    Research & Innovation
                                    Men's Health
                                    Women's Health
                        News & Gallery
                            Articles
                                    Calendar of Events
                                    Gallery
                                    Infographics
                                    Photos
                                    Videos
                                    In the Spotlight
                                    Social Media in the Military Health System
                        Reference Center
                            Clinical Practice Guidelines
                                    Congressional Testimonies
                                    DHA Publications Library
                                    Fact Sheets
                                    FOIA Library
                                    Forms & Templates
                                    Frequently Asked Questions
                                    Meeting References
                                    MHS Health Care Glossary
                                    Policies
                                    Presentations
                                    Publications
                                    Reports
                                    Technical Documents
                        I Want To...
                            Go to the MHS GENESIS Patient Portal
                                    Find Walk-in Contraceptive Services
                                    Go to TRICARE.mil
                                    Find Suicide Prevention Resources
                                    Veterans Health Care
                                    Donate Blood
                                    Do Business with DHA
                                    See TRICARE Rates & Reimbursements
                                    Become a TRICARE Provider
                                    Find a Military Hospital or Clinic
                                    File a Complaint
                                    Get Mental Health Care
                                    Get Copies of My Medical Records
                                    Submit a Media Inquiry
                                    Submit a Speaker Request Form
                                    Request a TRICARE Briefing
                                    Contact Us

        DHA Strategy Plan
                Privacy Policy
                No FEAR Act
                Fraud and Abuse
                Accesssibility
                FOIA
                DHAOIG
                Information Quality
                Open Government
                Plain Writing
                USA Gov
                White House
                OSC

    DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101
        Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.