COVID-19 VENDOR SUPPLIES AVAILABILITY

This survey is designed to take inventory of all medical supplies available to assist in combating the COVID-19 crisis.

Vendor Information

Vendor Name*

Vendor Address*

Contact Name*

Contact Email*

Contact Phone*

Supplies Information

N95s Available*

Yes

No

Are the N95s surgical-grade?*

Yes

No

Are they NIOSH Approved?

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Gowns Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Masks Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Gloves Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Face Shields Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Hand Sanitizer Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Disinfectant Supplies Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Nasopharyngeal Swabs Available*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Oropharyngeal (OP) Swabs Available?*

Yes

No

Are the products in the original packaging?

Yes

No

FDA Registration Number

FDA ID Information

What is the earliest date these supplies could be delivered?

Price per unit ($)

How many are available?

Other Supplies Available

Yes

No

Other Supplies Description

What is the earliest date these supplies could be delivered?

Price per unit ($) of each item listed in "other" supplies

Send me a copy of my responses

Powered by

Privacy Notice|Report Abuse