Supplier Backorder/Recall/Discontinuation Submission Form
Please complete and submit the following form with all applicable information related to your company's backorder, recall or product discontinuation.
Submissions received on Saturdays and Sundays will be processed during regular business hours.
Estimated Resolution Date of Backorder
If the type of incident reported is a backorder please provide the estimated date the it will be resolved.
Medbuy Contract Number
Medbuy Contract Manager
Denis Potvin (email@example.com)
Donna Woods (firstname.lastname@example.org)
Elise Gosso (email@example.com)
Joe Procaccini (firstname.lastname@example.org)
Markus Lenarczyk (email@example.com)
Marsha Van Groningen (firstname.lastname@example.org)
Mary Meadows (email@example.com)
Pennee Ingram (firstname.lastname@example.org)
Sandra Grozier (email@example.com)
Sheri McLeod (firstname.lastname@example.org)
Brief summary of the incident
Are there alternate products available?
Please submit the following documents where available:
- Original communications regarding the incident
- List of affected products in Microsoft Excel format
- Past 12 months of sales tracings for affected Members (if readily available)
For your convenience, a template on which to input affected items and their alternates is available. If needed, please download and reattach to this form. It can be accessed here:
Attach files here
Send me a copy of my responses
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