B2B_Attachment_2--NMLC_-_Vendor_Business_to_Business_(B2B)_Information_Request_Form.pdf

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Medical Coding Services
Solicitation number
N62645-16-R-0009
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B2B Attachment 2 Vendor Business to Business Information Request

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Vendor Business to Business (B2B) Information Request

Company Information

Name of the Company

Street

Commercial Address

City

Phone Number

State

Country

Project Manager

Name

Title

Phone Number

Email

Email

Phone Number

Title

Name

Security Officer / Manager

Email

Phone Number

Title

Name

Network Engineer (Manage Firewalls)

List Medical Treatment Facilities (MTF) that you will connect to:

1.

2.

3.

4.

5.

6.

7.

8.

List three purposed dates: (Three weeks out from receiving this form)

Form created by: Naval Medical Logistics Command (NMLC) - Fort Detrick, Maryland

1st Date/Time Field

2nd Date/Time Field

3rd Date/Time Field

Vendor Business to Business (B2B) Information Request Company Information Commercial Address Project Manager Security Officer / Manager Network Engineer (Manage Firewalls) List Medical Treatment Facilities (MTF) that you will connect to:

List three purposed dates:

(Three weeks out from receiving this form) Form created by: Naval Medical Logistics Command (NMLC) - Fort Detrick, Maryland 8.2.1.4029.1.523496.503679

TextField1:
TextField2:
PhoneNum:
State: AL
Country: AL
email:
PrintButton1:
DateTimeField1:

File details come from the government source that posted it. Updated .