Vendor Registration | UVA Health

Is your company a SWAM Vendor? *

Small Business, Women-Owned Business and Minority Business Status information (SWAM), please select one or more of the following:

Small Business Enterprise (together with affiliates, having fewer than 250 employees or $10 million annual receipts or less, averaged over the previous 3 years.)

Minority-Owned Business (51 % owned by one or more minorities, and whose management and daily business operations are controlled by such individuals.)

Woman-Owned Business Enterprise (51% owned by one or more women, and whose management and daily operations are controlled by such individuals.)

Disadvantaged Business Enterprise (51% owned by one or more socially and economically disadvantaged individuals, and whose management and daily operations are controlled by such individuals.)

Micro-business: a certified small business that has no more than twenty-five (25) employees and no more than $3 million in average annual revenue over the three-year period prior to certification.

Minority Business Enterprise Certification: To be included in benefits of State procurement opportunities, entities must be certified by the Commonwealth of Virginia. However, no vendor shall be to certify under this program and no vendor shall be excluded from doing business with the Commonwealth because of their failure to become certified. For information regarding certification, contact the Virginia Department of Minority Business Enterprise, 200 N 9th St., Richmond, VA 23219 or call (804) 786-5560 from 8:00am to 5:00pm or access their website at www.dmbe.state.va.us.

Guidelines for Accepting Orders from UVA Health:

Always provide a purchase order number (PO) on all billing documents/invoices.
Rector & Visitors of the University of Virginia doing business as UVA Health.

Email: ghxodap.universityofVirginia@na.firstsource.com

Mail To: Post Office Box 31260
Salt Lake City, UT 84131
United States

Be aware that the Medical Center processes its purchase orders independent of the University of Virginia.
All invoices are required to have a purchase order in order to be processed.

Certification (required)

By submitting this form, I certify the following:

Taxpayer Information:

The taxpayer identification number(s) provided on this form are correct, and the names listed are the legal names as registered with the Internal Revenue Service (IRS) or the Social Security Administration (SSA).

Backup Withholding:

I am not subject to backup withholding because:

I have not been notified by the IRS that I am subject to backup withholding, or
The IRS has notified me that I am no longer subject to backup withholding.

Check here if you have been notified by the IRS that you are currently subject to backup withholding.

Employment Affiliation Disclosure (MANDATORY):

Neither I nor any immediate family member is currently employed by the University of Virginia, UVA Medical Center, or any other state agency of the Commonwealth of Virginia.

"Immediate family" includes:

A spouse, and
Any person residing in your household who is your dependent or of whom you are a dependent

A "dependent" includes a son, daughter, parent, sibling, or any other individual - regardless of relation - who receives from you, or provides to you, more than one-half of their or your financial support.

IMPORTANT:

If you or an immediate family member is employed by any of the above entities, DO NOT submit this form. Instead, you are REQUIRED to notify the UVA Health Vendor.

Registration Team first by emailing:

Email: ruvamcvr@uvahealth.org

Phone: (434) 924-2954 (Email is preferred for tracking purposes.)

Once your notice is received, our team will review the information and provide specific guidance on the appropriate next steps. Vendor registration will not proceed until this review is completed.

If this form was requested due to changes in your company (e.g., merger, acquisition, name change), please attach documentation detailing these changes. For future updates related to company name, addresses, tax information, mergers, or acquisitions, contact us at RUVAMCVR@uvahealth.org. For banking or payment inquiries, reach out to our Accounts Payable department at rhealthap@uvahealth.org. For questions regarding purchasing or to contact a buyer, please contact our Procurement Team at AskProcurementOPS@uvahealth.org.

UVA Health Substitute Form W-9 and Vendor Registration Form

Medical Center Supply Chain Data Integrity