Supplier Registration
Please complete the form below to register your company.
Supplier Data
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Corporate Headquarters-US
Contact Information
Primary Contact
Secondary Contact
Company Description
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(Please click here to verify if your quality as a small business as per SBA)
Make sure to review definitions for diverse business certifications in Federal Acquisition Regulation 19.7 or 52 219-8 at before responding below. For questions, check the US Small Business Administration's website at or contact your local SBA office.
Diversity Information
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(Check if true)
Diverse Classification Certified By Agency Name Other Agency Name Expiration Date
Minority Business Enterprise (MBE)
Woman Owned Business Enterprise (WBE)
Veteran owned Business Enterprise (VET)
Service Disabled Veteran Owned Business Enterprise (SDV)
Lesbian / Gay / Bisexual / Transgender Owned Business Enterprise (LGBT)
Hubzone (HUBZ)
Small Disadvantaged Business Enterprise (SDB)
Small Business Enterprise (SBE)
Disadvantaged Business Enterprise (DBE)
Disabled Person Owned Business Enterprise (DOBE)
Small Business Administration 8(a) (SBA 8(a))
Woman-Owned Small Business (WOSB)
Economically Disadvantaged Woman-Owned Small Business (EDWOSB)
Historically Black College/University or Minority Institution (HBCU)
Alaskan Native and Indian Tribe (ANIT)
Other (OTHER)
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Authorized Representative
Retype Printed Name for Signature

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.