Healthcare Provider Registration

Healthcare Provider Registration Form

To register as a Healthcare Provider with AlPep LLC, please complete the form below. Eligibility is limited to individuals or entities holding an active professional license in healthcare (e.g., physicians, nurses, or other licensed providers). Upon successful registration, you may gain access to the following benefits, subject to AlPep LLC’s review and approval:

  • Upgrade of your account to Healthcare Provider status on alpepllc.com
  • A unique coupon code for discounts on UniSUC products
  • Competitive pricing on UniSUC products, which may include reductions based on purchase volume (subject to applicable laws, including disclosure and reporting requirements where federal healthcare program reimbursement is involved)
  • One complimentary Hospital New Admit Kit
  • Access to AlPep’s equipment loaner program (subject to separate agreement terms)

Your submission will be reviewed by the AlPep team. You will be notified once your Healthcare Provider account has been approved and activated.

Note: AlPep LLC is not an enrolled Medicare DMEPOS supplier and does not participate in Medicaid or commercial insurance plans. No guarantees are made regarding reimbursement or insurance coverage. Benefits are provided at the discretion of AlPep LLC and may be subject to additional terms. All arrangements are intended to comply with applicable federal laws, including the Anti-Kickback Statute. Discounts or pricing reductions are not conditioned on referrals or the volume or value of any federally reimbursable business generated.

Name
Name
First Name
Last Name
FACILITY ADDRESS
FACILITY ADDRESS
City
State/Province
Zip/Postal
How did you learn about UniSUC?
I would like to receive:
Resaler to Patients
Selecting this option indicates your interest in resale activities. If checked, you will be required to:

  • Submit proof of any necessary reseller, distributor, or durable medical equipment (DME) supplier license(s) required under applicable state or federal law.
  • Complete and submit a separate resale agreement form provided by AlPep LLC.

Important Compliance Note:
AlPep LLC does not provide legal, regulatory, or professional advice regarding whether resale is permitted under your specific license, scope of practice, or state regulations. Any resale must fully comply with:

  • FDA requirements — including proper registration/listing (if applicable), accurate labeling, and ensuring devices are not altered, remanufactured, or misrepresented.
  • FTC guidelines — ensuring any advertising, promotion, or patient communications are truthful, non-deceptive, and substantiated.
  • Anti-Kickback Statute (AKS) — Discounts, pricing, benefits, or other arrangements from AlPep LLC are not offered or conditioned on referrals, the volume/value of federally reimbursable business, or any intent to induce prohibited remuneration.

This checkbox helps AlPep LLC identify potential resale scenarios and route your request appropriately, while emphasizing that resale is the provider’s responsibility to conduct lawfully.

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