Update your clinic information:

Start typing the name of your clinic and if your clinic is already known by CCHF you will see it on the list. When you select your Clinic Name, the address fields will be prefilled.

If you don't find your clinic above

Clinic Authorized Primary Contact

Please fill out the contact details of the person who will be updating your clinic information. NOTE: We require your birthdate and the last 4 digits of your Social Security number to verify your identity and keep your clinic information safe. 


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CEO/Executive Director

Medical Director

About Your Clinic

How would you describe your clinic's on-site pharmaceutical services? (If your clinic operates multiple sites, more than one answer may apply. 

(best guess)
What Percentage of Your Patients Are (best guess):

Your Clinic's Staff

Student Program Coordinator

Your Signature and Payment

Clinic membership annual dues are based on a sliding scale relative to your organization's annual budgeted revenue.

The CCHF family appreciates the role that your clinic plays in our movement and the unique pressures that smaller or newer clinics sometimes face. We recognize that often clinics that may benefit the most from CCHF are the ones that can least afford it. CCHF will offer the same service to our clinics regardless of their ability to pay. If you need grace, pay what your clinic can afford.

Suggested donation amounts are: 

Annual Budget Suggested Amount
1) <$150,000 $250
2)  $150k-$499k $450
3)  $450k-$749k $800
4)  $750k-$1.1M $1200
5)  $1.2M-$2.9M $1,800
6)  >$3M $2,400
7) +$120 for every million above $3M




Signature of Authorized Clinic Representative