State of California COVID-19 Medical Supply Contributions

Please use this form to describe resources you have to contribute, either for donation or purchase, to support California’s response to COVID-19.

If you are an individual looking for an avenue to donate a smaller amount of resources, please consider donating to your local community COVID-19 response efforts.

california for all your actions save lives visit California for All website
visit Department of Public Health website

Organization and Contact Information

What resources are you offering?

Please read the CDPH Specifications PDF, and identify resources that you have that meet these specifications. Please identify all of the relevant information, including estimated unit cost and initial ship date, to enable a more efficient review of the resources.

Resource
Quantity
Unit Cost (USD)
Initial Ship Date
Ventilators
$
N95 Respirators (Disposable)
$
Surgical Masks
$
Coveralls (Hospitals and EMS)
$
Surgical or Exam Gowns
$
Face Shields (Disposable)
$
Goggles
$
Examination Gloves
$
Hand Sanitizers
$
Wipes
$
Swabs
$
Viral Testing Media
$
Maximum 245 characters

Are you interested in donating these resources?


Are you able to deliver further shipments of these resources?

Beyond the initial shipment identified above, please provide information for future shipments. If applicable, please describe the items you can provide, the quantity, and delivery dates you anticipate you can fulfill.

Maximum 240 characters

Do you have a current supply of this resource and/or are you able to manufacture this resource?

For offers of manufacturing only:

Guidance Documents

Business Entity:

Please fill out more detailed information about your business entity, including your federal tax identification and year of incorporation, to enable a more efficient review of your business.

Location / Address


Supplier Information:


Supplier Location / Address