This paper adopts an agency theory perspective to analyze a medical devices procurement triad consisting of a centralized purchasing unit, a medical unit of a hospital and an external medical device supplier. Through an in-depth case study of this triad, we examine agency issues and how they hinder the governance of triad-level outcomes i.e., value-based procurement. Our findings contribute to agency theory by positing that each triad member may pursue individual goals creating goal incongruence not as a result of opportunism but rather caused by role-based norms and incentive structures. Furthermore, information asymmetry in triads should be approached as a multilateral phenomenon when all triad members are boundedly rational actors possessing limited information processing capacity and thus suffering from specialized information and hidden (bilateral) actions of the other triad members. Finally, we find social factors such as power asymmetry and institutionalized mindset of unit price myopia to moderate the effects of information asymmetry and goal incongruence on triad-level governance. These factors together appear to curtail moves towards more outcome-based contracts and hence value-based procurement.