New and existing providers must complete the Provider Enrollment Process. Re-certification is required annually for all providers.
Provider Enrollment Process NEW (1/13/14)
2015 Provider Profile NEW (1/13/14)
Vaccine Coordinator Checklist NEW (12/01/14)
Providers that are enrolled in a public vaccine program who wish to withdrawal must complete the following withdrawal process and form.
Providers are financially responsible for publicly-supplied vaccines until they are safely transferred to another provider under the approval of the Immunization Program.
Withdrawal Process NEW (11/06/14)
Withdrawal Form (5/01/14)