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Provider Portal:  Enrollment and Withdrawal

New and existing providers must complete the Provider Enrollment Process. Re-certification is required annually for all providers. 

 

Enrollment

Provider Enrollment Process                                         NEW    (1/13/14)

 

2015 Provider Profile                                                    NEW    (1/13/14)

                                                    

Vaccine Coordinator Checklist                                       NEW  (12/01/14)


Withdrawal

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)        

 

  


 

 

 

 

 

 

 

 

 

 

 

 

 

 

Contacts

 

Jude Alden, MBA, CPM
VFC Coordinator
307-777-2413
jude.alden@wyo.gov