Provider Enrollment

Each year, a completed provider agreement is required prior to the receipt of publicly supplied vaccine. More information can be found in the Adult Vaccine Program User Manual

Provider Enrollment Form (RedCap)

This form is only for clinics, pharmacies, or hospitals interested in administering Adult Vaccine Program vaccines. You can use the Adult Vaccine Provider Enrollment Guide (PDF) to help you through the enrollment process.

If you're a newly enrolled provider in the Adult Vaccine Program, here is a guide for clinics moving from the COVID-19 Program to the Adult Vaccine Program (PDF) that contains all the information you need to have a smooth transition.

If you have any questions, please email