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

AVP enrollment and re-enrollment for the 2024-2024 year will begin on June 3rd, 2024.

If you are a  provider who was NOT enrolled in AVP last year:

  • You may use the link below starting on June 3rd, 2024 to begin enrolling in AVP. Please do not start enrolling prior to June 3rd or you will need to complete the enrollment form again.

If you are a provider who was enrolled in AVP last year who wishes to re-enroll:

  • Do not use the link below. Your facility contacts will receive an automated email on June 3rd with a link to your pre-populated, facility specific provider agreement to update and sign. If you need to update your facility contacts, please reach out to us at

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