2018 MnVFC Program Provider Agreement
- All sites enrolled in the MnVFC program must submit a signed MnVFC Program Provider Agreement by Nov. 30 each year.
- Complete the MnVFC Program Provider Agreement, including the list of additional providers in your practice, and have your medical director sign it.
- The site must indicate the immunization manager and vaccine coordinator have completed the required annual MnVFC online training by marking the appropriate circle on this agreement.
- Ordering privileges may be suspended if you do not submit the MnVFC Program Provider Agreement by Nov. 30, 2017.
- If your site practices the replacement method of vaccine management, you must also sign the Replacement Method of Vaccine Management Agreement by Nov. 30 each year. This agreement is available on Required Annual Reports and Trainings.
* All fields for the site information, medical director, immunization manager, and vaccine coordinator above are required to continue the online agreement. The employee identification number (EIN) is an optional field.
Please note: You will need to list all licensed health care providers (MD, DO, NP, PA) at your site who have prescribing authority at the end of this agreement.