If you need assistance please email PDPH's Immunization Program

The Centers for Disease Control and Prevention (CDC) greatly appreciates your organization’s (hereafter referred to as Organization) participation in the CDC COVID-19 Vaccination Program.

Your organization’s chief medical officer (or equivalent) and chief executive officer (or chief fiduciary) are the Responsible Officers for the CDC COVID-19 Vaccination Agreement.

As the Responsible Officers, the chief medical officer (or equivalent) and chief executive officer (or chief fiduciary), (hereafter referred to as the Responsible Officers) must complete and sign the CDC COVID-19 Vaccination Program Provider Requirements and Legal Agreement Section A).

The CDC COVID-19 Vaccination Program Provider Profile Information (Section B) must be completed for each vaccination location covered under the Organization listed in Section A.

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