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VFC Provider Profile and Agreement 2022

All Vaccines for Children providers will need to complete, sign, and submit a 2022 Provider Profile and Agreement forms.  This is to be completed annually. The completed and signed forms should be submitted to the Ohio Department of Health Immunization Program via any of the following methods:

1. Email the completed forms to: vfc@odh.ohio.gov

2. Fax the completed forms to: 614-728-4279 (Attention: VFC)

3. Mail the completed forms to:

Immunization Program
Ohio Department of Health
246 N. High St., 2nd Fl
Columbus, Ohio 43215

Click the "Download" button to access the 2022 VFC Provider Provider and Agreement.