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Ohio COVID-19 Provider Enrollment
Ohio COVID-19 Provider Enrollment

Introduction

This page provides information about how providers can enroll to participate in the COVID-19 Vaccination Program.

How to Become an Ohio COVID-19 Vaccine Provider

Thank you for your interest in becoming an Ohio COVID-19 vaccine provider. Any facility licensed by the Ohio Board of Pharmacy to administer or provide vaccination services is eligible to enroll as a potential COVID-19 Provider.

To successfully enroll in the program, each facility must:

  1. Complete all required agreements and verification forms
  2. Meet program standards for vaccine storage and handling and
  3. Review and be familiar with training requirements specific to handling and administering COVID-19 vaccine

ODH will review all enrollment requests.  Enrollment will be approved based on the facility's ability to meet the above requirements. ODH may deny or cancel any application due to incomplete submissions or breach of any terms or conditions of agreements.

Before completing the enrollment agreements, make sure to review the enrollment checklist and FAQ’s Document 

Facilities who are interested in enrolling in the COVID-19 Vaccination Program can:

Required Agreements and Forms

IMPORTANT: A facility's license (TDDD) (preferred) is required to save and submit Section A) CDC COVID-19 Vaccination Provider Agreement.

Before you register, you must have your Facility's Terminal Distributor of Dangerous Drugs (TDDD) license number. All forms completed for a facility must include the same TDDD license number and address. To find your TDDD license number, please visit the State of Ohio Board of Pharmacy license lookup. 

Facilities will begin the process with form (Section A). 

To begin the enrollment process, each facility must complete, sign, and submit the following forms: 

Step 1: (Section A) CDC COVID-19 Vaccination Provider Agreement

Step 2: (Section B) CDC COVID-19 Vaccination Provider Profile

Step 3: ODH Outbreak Response Immunization Initiative Agreement

Step 4: ImpactSIIS Security Agreement (if a facility is not already enrolled)

CDC COVID-19 Vaccine Provider Requirements

All COVID-19 Vaccine Providers must be able to adhere to the following requirements:

1. Providers must administer COVID-19 vaccine in accordance with all requirements and recommendations of CDC and CDC’s Advisory Committee on Immunization Practices (ACIP).

2. Within 24 hours of administering a dose of COVID-19 vaccine and adjuvant (if applicable), providers must record in the vaccine recipient’s record, and report required information to the relevant state, local, or territorial public health authority. Details of required information (collectively, Vaccine-Administration Data) for reporting can be found on CDC’s website.

Providers must submit Vaccine-Administration Data through either (1) the immunization information system (IIS) of the state and local or territorial jurisdiction or (2) another system designated by CDC according to CDC documentation and data requirements.

Providers must preserve the record for at least 3 years following vaccination, or longer if required by state, local, or territorial law. Such records must be made available to any federal, state, local, or territorial public health department to the extent authorized by law.

3. Providers must not sell or seek reimbursement for COVID-19 vaccine and any adjuvant, syringes, needles, or other constituent products and ancillary supplies that the federal government provides without cost to the provider.

4. Organization must administer COVID-19 Vaccine regardless of the vaccine recipient’s ability to pay COVID-19 Vaccine administration fees or coverage status. Organization may seek appropriate reimbursement from a program or plan that covers COVID-19 Vaccine administration fees for the vaccine recipient. Organization may not seek any reimbursement, including through balance billing, from the vaccine recipient.

5. Before administering COVID-19 Vaccine, providers must provide an approved Emergency Use Authorization (EUA) fact sheet or vaccine information statement (VIS), as required, to each vaccine recipient, the adult caregiver accompanying the recipient, or other legal representative.

6. Providers' COVID-19 vaccination services must be conducted in compliance with CDC’s Guidance for Immunization Services During the COVID-19 Pandemic for safe delivery of vaccines.

7. Providers must comply with CDC requirements for COVID-19 Vaccine management. Those requirements include the following:

a) Providers must store and handle COVID-19 vaccine under proper conditions, including maintaining cold chain conditions and chain of custody at all times in accordance with the manufacturer’s package insert and CDC guidance in CDC’s Vaccine Storage and Handling Toolkit, which will be updated to include specific information related to COVID-19 vaccine;
b) Providers must monitor vaccine-storage-unit temperatures at all times using equipment and practices that comply with guidance located in CDC’s Vaccine Storage and Handling Toolkit;
c) Providers must comply with each relevant jurisdiction’s immunization program guidance for dealing with temperature excursions;
d) Providers must monitor and comply with COVID-19 Vaccine expiration dates; and
e) Providers must preserve all records related to COVID-19 Vaccine management for a minimum of 3 years, or longer if required by state, local, or territorial law.

8. Providers must report the number of doses of COVID-19 vaccine and adjuvants that were unused, spoiled, expired, or wasted as required by the relevant jurisdiction.

9. Providers must comply with all federal instructions and timelines for disposing COVID-19 vaccine and adjuvant, including unused doses.

10. Providers must report moderate and severe adverse events following vaccination to the Vaccine Adverse Event Reporting System (VAERS).

11. Providers must provide a completed COVID-19 vaccination record card to every COVID-19 Vaccine recipient, the adult caregiver accompanying the recipient or other legal representative. Each COVID-19 Vaccine shipment will include COVID-19 vaccination record cards.

12. Providers must comply with all applicable requirements as set forth by the U.S. Food and Drug Administration, including but not limited to requirements in any EUA that covers COVID-19 Vaccine. Providers must administer COVID-19 vaccine in compliance with all applicable state and territorial vaccination laws.