COVID Vaccine Request for Healthcare Entities

If you are healthcare entity (hospital, clinic, long-term care facility, private practice, etc) and you have the capacity to receive, store and provide the vaccine to your staff, please contact Elisabeth Wilson at [email protected] and provide:

  • Name of Facility
  • Address of Facility
  • Point of Contact (Name, Title)
  • Email Address for contact
  • Phone Number for contact
  • Indicate your capacity to receive, store, and provide vaccines to your staff.

START by completing a closed POD partner enrollment form:
In District 10, we prefer that providers become a closed POD to help with planning. Please complete and submit the “Healthcare Closed POD Partner Enrollment Form 2020” (MS Word)

Last Updated on December 15, 2020

Print Friendly, PDF & Email