Vaccine Protocol Registration

GCMB has been designated caretaker for the Vaccine Protocol Agreement process. Please find below the application material to submit for Vaccine Protocol Agreement registration.

Letter from DPH to Pharmacist regarding Vaccine records and process



Vaccine Protocol Agreement General Information and Checklist

Vaccine Protocol Agreement Form WITH Alternate Physician

Vaccine Protocol Agreement Form WITHOUT Alternate Physician

Vaccine Protocol Agreement Affidavit


If you have any questions regarding the process, contact:


Licensure Specialist Carol Dorsey

Contact for Vaccine Protocol / Residency Training Permit applicants