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.

If you have any questions regarding the process, contact:

Letter from DPH to Pharmacist regarding Vaccine records and process

Forms

General Information and Checklist

Vaccine Protocol Agreement Form with Alternate Physician

Vaccine Protocol Agreement Form without Alternate Physician

Affidavit for Vaccine Protocol Agreement