Flu Vaccine Distribution

We distribute flu vaccine only to providers who agree to certain guidelines about to whom they will administer the vaccine and how and when to report usage. Please review the Program Guidelines below for all information on participation and if you are interested in joining our program, call us at 510-267-3230.
For providers who have already been contacted by us with their allocation information, please follow the links below to review the participation guidelines complete the Usage Agreement, submit clinic information and usage reports.

For online form submission, follow these links:
Program Guidelines and Usage Agreement – Due August 24, 2018
2018-19 ACPHD Flu Program Pre-Participation Survey – Due July 20th, 2018
Clinic Schedule Form – September 14th, 2018
Simple Inventory - Due November 16th, 2018
First Usage Report - Due February 8th, 2019
Second Usage Report - Due June 3rd, 2019

Additional Useful Forms not for submission:
Vaccine Authorization Record:  EnglishSpanish
Vaccine Screening Form
Transporting Refrigerated Vaccines
Refrigerator Set-Up for Vaccine Storage
Injectable Flu Vaccine Information Statement (VIS)EnglishSpanish

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