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 25, 2017
2017-18 ACPHD Flu Program Pre-Participation Survey – Due August 25, 2017
Clinic Schedule Form – Due August 25, 2017
Simple Inventory - Due November 17, 2017
First Usage Report - Due February 12, 2018
Second Usage Report - Due June 2, 2018

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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