Hawaii Immunization Program
Information for Immunization Providers

VFC Enrollment Process

Enrollment in the Hawaii Vaccines For Children Program is an easy process. The Provider Profile must be updated on an annual basis, at minimum. Any changes to a provider’s delivery address, phone number, times when vaccine may be received, contact person, or persons authorized to write prescriptions and who may administer vaccine within the practice should be reported in writing to the Hawaii VFC Program as soon as possible.

When completing the Enrollment Packet you will be asked to provide:

• The address where you can receive vaccine shipments, as well as the name of a contact person and a contact phone and fax number.

• The signature of the person completing the enrollment forms indicating that those associated with your clinic/practice will comply with the conditions stated in the enrollment forms.

• The names, Medicaid Provider Numbers, and Medical License Numbers of all providers in your clinic/practice who are authorized to write prescriptions and administer vaccine.

• A projected number of children you (the provider) expect to vaccinate in a 12 month period, (includes both VFC and non-VFC eligible children) as well as the number of those children who are eligible to receive VFC vaccine.

Hawaii Immunization Program
1250 Punchbowl Street
Honolulu, HI 96813
(808) 586-8300