Get Mo Provider Enrollment Packet 2018-2025

The MO Provider Enrollment Packet is essential for medical providers wishing to participate in the Vaccines for Children Program in Missouri. This guide offers clear, step-by-step instructions for completing the packet online, ensuring you meet all necessary requirements.

Follow the steps to successfully complete the MO Provider Enrollment Packet online.

1. Press the ‘Get Form’ button to retrieve the MO Provider Enrollment Packet and access it in your preferred editor.
2. Begin by entering your facility's information, including the facility name, VFC Provider Identification Number (PIN), address, and contact details.
3. Designate primary and backup vaccine coordinators, providing their names and contact information.
4. Complete the Vaccine Delivery Schedule section, detailing availability for receiving vaccine deliveries across specified days and times.
5. Indicate the number and type of vaccine storage units your facility has, including any specific storage characteristics.
6. Select the vaccines offered at your facility, ensuring you meet the criteria for participating providers.
7. Estimate the number of children receiving vaccines at your facility by age group and eligibility status, filling in necessary data in the provided tables.
8. Include signatures where required, especially on essential forms, such as the Provider Participation Agreement, which outlines compliance with program requirements.
9. Compile all required documents, including calibration certificates for data loggers, temperature logs, and agreements.
10. Finalize by reviewing the completed packet for accuracy, then save your changes. You can download, print, or share the document as needed.

Complete your MO Provider Enrollment Packet online to join the Vaccines for Children Program and ensure comprehensive immunization for eligible children.