Follow the steps to complete your Maryland Vfc enrollment online.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your web browser.
2. Begin by entering the required VFC Provider Practice/Facility Information, including: VFC PIN, today's date, practice/facility name, type, address, city, state, ZIP, county, primary telephone number, alternate telephone number, fax number, email address, and mailing address if different.
3. Fill out the Responsible Medical Provider Information. This will include first name, last name, credentials, medical license number, Medicaid provider number (if applicable), and contact information.
4. Complete the Practice/Facility Vaccine Supply Contact Information to provide details about the designated vaccine supply contact person, different from the responsible medical provider.
5. Review and acknowledge the VFC Provider Enrollment Agreement by selecting the appropriate acknowledgments that confirm your commitment to adhere to the guidelines outlined.
6. List any additional medical providers within your practice who will administer VFC vaccines, providing their names, medical license numbers, and credentials.
7. Select your vaccine brand preferences for different vaccines available under the VFC program, noting the options provided for each type of vaccine.
8. Provide the vaccine shipping address along with the corresponding city, state, ZIP code, county, and telephone information.
9. Answer the optional programmatic questions related to your facility's interest in VFC program training and provide any feedback regarding electronic health records.
10. Once all sections have been completed, ensure that all mandatory fields marked with an asterisk (*) are filled, and check for accuracy before submitting the form online.
11. After submission, save any changes, and follow any prompts provided to download, print, or share the completed form as needed.

Complete your Maryland VFC enrollment online today to ensure your facility can provide essential vaccinations for children.