If you are a new provider joining the Connecticut Vaccine Program (CVP), please fill out the New Provider Enrollment Form and e-mail to dph.immunizations@ct.gov. Once we receive this form, a member of our staff will review the information and contact you. In order to be an approved CVP provider, you must receive a new enrollment visit by a DPH staff member. This visit will review the following:
- All requirements of the program per CDC and the State of Connecticut (Blue Folder)
- All storage units that will store CVP vaccines: Refrigerator(s) and Freezer(s)
- A data logger in each unit as well as a backup data logger.
- At least 72 hours of stable temperatures. If this is not available at the time of the visit, temperature logs will be required to be sent to DPH before approval of clinic.
For Public Health Departments and Federally Qualified Health Care Centers (FQHC's) who are enrolling in the CVP for adult patients ages 19 years and older please complete the Adult New provider Enrollment Form. Once approved, clinics can request access to CT WiZ and complete the enrollment process. A DPH staff member will contact you for CT WiZ training.
Just a reminder, the adult vaccine program is only available for non insured patients.
Supporting Documentation