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Thank you for your interest in becoming a COVID-19 vaccine provider.

  • If you are familiar with the process, scroll down and click "Start Enrollment".
  • If you are not familar with the process, please read until you reach "Start Enrollment" button at the bottom of this page.

Any facility, organization, or healthcare provider licensed to possess vaccine, administer vaccine, or provide vaccination services in Oklahoma is eligible to enroll. 

Only local County and City-County Health Departments and providers enrolled through this online enrollment and approved by the Oklahoma State Department of Health (OSDH) can receive and administer COVID-19 vaccine in Oklahoma.  

Instructions

Submit a separate enrollment for each organization's facility

CDC requires organizations to submit a separate enrollment for each organization's facility. All organization's facilities, including those that are part of a hospital system or clinic network, must complete this enrollment separately. It includes outpatient clinics and physician practices that are owned or managed by the system. Example: if a clinic network has 12 clinics, then each of 12 clinics must complete this enrollment.

Do not submit enrollment for each individual healthcare provider

Do not submit enrollment for each individual healthcare provider practicing at the facility. CDC requires organizations to submit only one enrollment per organization's location. Example: if a clinic has 10 doctors, then clinic must complete only one enrollment and list 10 doctors at the end of the enrollment.

Complete and sign Section A and then proceed with this online enrollment

  • Step 1: The medical (or equivalent role) and chief executive officer (or chief fiduciary) should complete and sign the CDC COVID-19 Vaccination Program Provider Agreement (Section A of this enrollment). This should be done before medical/pharmacy director or location’s vaccine coordinator start this online enrollment. A person completing the online enrollment will upload an electronic copy of the Section A while completing this online enrollment.
  • Step 2: Medical/pharmacy director or location’s vaccine coordinator should complete and sign the online enrollment after they have an electronic copy (pdf file) of the completed and signed Section A. They will upload Section A during this online enrollment. This person can complete enrollments for all organization's locations/facilities. Depending on responses, this enrollment may take up to two hours.  

Do not email/fax/mail a copy of Section A and the completed enrollment to the OSDH

There is no need to email/fax/mail Section A and the completed enrollment to the OSDH. The entire process should be completed online. The OSDH will receive your answers as soon as you click the “Submit” button at the end of the online enrollment.

Important for providers who signed MOA with the OSDH in June 19-October 7, 2020

  • If you have previously signed MOA with the Oklahoma State Department of Health (June 19-October 7, 2020) to distribute any pandemic vaccine, you still have to compete COVID-19 Vaccine Provider enrollment to receive COVID-19 vaccines.
  • As of December 14, 2020, previously enrolled providers who signed MOA with the OSDH (June 19-October 7, 2020), can also use the general online enrollment tool.
  • There is not need to use the “retake” link if you don’t have one.
  • If you have one or already started the enrollment, complete the enrollment with the link you have – it will not affect your enrollment.

Deadline

  • There is no official deadline for this enrollment.
  • However, we encourage you to enroll as soon as possible to allow the OSDH enough time to process your enrollment.

How to complete the online enrollment

During the completion of this COVID-19 Vaccination Program Provider Enrollment, providers are required to fill in and sign two sections of the Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Program Provider Agreement:

  • Section A. COVID-19 Vaccination Program Provider Requirements and Legal Agreement;
  • Section B. CDC COVID-19 Vaccination Program Provider Profile Information.

Both sections are included in this online enrollment tool.

Step 1: "Section A. COVID-19 Vaccination Program Provider Requirements and Legal Agreement"

Chief Medical Officer (or Equivalent) and Chief Executive Officer (or Chief Fiduciary) must complete and sign this form before medical/pharmacy director or location’s vaccine coordinator start the enrollment by clicking Start Enrollment button at the bottom of this page. 

  1. Please download CDC COVID19 Vaccination Program Provider Agreement_Section A
    1. It is a fillable pdf form.
    2. It can be completed and signed electronically in Adobe Reader or printed and signed by hand.
    3. If Section A is signed by hand, it should be scanned and saved as a pdf document to be uploaded during this online enrollment (please keep reading to learn how to do it).
  2. CEO and CMO should fill in and sign only one Section A for their organization. The same Section A will be use for separate enrollments of all organization's facilities.
  3. If you are a CEO/CMO, please fill in, sign, and email or provide a paper copy of the signed Section A to a medical/pharmacy director or location’s vaccine coordinator who will be completing this online enrollment.
  4. If you are not a CEO/CMO, please email them this form and ask to fill in, sign, and email or provide a paper copy of the signed Section A back to you. You will use the answers from this section and upload it to complete this online enrollment. You cannot proceed with the enrollment until you have a copy of Section A.

Please do not email/fax/mail Section A forms to the OSDH. Only Section A forms uploaded through this online enrollment tool will be accepted.  

Step 2: Upload of Section A and completion of "Section B. CDC COVID-19 Vaccination Program Provider Profile Information"

During this step, medical/pharmacy director or location’s vaccine coordinator will:

  1. Copy and paste answers from Section A to this online enrollment tool.
  2. Upload Section A to this online enrollment tool.
  3. Answer Section B questions and electronically sign the enrollment. Section B questions and signature are incorporated into this online enrollment tool. Section B is not a separate document.
  4. Submit the enrollment to the OSDH by clicking "Submit" button at the end of this online enrollment.
  5. Download and save a copy of facility's enrollment for future records. 

Please do not email/fax/mail your completed enrollment to the OSDH. Only enrollments submitted through this online enrollment tool will be accepted.

Step 3: Registration and Enrollment Confirmation

The OSDH receives all enrollments as soon as you click "Submit" button. The OSDH doesn't email confirmation of receipt. Once approved by the OSDH, Primary and Back-up COVID-19 vaccine coordinators (you will enter their contact infomation during the enrollment) will receive an email confirming facility's status as a COVID-19 vaccine provider. It may take a few days to process the enrollment during this busy time. Please be patient with us and keep check Primary and Back-up COVID-19 vaccine coordinators' emails regularly.

Technical Guidance

  • If this online enrollment tool is not loading or you are experiencing any other issues, please try other browsers such as Chrome, Firefox, Edge.
  • This enrollment will be active for one month after you clicked this link.
  • During one month, all previously entered responses will be saved automatically (there is no "Save" button) and the survey can be re-visited and completed at a later time.
  • Please use "Back/Previous" buttons to go back and edit your responses before you submit the enrollment.
  • After one month, your responses will be recorded automatically and sent to the OSDH even if you don't click "Submit" button. If you don't finish enrollment within one month after opening this link, you will have to start over.
  • Only one person can work on one enrollment. If you enter responses and send the link to other people, they will not see your responses and will have to start over.  

One-on-One Provider Enrollment Assistance

If you need help with the COVID-19 Vaccination Program Provider Enrollment, meet with an OSDH team member that can help walk you though the process. Once you have booked you will receive a calendar invite with a Microsoft Teams link for the meeting.


Training Materials for the COVID-19 Vaccine Providers


How to Place COVID-19 Vaccine Orders