ALABAMA DEPARTMENT of PUBLIC HEALTH
 
VFC Influenza Vaccine Order Form 2019-2020

2019-2020 INFLUENZA VACCINE ORDER FORM ALABAMA VACCINES FOR CHILDREN PROGRAM
Generally in January and February of each year, the Alabama Vaccines For Children (AL VFC) Program ask VFC providers to submit their preferred presentations of VFC influenza (flu) vaccine by mail/email, which is called prebook. CDC requests from all state VFC Programs their pre-booked orders by March 1. In the last summer or early fall, CDC allocates flu presentations based what has been delivered to McKesson, CDCís VFC vaccine distributor. When McKesson receives doses, they update the information in CDCís VTrckS. AL VFC Program approves orders to be distributed based on what is in stock at McKesson. State VFC Programs are not told which presentations will arrive first, just what is received at McKesson. AL VFC Program fills flu orders based on first ordered, first distributed. For example, a provider who prebooked on April 28 requested 100 doses of 6 to 35 months Fluzone and 100 doses of 36 months and older Fluzone pre-filled syringes. Those presentations were not available by the time the providers who ordered before April 28 were filled. Other presentations of Fluzone maybe available, i.e., 6 months and older multiple dose vials. Providers are notified if their preferred presentation is no longer available and AL VFC Program will ask providers if they will accept another presentation not requested. The AL VFC Program recommends providers submit their prebook as soon as possible with different presentations and manufacturers to ensure you receive flu vaccine early in the season. Influenza orders will be submitted to the National Centralized Distribution Center in the order they are received.

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* VFC Provider Name

* Contact Person

* VFC PIN

* Shipping Address

* City

* State

* Zip Code

* Phone #

Fax #

* Email Address

* Special Delivery Instructions (e.g. days/hours closed)


Please call 1-866-674-4807 with any questions. Please indicate the vaccine presentation you prefer. If preferred presentation is not available, you will receive what is available. Please enter the number of doses in 10 dose increments in the spaces provided.

If the vaccine presentation that I requested is not available, I agree that another presentation can be substituted in its place.

I agree  

Fluzone Quad (Age 6 mths and older) Multi-dose vials

Fluzone Quad (Age 6 mths to 35 mths) No-Preservative 10 pk-1 dose syringes

Fluzone Quad (36 mths and older) No-Preservative 10 single dose vials

Fluzone Quad (36 mths and older) No-Preservative 10 single dose syringes

Fluarix Quad (6 mths and older) No Preservative-10 single dose syringes

Flucelvax Quadrivalent (4 yrs and older) Single dose syringes

Flucelvax Quadrivalent (4 yrs and older) Multi-dose Vials

FluLaval Quadrivalent (6 mths and older) Multi-dose vials

FluLaval Quadrivalent (6 mths and older) No Preservative-Single dose syringes