COVID-19 Vaccine Program Provider Agreement

October 16, 2020

The New York City Department of Health and Mental Hygiene (DOHMH) issued a letter (attached) reporting that it is now enrolling hospitals located in the five boroughs of New York City in the Centers for Disease Control and Prevention COVID-19 Vaccination Program.

Hospitals in New York City that plan to receive and administer COVID-19 vaccines are required to sign a Federal Provider Agreement and Provider Profile (attached), which is now available in the NYC Citywide Immunization Registry (CIR).

The Provider Agreement must be signed by the Chief Medical Officer (or equivalent) and the Chief Executive Officer (or Chief Fiduciary Officer). The Provider Profile for each vaccination site must be signed by a designated COVID-19 vaccine coordinator or the medical/pharmacy director.

DOHMH will host the following webinars to provide guidance on completing the Provider Agreement and Provider Profile in the CIR. Please use the links to register:

Webinar 1
Date: Tuesday, October 20, 2020
Time: 1:00 p.m. to 2:00 p.m.
Webinar 2
Date: Thursday, October 22, 2020
Time: 3:00 p.m. to 4:00 p.m.

DOHMH has provided instructions (attached) for accessing the CIR. For questions about how to access the CIR, how to find your CIR facility codes, or for any other immunization issue, please call (347) 396-2400 during regular business hours (Monday to Friday, 9:00 a.m. to 5:00 p.m.) or e-mail

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