Complete Story

COVID Vaccine - Provider Sign-Up Now Open

COVID-19 Vaccine Provider Sign Up

The Ohio Department of Health (ODH) and the State of Ohio Board of Pharmacy held a joint webinar October 21, 2020 to discuss the ongoing state strategy to roll out the COVID-19 vaccine. The strategy document is a working document, subject to change based on stakeholder input. Initial updates are outlined below:

Interested providers are requested to voluntarily sign up to be recognized as a COVID-19 vaccine provider. The state of Ohio will not require that all providers offer the vaccine once it is available to the public. Additionally, the state is not requiring that Ohio residents get vaccinated with the COVID-19 vaccine once available. A timeline of the vaccine release date was shared with a predicted release in mid-November for a two-dose COVID-19 vaccine series. The vaccines will be delivered in kits with a minimum of 100 doses per kit. Long term care facilities have the option of signing up with CVS, Walgreens, or other pharmacies to receive on-site vaccination services through signing up via

In response to the call by CDC for a vaccine strategy, ODH has created an application process for providers interested in administering the COVID-19 vaccine here. Providers will create a login then click on the Sites and Applications tab and search for the Vaccination Program (COVID-19) application to begin the process. The sign-up consists of 4 forms to be completed before ODH will approve a location as a COVID-19 vaccine provider. The application sections are listed as follows:

  1. CDC COVID-19 Vaccination Provider Agreement: mandatory provider agreement signed by the organization’s Chief Medical Officer and Chief Fiduciary Officer (the same individual can sign for this if the position is combined). Providers will be requested to provide a valid email and a Terminal Distributer of Dangerous Drugs (TDDD) License number.
  2. CDC COVID-19 Vaccination Provider Profile: asks applicants to provide information about the facility including but not limited to:
  • Address where the vaccine will be stored
  • Address where the vaccine will be administered
  • Hours of operation to receive the shipment
  • Contact information
  • Vaccination location type (school, pharmacy, doctor’s office)
  • Number of patients served
  • Highest number of flu vaccines administered in one week in the last flu season
  • Demographics of patients served
  • Cold storage capacity
  • List of licensed healthcare providers
  1. ODH Outbreak Response Initiative Agreement signed by a designee
  2. Proof that the provider location has signed up for the Ohio Impact Statewide Immunization Information System (ImpactSIIS)

After the application is sent, the following steps will occur:

  1. ODH will email the applicant when each section is submitted
  2. Once approved, ODH will send information regarding COVID-19 vaccine storage and staff training
  3. Applicants will have to attest to participation in the COVID-19 vaccine administration training
  4. Applicants will attest to have appropriate storage facilities
  5. ODH will send a final confirmation that the provider has successfully signed up as a COVID-19 vaccine administrator.

ODH has urged pharmacists to begin compiling the required paperwork needed to apply. Enrollment for pharmacies starts on Friday 10/23. The enrollment form can be found at COVID-19 vaccine questions can be sent to ODH will continue to update stakeholders of the COVID-19 vaccination strategy as it develops.

Please let OPA know how we can support you by contacting Myriam Shaw Ojeda at

Printer-Friendly Version