Vaccine Program Specialist
307-777-2413
LaChel May
Provider Relations Administrative Assistant
307-777-8503
Fax reports to: 307-777-3615
WyVIP Providers in Wyoming by County (clickable map)
Agreements must be submitted, with original signatures by mail
No Later Than February 19, 2010
2010 WyVIP/VFC Policy Packet
2010 Non-PHN Child Agreement
2010 Non-PHN Adult Agreement
2010 PHN Child Agreement
2010 PHN Adult Agreement
WyVIP Provider Forms
Vaccines Currently Available through WyVIP (VAC1) updated 02/02/10
Doses Administered Form (VAC2) updated 02/02/10
Vaccine Request Form updated 02/02/10
Special Clinic Order Form (VAC3) updated 02/02/10
Special Clinic Doses Administered Form (VAC4) updated 02/02/10
Flu Doses Administered and Inventory Form (VAC5) updated 02/02/10
Expired and Wasted Vaccine Return Form (VAC6) updated 02/02/10
Vaccine Transfer Form (VAC7) updated 02/02/10
Vaccine Temperature Log - Celcius (VAC9) updated 02/02/10
Vaccine Storage Troubleshooting Report updated 02/02/10
Current Inventory Form (VAC10) updated 02/02/10
Flu Special Clinic Order Form (VAC11) updated 02/02/10
Vaccine Transfer Request (VAC12) updated 02/02/10
Vaccine Arrival Report (VAC13)
Emergency Plan Form for Providers Clickable PDF Updated September 4, 2009
Emergency Plan Example Updated September 4, 2009
OTHER INFORMATION
Sharp Shooter Award Application
Handle With Care-Cold Chain Flyer Updated October 6, 2009
Cold Chain and Vaccine Storage and Handling Information