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KENTUCKY H1N1 VACCINE PROGRAM Enrollment Form. Practice or Facility name: Do you have an AFC PIN #? If yes, please write it on the line Vaccine Delivery/Shipping Address (cannot be a PO Box): City,
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How to fill out h1n1 pharmacy provider enrollment

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How to fill out h1n1 pharmacy provider enrollment

01
Gather all necessary information and documents such as enrollment forms, business license, NPI number, etc.
02
Review the enrollment form and fill out all the required fields including personal information, pharmacy details, and contact information.
03
Provide supporting documentation as required, such as proof of qualifications, licenses, accreditations, etc.
04
Double-check all the information provided for accuracy and completeness.
05
Submit the completed enrollment form along with the supporting documentation to the appropriate authority or organization.
06
Wait for the enrollment to be processed and approved. You may need to follow up or provide additional information if requested.
07
Once approved, you will receive confirmation of your enrollment as an H1N1 pharmacy provider. Keep this documentation for future reference.

Who needs h1n1 pharmacy provider enrollment?

01
Pharmacies and pharmacists who wish to participate in the H1N1 vaccination program as providers need to fill out the H1N1 pharmacy provider enrollment. This applies to both independent and chain pharmacies.

What is H1N1 Pharmacy Provider Enrollment - Kentucky Health ... Form?

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