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COVID-19 Vaccination Program Enrollment for New York City FQHCs

November 17, 2020


The New York City (NYC) Department of Health and Mental Hygiene is launching the enrollment process for federally qualified health centers (FQHCs) interested in receiving and administering COVID19 vaccine when it is available. To be able to do so, health centers with FQHCs in NYC that would like to receive and administer COVID-19 vaccine are required to sign a Federal Provider Agreement and complete a Provider Profile, available in the NYC Citywide Immunization Registry (CIR) starting November 16th, 2020.


The Provider Agreement must be signed by the Chief Medical Officer (or equivalent) and 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.


The NYC Health Department is asking FQHCs to complete their Provider Agreements, Sections A and B, by Monday, November 30th, 2020.

In collaboration with the Community Health Care Association of New York State (CHCANYS), the NYC Health Department will host the following webinar to provide guidance on completing the Provider Agreement and Provider Profile in the Online Registry. Please use the below link to register. The webinar is on November 20, 2020 at 03:00 PM and will be for FQHCs with locations in the 5 boroughs of NYC.


WEBINAR REGISTRATION


For questions about how to access the Online Registry, how to find your CIR Facility Codes or any other immunization issue, please call (347) 396-2400 during regular business hours (Monday to Friday, 9 a.m. to 5 p.m.) or email nycimmunize@health.nyc.gov.

Additional Documents:


COVID-19 Vaccination Program Provider Ag
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Download • 243KB
COVID-19 Provider Vaccination Agreement
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Download • 526KB
FQHC_Covid19_Vaccine_Agreement_Notice_ 2
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Download • 216KB










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