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* 1. What is the name of your community?

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* 2. What county is your community located in?

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* 3. Which pharmacy are you partnered with?

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* 4. Has your community been scheduled for its vaccination clinics?

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* 5. If yes, what is the date of your first clinic?

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* 6. Have you made alternative efforts to get vaccinations (e.g., county health department, strike teams, etc.)

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* 7. Name of person completing survey

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* 8. Title (ie: Executive Director, etc.)

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