Request for Additional Vaccines

Please complete the questions on this form if you would like to request additional vaccines.
Questions: MEAdultVaccine@maine.gov

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* 1. Provider Site Information

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* 2. What month are you requesting additional vaccines for?

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* 3. Please select which vaccines you would like to order on the above date. (increments of 10 doses per box)

  # of Doses
Vaqta - 10 pack/1 dose syringe ($40.33)
Havrix - 10 pack/1 dose syringe ($38.57)
PreHevbrio - 10 pack/1 dose vial ($33.80)
Twinrix - 10 pack/1 dose syringe ($75.96)
Gardasil9 - 10 pack/1 dose syringe ($178.33)
Boostrix - 10 pack/1 dose syringe ($28.54)
Trumenba - 10 pack/1 dose syringe ($108.18)
Bexsero - 10 pack/1 dose syringe ($127.07)
Prevnar 20 - 10 pack/1 dose syringe ($176.84)
Shingrix - 10 pack/1 dose vial ($120.93)
MMR-II - 10 pack/1 dose vial ($61.20)
Varivax - 10 pack/1 dose vial ($106.36)

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* 4. Please select which vaccines you would like to order on the above date. (increments of 5 doses per box)

  # of Doses
Heplisav-B - 5 pack/1 dose syringe ($74.94)
Adacel - 5 pack/1 dose syringe ($28.49)
Menquadfi - 5 pack/1 dose vial ($79.37)

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* 5. ACKNOWLEDGE: If you have requested a specific order date above, you will need complete the following on that calendar day:

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