This survey will be open weekly from Friday at 10am thru Thursday at 4pm. 

A new survey must be completed each week to request vaccine. 
Completing survey does not guarantee vaccine. 
MSDH Office of Immunization will do our best to accommodate the requested amount and type of vaccine. 
The number of doses provided may be less than requested or the vaccine requested may not be available.
If vaccine is ordered for your facility, the facility contacts indicated on the provider enrollment agreement will receive an email. 

Question Title

* 1. Are you an enrolled COVID-19 Vaccine Provider

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