Common Contracts
1 similar Provider Enrollment Agreement contracts
IDAHO IMMUNIZATION PROGRAM PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • October 31st, 2012
To receive vaccines through the Idaho Immunization Program, which includes the federal Vaccines for Children (VFC) program, and to receive federal and state procured vaccine at no cost, I, on behalf of myself and all practitioners for whom I am the medical/agency director or equivalent, agree to the following:
