Maryland vfc 2026

1. Click ‘Get Form’ to open the Maryland VFC enrollment survey in the editor.
2. Begin by filling out the 'VFC Provider Practice/Facility Information' section. Enter your VFC PIN, today's date, practice name, type of facility, and address details. Ensure all fields marked with an asterisk (*) are completed as they are mandatory.
3. Proceed to the 'Responsible Medical Provider Information' section. Fill in the first and last name, credentials, medical license number, and contact information for the responsible provider.
4. In the 'Practice/Facility Vaccine Supply Contact Information' section, provide details for a different contact person who will manage vaccine supplies.
5. Review and acknowledge each item in the 'VFC Provider Enrollment Agreement' by checking the radial buttons next to each statement.
6. Complete any additional sections regarding other medical providers within your practice and specify your vaccine brand preferences.
7. Finally, fill out the shipping address for vaccines and answer any programmatic questions before submitting your form.

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