Enrolling Private Practice into NYC COVID-19 Vaccination Program

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If you would like to enroll your private practice or facility into the NYC COVID-19 Vaccination Program in order to provide vaccination for your staff, you will need to complete the COVID-19 Provider Agreement in the online Citywide Immunization Registry (CIR).

 

Please note individual providers other than private practitioners do not need to enroll; only one enrollment form should be submitted per facility. 

 

If you are on staff at a hospital or Federally Qualified Health Center, these facilities have already completed the Provider Agreement or are in the process of doing so. Likewise, individual clinics that are part of a hospital network should not enroll at this time, as vaccines will be sent to a central point of distribution for the network.

 

Facility groups or networks should complete a single Provider Agreement (Section A) but must identify each vaccination site and complete a Provider Profile for each site (Section B). The Provider Agreement must be signed by the Chief Medical Officer (or equivalent) and Chief Executive Officer (or Chief Fiduciary). The Provider Profile for each vaccination site must be signed by a designated COVID-19 Vaccine Coordinator or the Medical/Pharmacy Director. 

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Please see below for instructions on how to register your practice.