PENNSYLVANIA DEPARTMENT OF HEALTH, DIVISION OF IMMUNIZATIONS ADOLESCENT AND ADULT HIGH RISK IMMUNIZATION PROGRAM QUICK GUIDE
Form Order Forms How to submit Fax, email or US mail Where to submit Fax: 717-441-3801 AAHRIP@state.pa.us Department of Health 7th and Forster Streets Rm 1026, H&W Bldg Harrisburg, PA 17120 Same as above When to submit and additional information. Remember to include Pin # and provider name on order form.
Usage and Inventory Report
Fax, email or US mail
Temperature Log (Take temperatures twice a day)
Fax, email or US mail
Same as above
Incident Reports
Fax, email or US mail Send in shipping box
Same as above to the DOH also Return form and vaccine to McKesson Specialty Distribution 4853 Crumpler Road Memphis, TN 38141
Remember to include Pin # and provider name on usage report. Due quarterly January 5th April 5th July 5th October 5th Remember to include Pin # and provider name on temperature log. Due monthly by the 5th of every month after the reporting month. Complete when you have temperature problems, power outage or vaccine wasted due to shipping damage.
** Remember to put pin number on all forms (especially temperature logs) Any questions contact Immunizations at 717-787-5681
June 2008