2014 immunization provider vaccine agreement
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PART B: Of the total number for each age group entered in Part A, indicate by category how many children are VFC eligible at your health facility and how many are not VFC eligible (Insured). The total shown in Part A should equal the total shown in Part B.
*Maine legislation requires private health insurance companies to cover the cost of ACIP recommended vaccines for those individuals, up to age 19, who are under their health plan. B. Health Professionals Please type the names of all health professionals authorized to prescribe and/or administer vaccines in your facility. NOTE: Individuals or entities that have been placed in non-payment status under Medicare, Medicaid and other Federal health care programs, including the VFC program by the U.S. Department of Health and Human Services, Office of Inspector General (OIG) or through Executive Order by another Executive department (e.g., Department of Transportation, Office of Personnel Management, Department of Justice, Department of Labor, Department of Defense) are not allowed to enroll or participate in the VFC program or receive VFC vaccine. VFC providers are responsible for checking the Office of the Inspector General (OIG) list of excluded Individuals/Entities on the OIG website (www.hhs.gov/oig) prior to hiring or contracting with any individuals or entities. VFC enrolled provider sites who are found to have a person employed that is on the OIG excluded provider list shall be terminated from the VFC program. *National Provider Identifiers (NPIs) are given to health care providers—individuals, groups, or organizations that provide medial or other health services that need them to submit claims or conduct other transactions specified by HIPAA. The NPI is a 10-position numeric identifier. FAQs about the National Provider Identifier (NPI) can be found at: http://aspe.hhs.gov/admnsimp/faqnip.htm
This record is to be submitted to and will be kept on file at the State of Maine Department of Health and Human Services, Immunization Program. The Maine Immunization Program should be notified within ten (10) days of any changes, additions or deletions to this list. Directory: dhhs -> mecdc -> infectious-disease infectious-disease -> Maine aids drug Assistance Program (adap) Policy infectious-disease -> Maine aids drug Assistance Program (adap) hiv diagnostics and Laboratory Test Policy infectious-disease -> Maine aids drug Assistance Program (adap) MaineCare Supplemental Assistance Program Policy dhhs -> Adults only school, Home, and Office: Examples of Inhalants and Safer Alternatives mecdc -> Date: March 7, 2012 Project: Construction of New Nursing Facility in Bucksport, Maine. Proposal by mecdc -> Date: November 6, 2012 Project mecdc -> Date: November 17, 2011 Project: Construction of Replacement Nursing facility for Collier’s Healthcare in Ellsworth, Maine. Proposal by Download 184.01 Kb. Share with your friends:
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