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Looking for a COVID-19 immunization or an influenza vaccine? Find a participating pharmacy near you
Please enter your existing information
* Please indicate the changes you’re requesting below and provide any mandatory information required for the changes you’ve selected in the sections that follow
Please note that change of ownership requires termination of your existing account. Please provide the following information:
Note: the new provider will need to complete and submit a new request for secure website access before they can access the site.
Consolidate multiple online direct billing accounts so that the clinic may submit for all service types under one login ID.
If you’d like to set up single sign on access, please provide the information that corresponds to your existing account type. Depending on your account, you may also be able to submit a new request for secure website access.
This account type requires you to terminate your current account, and sign up for secure website access again.
Complete a request for secure website access.