YOUR ACTION REQUIRED: COVID-19 Vaccine Program - Annual Provider Renewal Process

Louisiana Department of Health - Office of Public Health - Louisiana Immunization Program

YOUR ACTION REQUIRED: COVID-19 Vaccine Program -

Annual Provider Renewal Process

The Louisiana Immunization Program is conducting a renewal process for all existing vaccination providers enrolled in the state’s COVID-19 Vaccine Program. It is quick and easy. To continue participating in the Program, please complete and submit this short renewal form by the deadline (only one submission per site please).

Renewal Form Link: https://www.surveymonkey.com/r/Renew_2023

Completed program renewal forms are due by 5:00 p.m. on Wednesday, February 15, 2023.

IMPORTANT: A response is required to continue participating in the state’s COVID-19 Vaccine Program. Any sites failing to complete a renewal form by the deadline may be suspended or removed from the program and will be unable to order or administer Louisiana COVID-19 Vaccine Program vaccines.

The Program also prepared a one-page Program Requirement Reminder Resource for providers participating in the Louisiana COVID-19 Vaccine Program.

If you have additional questions please contact your regional COVID-19 Vaccine Specialist listed below:

Region 1: tammy.leonard@la.gov

Region 2: jennifer.carter@la.gov

Region 3: peggy.bowers@la.gov

Region 4: julia.ceaser@la.gov

Region 5: justus.gennuso@la.gov

Region 6: susan.babineaux@la.gov

Region 7: primette.braden@la.gov

Region 8: danielle.hudleston@la.gov

Region 9: lena.decker@la.gov

Region map: https://ldh.la.gov/assets/docs/OrgCharts/RegionMap.jpg