Information Regarding H1N1 Vaccine and Antivirals

Vaccine Antivirals Information Regarding H1N1 Vaccine and Antivirals 29 5 Pre Registration Includes Pharmacists 2 3 Pre Registration Does Not Include Pharmacists 1 4 Pre Registration Under Development 8 6 Need to Contact for Registration Information 1 22 No Formal Registration Process/State Directed Plan 14 0 Deadline Passed 4 11 No information available at this time

State Contact Person H1N1 Vaccine Antivirals ADPH Immunization Division https://dph.state.al.us/order/ INSTRUCTIONS FOR ORDERING 334-206-5023 Order Request Form for H1N1 Vaccine and Antivirals 1) Go to http://adph.org/Default.asp?bhcp=1 ADPH Immunization Division 2) Select "Log In" from the Top Menu http://www.adph.org/H1N1Flu/Default.asp?id=3574 3) Select "ORDER (Ordering Resources During ADPH Information for Healthcare Providers an Emergency Response)" from the List of possible Links 4) Choose License Type and Select "Pharmacy Permit" 5) Enter Your Permit Number in the License or Permit Number Field 6) Then click the Login button 7) Ensure Your information is correct on this Alabama page and follow the instructions. Laurel Wood https://vactrak.alaska.gov/hss/signup.html http://www.pandemicflu.alaska.gov/PDFs/Antiv 907-269-8000 https://vactrak.alaska.gov/hss/index.html iral_QA.pdf [email protected] To protect the public from novel H1N1 influenza virus this State stockpiled antivirals should be viewed as a fall, the U.S. government will provide states with federally last resort. Antivirals are readily available from funded novel H1N1 ("swine flu") vaccine and supplies, pharmaceutical companies through the usual including needles, syringes, alcohol swabs, and sharps supply chains. If it is determined that local containers. Details of this planned vaccination effort are resources have been exhausted and the usual still being determined. Initially, vaccine will be supplied in supply chain cannot be quickly accessed, incremental allotments. However, ultimately sufficient requests for additional antiviral product can be vaccine will be available to saturate U.S. demand. made from the nearest stockpile site. If a The Alaska Department of Health and Social Services provider is not sure where the nearest stockpile Alaska (DHSS) is extending the opportunity to receive and site is located, they can call 1-888-972-6358.

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals administer novel H1N1 vaccine to all interested immunizing health care providers in the state, including hospitals, clinics, pharmacists, and community vaccinators. Providers are not required to be current participants in the state's vaccine distribution program in order to receive H1N1 vaccine. The enrollment, ordering and reporting process for novel H1N1 vaccine will occur through a process that is separate from routine vaccine procedures. For questions about registration, contact the Alaska Immunization Program at 907-269-8000. http://www.surveymonkey.com/s.aspx?sm=WOshQr3nUy The Arizona Department of Health sent out QM8hIAjitxww_3d_3d state antiviral SNS to country health All Arizona healthcare providers interested in participating coordinators and the country health in the novel H1N1 Influenza Vaccine Distribution Program coordinators distributed their allotment of must complete this form. Pre-registration information will vaccine to local healthcare providers. The State be used to estimate vaccine needs and establish a shipping DOH acts as distributors for the antiviral address. Providers are not committed to receive vaccine by product from the SNS but the county health completing this form. When the vaccine becomes available coordinators are in charge of the allocation for distribution, providers will receive a provider agreement decisions amongst local healthcare providers. and order form that must be returned to ADHS in order to Requests for additional antivirals will be made receive vaccine. Submit only one pre-registration form per through the county health coordinators. practice site. Call (602) 364-3895 for further questions.

Arizona Deadline for Submission: 9/11/2009 http://www.healthyarkansas.com/news/H1N1_Pre- The ordering form and instructions are in the Reg_Letter.pdf final stages of approval and we will receive a Arkansas copy from the SNS coordinator once it is

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals To pre-register your interest in administering H1N1 finalized. Vaccine: 1. Go to the following ADH Internet Application website: https://health.arkansas.gov/ADHInternetApps/ 2. Use this generic User Email Address and Password to access the online survey Title: H1N1 Provider Information Form User Email Address: [email protected] Password: H1N1 Vaccine 3. Once the survey is complete, print a copy if needed for your files 4. Click “Save” at the bottom of the form and the form will be sent to ADH. The Survey form will return to blank after submitting. 5. Close your browser to exit the form

www.calpanflu.org Decisions made on local health department State officials announced plans for an online registration level. Healthcare providers wishing to dispense process for all healthcare practitioners who plan to antiviral product from the SNS should contact immunize. The state will use this system to determine who the local department in question (There is no is qualified to receive vaccine, so it is important that you state-wide solution). California register at: Colorado Immunization Program If you are a provider that would like to administer H1N1 Colorado has a very limited stockpile of antiviral 303-692-2650 vaccine, please contact your drugs. When it is deployed, it is meant for ill Colorado local public health agency. patients already at hospitals.

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals http://www.denverhealth.org/portal/Portals/0/docs/public See this press release: _health/Colorado_H1N1_Provider_Pre- http://www.cdphe.state.co.us/release/2009/05 registration_Form.pdf 0109b.html DEADLINE extended to 9/9/09 (originally was 8/21/09) Pre Registration The State of Connecticut has shipped SNS antivirals to acute care hospitals. Discussions Immunization Program • Cover letter are under way for if/when the state will deliver • H1N1 Provider Agreement SNS antivirals to pharmacies or other (860) 509-7929 • H1N1 Provider Profile healthcare organizations. Currently there is no • Refrigeration Capacity Information formal registration form or process for • H1N1 Vaccine Q & A - For Providers healthcare providers to request additional • H1N1 Vaccination Liability Protections antiviral product from the state SNS. Connecticut http://www.dhss.delaware.gov/dhss/dph/dpc/files/h1n1pr The State of Delaware does have a formal policy oviderpreregform.pdf and procedure in place. In the event that the Delaware Pre-Registration for Providers Interested in antiviral SNS would need to be accessed, the Administering the Novel H1N1 Influenza Vaccine state would implement measures it has set in Pharmacists not specifically included but there is a space place to respond and roll out the appropriate for “other” program and release forms to allow healthcare providers to make formal requests for Delaware additional antiviral product from the SNS. Beverly A. Pritchett http://forms.dc.gov/lfserver/44a5ecz12320c0fc71zx4ae41x http://doh.dc.gov/doh/cwp/view,a,1370,q,604 202-671-4222 2x111x52?DFS__Action=FormsGT&44a5ec:12320c0fc71:- 320.asp [email protected] 2b9b No information available at this time DC H1N1 Vaccine Pre-Registration Form

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals [email protected] https://www.flshots.com/enrollment/index.html http://www.doh.state.fl.us/DEMO/php/FluInfo. H1N1 Pre-Registration Process htm Florida No information available at this time Monica Trigg http://www.gpha.org/displaycommon.cfm?an=1&subarticl The GA DCH distributed part of its antiviral SNS 404-657-9635 enbr=270 this past spring to its regional coordinating [email protected] Immunization Vaccine Protocol Agreement Information for hospitals. The DCH is developing a plan to Pharmacists and H1N1 Update distribute most of its remaining antiviral SNS to http://health.state.ga.us/h1n1flu/vaccine.asp health departments, healthcare facilities, and Contact GRITS at 888-223-8644 or [email protected] pharmacies. The DCH will soon release a DEADLINE 9/15/09 registration form for pharmacies to become antiviral product providers. All requests for additional antiviral product from the SNS will go Georgia through the DCH. http://h1n1vax.doh.hawaii.gov/H1N1Register.html http://hawaii.gov/health/about/H1N1.html#ant Registration Pages for physicians and community providers ivirals Hawaii No information available at this time [email protected] The State of Idaho works on a decentralized basis. There The Idaho State Department of Health has given are 7 regional health districts that coordinate with local control of the distribution of antiviral healthcare providers in regards to H1N1. The 7 regional medication to the regional health districts. The public health districts will select certain healthcare regional health districts control the flow of providers within their districts to provide vaccine to the antiviral medications and will select local general population. The healthcare providers will be distributors on a case by case basis. The 7 selected based on population area served and other regional districts would make requests to the attributes set by the local health districts. The forms and state to gain access to the state stockpile in the policies are in place for the healthcare providers to get in event of an emergency. There are no publicly touch with the regional health districts to gain access to the released forms or procedures as all Idaho vaccine supply. communications and request forms are ready

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals and done internally between local health providers, regional district health departments, and the state department of health. Immunization Section http://www.idph.state.il.us/h1n1_flu/H1N1_Vaccine_Deliv http://www.idph.state.il.us/h1n1_flu/SwineFlu 217-785-1455 ery_Process.pdf _InterimGuidelinesDistributionAntivirals.pdf For more information or questions regarding pre- Guidelines on Local Health Department registration or any aspects of this process please call the Distribution of Strategic National Stockpile Illinois IDPH Immunization Section at 217-785-1455 (SNS) Antivirals Immunization Division No information available at this time – 9/21 Indiana State DOH has pre-positioned SNS 317-233-7704 antiviral product each of its local health departments. Local health departments are responsible for developing strategic allocation plans with their own jurisdiction for distribution of antivirals. Local health entities have guidance in place where by local providers can request access for additional antiviral product through Indiana the local health department. If you are a provider that would like to administer H1N1 Iowa has a decentralized health system in terms vaccine, please contact your local public health agency. of health care providers. Individual providers looking to order antivirals must get in touch with their local county public health agency to make the request for antiviral medication and from there, the local county health agency would put in a request order with the Iowa State Department of Health. There is no statewide order form for antiviral medication so any Iowa provider looking to receive supplies from the

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals State SNS must contact their local county public health agency. http://www.kdheks.gov/flu/download/Pre- http://www.kdheks.gov/H1N1/ registration_for_H1N1_vx_access.pdf The Kansas Department of Health and https://www.dhe.state.ks.us/surveys/private_provider_sig Environment will soon release an online n-up.htm registration and order form for healthcare 8-17-2009 - Notice to Immunization Providers - H1N1 providers to request additional supplies of Vaccine Pre-registration (click here to view).Notice to antiviral medication. The KDHE has pre- Immunization Providers deployed some of the existing state federal In an effort to create as many access points to vaccination cache this past Spring to local health as possible, state and local public health agencies will need departments. to partner with private sector immunization providers to administer H1N1 vaccine. KDHE is extending the opportunity to receive and administer H1N1 vaccine to all interested immunizing healthcare providers (including hospitals, clinics, pharmacists and community vaccinators) once vaccine supplies are sufficient. Pre-registered facility representatives will receive email updates about the pandemic vaccination program and enrollment as well as information to prepare for storing, handling and administering H1N1 vaccine properly. To register your potential interest in the administration of H1N1 vaccine and receive more information, go to the H1N1 Vaccine Kansas Provider Pre-registration.

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals https://khelps.chfs.ky.gov/VolunteerMobilizer/ Welcome to KHELPS H1N1 News: If you would like to register your medical Kentucky_Antiviral_D istribution_Plan_Final.doc clinic or practice to possibly become an H1N1 vaccine provider for the 2009 flu season, please join by clicking here and selecting the H1N1 Vaccine Provider group. By registering you are expressing interest in being contacted. Registering does not guarantee you will be selected or receive vaccine. We are especially interested in targeting practices that reach a high percent of high priority groups for vaccination, including children, pregnant women, and healthcare and emergency services personnel. Novel H1N1 vaccine will be provided to practices free of charge and practices will be allowed to charge a nominal administration fee. This is an evolving situation; we will provide updates regarding vaccine availability, distribution and administration to those practices registering on this Kentucky site. DHH OPH Immunization Program https://linksweb.oph.dhh.louisiana.gov/linksweb/la_h1n1_ The Louisiana Office of Public Health (LAOPH) is 504-838-5300 registration.jsp making plans to distribute antivirals to state Novel H1N1 Vaccine pharmacies based on demographics (poverty Healthcare Provider Registration levels and population size). The LAOPH has Louisiana determined how many pharmacies in each parish are needed to cover the populations in the area and these providers include chain drugs stores, independent pharmacies, hospitals, other healthcare providers. Providers Louisiana within each parish can request to receive This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals antivirals and the registration for that process will be done through the same LINKS system that providers used to register to distribute H1N1 Vaccine. On the LINKS system, there will be a H1N1 antiviral medication request form that the healthcare provider can send in to the LAOPH to gain access to additional antiviral medication. Peter Smith http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider- http://www.maine.gov/dhhs/boh/maineflu/swi [email protected] agreement-2009-2010.shtml ne-flu-2009-provider.shtml Maine 2009-2010 Provider Agreement for H1N1 Vaccine No information available at this time Maryland Center for Immunization http://dhmh.state.md.us/swineflu/h1n1registration.html The Maryland Department of Health and [email protected] The Maryland Department of Health and Mental Hygiene Mental Hygiene (DHMH) is considering (DHMH) requests interested vaccine providers to signup to releasing Tamiflu from its state stockpile, and is Ivan Zapata (for antivirals): receive H1N1 influenza vaccine. DHMH has established a looking for candidate pharmacies statewide [email protected] pre-registration process for immunization providers to that meet the following criteria: Mobile phone: (443) 520-7199 identify their facilities as possible vaccine administration Fax: (410) 333-5000 sites for the 2009 novel H1N1 influenza vaccine. Pre- 1) Are open a minimum of 12 hours a day registration with DHMH is the only way to receive H1N1 2) Will sign an agreement with DHMH influenza vaccine. (see contact information) 3) Can provide a local contact (DM, AM) with a phone and email address 4) Can potentially compound Tamiflu capsules into liquid if commercially available liquid is unavailable. DHMH will forward compounding instructions Maryland at a later date.

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals 5) Can provide information ASAP since DHMH is NOW releasing a small amount of medication

For pharmacies that meet the above criteria, please send a request to Ivan Zapata (see contact information) [email protected] or 617- http://www.mass.gov/dph/h1n1registration If your pharmacies are experiencing any 994-9828. Provider H1N1 Vaccine Registration shortages of antivirals, PPE, or any other item you deem important to your ability to Deadline October 9, 2009 respond appropriately, please direct these issues to our attention.

MA Free Training The supply line can be reached at Information.doc [email protected] or 617-994-9828. The Massachusetts Department of Public Health is providing free training opportunities for vaccine administrators who want some additional training prior to administering vaccine. There is no registration fee but pre- registration is required. Please read the information in the Massachusetts document above to access the dates for the programs. 1. Complete the MDCH Vaccine Provider Agreement, http://www.michigan.gov/mdch/0,1607,7-132- below. 2940_2955_22779---,00.html No information available at this time MDCH 2009 Influenza A (H1N1) Monovalent Vaccine Provider Agreement Michigan

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals MDCH 2009 Influenza A (H1N1) Monovalent Vaccine Provider Agreement Q&A

Questions and Answers specifically related to the MDCH vaccine provider agreement Vaccine Provider Agreement Q & A (CDC) General information about the vaccine provider agreement

2. Return the completed Vaccine Provider Agreement to your local health department .

Because the 2009 Influenza A H1N1 flu vaccine will be publicly purchased, providers who offer this vaccine must work in conjunction with their local health department . Beth Parilla http://www.health.state.mn.us/divs/idepc/immunize/prer http://www.health.state.mn.us/divs/idepc/dise 651-201-5532 eg.html ases/flu/h1n1/hcp/antiviralguid.pdf [email protected] Pre Registration Form Use and Management of Antiviral Medication: Interim Guide for Healthcare Providers and Other Distributors B fax on pre-regis aug09 (6).doc

http://www.health.state.mn.us/divs/idepc/diseases/flu/h1 n1/vaccine/ordering.html If you have questions, send an email to Minnesota [email protected] or call 612-807-0073.

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals Tammy Clark http://www.msdh.state.ms.us/msdhsite/_static/resources/ The State of Mississippi allocated part of its 601-576-7751 3330.pdf antiviral SNS this Spring to local hospital, acute [email protected] Mississippi State Department of Healthy 2009 Influenza A healthcare facilities and emergency rooms. The (Novel H1N1) Swine Flu Vaccine Provider Agreement MS DOH is developing a plan that target chain and independent pharmacies to be dispensers of antiviral product and all requests for additional antiviral product will be done Mississippi through the DOH. http://www.dhss.mo.gov/BT_Response/_MedProfs.html "[Local Public health Authorities] will identify Health care providers who are interested in administering community partners who can prescribe antiviral the vaccine against the new H1N1 flu virus should contact medications for treatment who would be their local public health agency. The health department willing to dispense this medication without serving your city or county will oversee distribution of the charge and to comply with other stipulations vaccine and will select certain health care providers to help set forth by DHSS and CDC regarding the administer the vaccine to the public distribution of subsidized medications. Community partners could include hospital pharmacies, retail pharmacies, health care providers, and other facilities with appropriate storage facilities, hours of operation, and staff Missouri to dispense the medication." Health care providers who are interested in administering The state of Montana Department of Health has the vaccine against the new H1N1 flu virus should contact already distributed its state stock pile of their local public health agency. The health department antiviral medication to local health serving your city or county will oversee distribution of the departments based on population vaccine and will select certain health care providers to help demographics. The local health departments administer the vaccine to the public. then distributed it to local health care providers Montana based on needs and requests. If a local

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals healthcare provider needs more antiviral medication, they contact their local health department to request more. Should the local health department not have any stockpile left, they would make a formal request to the State Department of Health who would in turn make the request to the Federal Government for access to the National Strategic Stockpile. All local healthcare providers have the contact information and request form procedures to access the antiviral medication from their local health departments. http://www.hhs.state.ne.us/H1N1flu/clinicians.htm The state of Nebraska will be running its Assist with H1N1 Immunizations antiviral program through the local health Planning for the administration of H1N1 vaccine to high risk departments. Local health departments will be groups in Nebraska is the responsibility of the local/district selecting providers to receive antiviral heath department. If you are a health care provider and medications. The level of supplies is fine at the would like to help immunize targeted risk groups, please moment and in the event an emergency, the contact your health department. local state health departments will allocate antiviral medications to providers they have Nebraska agreements with. http://flu.nv.gov/HealthCare_ProviderEnrollment.htm http://flu.nv.gov/AntiViral_OnlineForm.htm Pre-Registration for H1N1 Influenza Vaccine Administration Antiviral Product Request Form Sites in Nevada The SNS of antiviral is managed by local health jurisdictions but controlled by the Department Nevada of Health. Local health providers must make

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals requests for additional antiviral from the local health jurisdictions. The request will be routed from the local health jurisdictions to the state Department of Health which will make the strategic decision about how to distribute SNS antiviral product. http://www.dhhs.state.nh.us/DHHS/DHHS_SITE/h1n1provi The Department of Health & Human Services is ders.htm developing a plan where providers would be http://www.dhhs.state.nh.us/NR/rdonlyres/ewdabke743tr able to request additional antiviral from the xtg2yol5xtiizubitnrexhonlbuwuaxfslncapjtjfwh37kpkf6xeky state SNS through the NHHS. The DHHS looks to e74n5ltgdef6hrpnsh2lxsfe/08.24.09+H1N1+Influenza+Vacci roll out the plan within the next two weeks. ne+HAN.pdf Pre-Registration Form for Providers Interested in Providing Novel H1N1 Vaccine Pre-Registration Form for Providers New Hampshire Interested in Providing Novel H1N1 Vaccine http://njiis.nj.gov/njiis/jsp/registration/h1n1_provider_reg. New Jersey has no formal plan in place for jsp having healthcare providers access the state Provider Registration Form for H1N1 Vaccine System stockpile of the antiviral product. At the moment they are preparing for the release of the H1N1 vaccine and said they would formulate a strategy to allow healthcare providers access to the stockpile once it New Jersey became necessary. http://nmhealth.org/H1N1/provider/H1N1%20Response%2 http://www.health.state.nm.us/H1N1/provider 0by%20Pharmacies8_14_2009-kb.pdf /H1N1%20Response%20by%20Pharmacies8_14 Pre Registration Form _2009-kb.pdf New Mexico Pre-registration for ordering antivirals

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals New York State https://hcsteamwork1.health.state.ny.us/pub/top.html Both the State of New York and NYC have Bureau of Immunization H1N1 Vaccine Request Form for New York State extensive emergency preparedness plans and 518-473-4437 state and city health department officials have [email protected] http://www.nyc.gov/html/doh/html/cir/a03c.html plans and directives for distributing antiviral Provider Registration Form for H1N1 Vaccine for NYC product from the state SNS in the event of an New York City emergency. Citywide Immunization Registry New York 212-676-2323 http://www.ncalhd.org/county.htm North Carolina has a decentralized health system. The state stockpile has been allocated to local health departments. All healthcare providers must go through their local health departments to request additional antiviral product. Each local health department has placed supplies of the antiviral product at pharmacies and physician’s offices within their jurisdictions. If local health providers need to request additional supplies of the antiviral product, they should call their local health North Carolina department. Molly Sanders North Dakota H1N1 Influenza Provider Agreement and http://www.ndpandemicflu.gov/docs/Pan%20Fl 800-472-2180 or Registration Memo u%20Plan%20Summary.pdf 701-328-3386 "The system consists of a receiving process [email protected] North Dakota H1N1 Vaccination Site Registration from the federal government and distribution by the NDDoH to local public health North Dakota H1N1 Vaccine Provider Agreement emergency clinics called points of dispensing North Dakota (PODs). Local public health units have planned

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals The deadline to fill out and submit the for 75 PODs statewide." site registration and provider agreement form is 9/29/2009 http://h1n1vaccine.odh.ohio.gov/Documents/ProviderPreR The State of Ohio Health Department is pre- eg.pdf positioning most of its SNS antiviral cache with Pre Registration Form local county health departments. The Country health departments have their own strategic plans for working with local health providers to provide antiviral product. Any additional request by local healthcare providers for additional antiviral product from the SNS would be made to the local county health department and subsequently to the State Department of Health in the event the local health department Ohio has exhausted its antiviral supply. The Oklahoma State Department of Health (OSDH) is asking The OSDH will activate a full ICS during this for your assistance in identifying clinics or facilities phase (WHO 5 or 6) thereby implementing the interested in providing novel H1N1 vaccine. Clinics or antiviral drug distribution program and the facilities may pre-register at the following link: other countermeasure administration http://osiis.health.ok.gov. procedures from the OSDH Situation Room. Any available assets from the SNS will be requested according to the State’s SNS Plan. Requests OK-HAN - 120 - from hospitals, county health departments or H1N1 Vaccine Pre-registration.pdf governmental agencies for re-supply or additional antiviral drugs will be processed Oklahoma through the OSDH Situation Room. This Plan

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals does not involve Pharmacies. Scott Jeffries For Providers: Who to contact in your community if you are After the appropriate declaration, the Strategic 971-673-0316 interested in providing H1N1 Vaccine National Stockpile resources can be requested [email protected] H1N1 Contact List through the healthcare providers' local health department. This request will be sent to the state. The state will then review the request and move forward on what ever action is then Oregon decided upon http://www.papharmacists.com/PADOHH1N1VaccineRegis http://www.dsf.health.state.pa.us/health/cwp/ tryInformation.pdf view.asp?a=171&q=253193 Registry Letter No information available at this time https://siis.health.state.pa.us/siis/ Fill out brief online registration in the PA-SIIS (above address) and select the H1N1 Online Pre-Registration Request

Pre-Registration has now closed Pennsylvania http://pandemic.health.ri.gov/h1n1/action/register The State of RI DOH has distributed part of the 2009 H1N1 Vaccine Provider Enrollment Form state antiviral stockpile to hospitals, healthcare facilities and free clinics. The DOH is also about 2009 H1N1 Vaccine Provider Enrollment to distribute antivirals to Pharmacies to increase public access to the medication. If is closed hospitals and healthcare facilities exhaust their antiviral supplies, they can call the H1N1 Operations Center at the state DOH and Rhode Island request more medication from the state This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals stockpile. If pharmacies are in need of additional antiviral medication, they would contact the RI State Board of Pharmacy. South Carolina State Director for https://www.scdhec.gov/health/disease/han/docs/10178- https://www.scdhec.gov/health/disease/han/d Immunization DAD-08-03-09-H1N1.pdf ocs/10178-DAD-08-03-09-H1N1.pdf [email protected] Pre Registration Form https://www.scdhec.gov/panflu- Registration form for Antiviral preregistration/ Pre-registration questions related to vaccine call Rebecca Morrison or Susan Smith at (803) 898-0460 or (800) 277- 4687

South Carolina Pre-Registration Process is Closed Tim Heath http://doh.sd.gov/H1N1/default.aspx http://doh.sd.gov/H1N1/default.aspx 605-773-5323 No information available at this time No information available at this time [email protected]

South Dakota https://twis.tn.gov/twisprod/Register/registration.asp The State of Tennessee Department of Health is http://health.state.tn.us/twis/ in the process of developing the procedures Registration Information Page and Access to online form and processes for ordering antiviral medication from the SNS. The plan is in the contract phase Pre-Registration Process is Closed and once everything is set, there will be a general call to all healthcare providers in the state to receive antiviral medications. This plan will use a distinct registry that is different from the vaccine registration system. The Tennessee Tennessee Pharmacist Association and Department of This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals Health will work together to ensure that antivirals get to as many parts of the state as possible. The information will made available to all healthcare providers through direct solicitation as well as on the website once it is finalized. The TN DOH is hoping that the system and plan will be ready to roll out in the next month. https://vaccineregistration.questionpro.com/ http://www.dshs.state.tx.us/swineflu/ Registration form DEADLINE 9/11/09 Draft Contract for Draft Contract for Chain Pharmacy Retailers.doc Independent Pharmacy Retailers.doc

TexasAntiviralDistrib utionNetworkToolKit_ac.pdf Texas Linda Abel http://health.utah.gov/epi/h1n1flu/groups/vaccine_provid Dispensing to the general public will only be 801-538-9450 er.html performed if treatment facilities are [email protected] 2009 Pandemic Influenza A (H1N1) overwhelmed by need. Local health Vaccine Provider Training, Registration Information departments will be responsible for establishment of emergency points of dispensing or protocols for dispensing to those in need that are not able to receive medicines from treatment facilities or physicians. Use and allocation of local health jurisdiction allotments Utah will be determined by the local health officers

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals or tribal leadership for their respective jurisdictions. http://healthvermont.gov/panflu/hcprovider.aspx http://healthvermont.gov/panflu/documents/0 No information available at this time 706PandemicFluPlan.pdf "As with distributing vaccine, if VDH obtains and distributes antiviral medications from the SNS the department will activate its SNS Plan Vermont and its Clinic Plan." http://www.vdh.virginia.gov/epidemiology/Immunization/ http://www.vdh.state.va.us/news/Alerts/Swine h1n1reg.htm Flu/ProviderResources.htm http://spreadsheets.google.com/viewform?formkey=dHZra No information available at this time 0ZGRGIzdFV3STZfa214QUdydXc6MA Virginia Pre Registration Forms Fill out the pre-registration checklist and form online. http://www.doh.wa.gov/swineflu/ The federal government is planning to provide H1N1 (swine No information available at this time flu) vaccine to the Washington State Department of Health for Washington residents who wish to be voluntarily vaccinated. The department, working with local health jurisdictions, is pre-registering licensed health care providers interested in providing H1N1 vaccine. For questions about pre-registration, please contact your local health jurisdiction.

Pre-Registration Process is Closed Washington http://www.wvidep.org/Portals/31/PDFs/IDEP/healthalerts www.wvdhhr.org/healthprep/common/Public_ West Virginia /WV%20HAN%20Advisory%200024-09-03- Health_Preparedness_WV_Overview_4_07.pps This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals 09%20H1N1%20Vaccine%20Pre%20Registration.pdf Local Health Departments are responsible for Does not specifically mention pharmacists, but includes dispensing to the public; hospitals are “other” responsible for their own staff and patients. Complete by 9/15/09 if possible [email protected] http://pandemic.wisconsin.gov/category.asp?linkcatid=314 http://pandemic.wisconsin.gov/docview.asp?d 7&linkid=903&locid=106 ocid=16724&locid=106 This site has a link to the Stockpile Ordering Wisconsin Pre-Registration Process is Closed Form: Pharmaceuticals. Immunization Section http://www.health.wyo.gov/DynamicForm.aspx?DynamicF The State of Wyoming distributed their SNS 307-777-7952 ormId=12 cache this past spring to county health Deadline for Submission August 31, 2009 departments and from there the county health departments disbursed the antiviral product to local providers. Local providers would request additional antiviral product through their local Wyoming county health department. American Samoa Federated States of Micronesia Guam Marshall Island Northern Mariana Islands Palau

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09

State Contact Person H1N1 Vaccine Antivirals Puerto Rico US Virgin Islands

This information compiled jointly by the National Alliance of State Pharmacy Associations and Rx Response Last Updated: 11/03/09