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Department of Health

CDC Supplemental COVID-19 Vaccine Redistribution Agreement

Introduction

CDC Supplemental COVID-19 Vaccine Redistribution Agreement U.S. Department Health Centers Control

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The Centers for Disease Control and Prevention (CDC) plans to ship a minimum order size of COVID-19 vaccine, constituent products, and ancillary supplies at no cost directly to enrolled COVID-19 vaccination providers throughout the United States. The federally contracted vaccine distributor uses validated shipping procedures to maintain the vaccine cold chain and minimize the likelihood of vaccine loss or damage during shipment. There may be circumstances where COVID-19 vaccine needs to be redistributed beyond the identified primary CDC ship-to sites (i.e., for orders smaller than the minimum order size or for large organizations whose vaccine is shipped to a central depot and requires redistribution to additional clinic locations). In these instances, vaccination provider organizations/facilities, third-party vendors, and other vaccination providers may be allowed to redistribute vaccine, if approved by the jurisdiction’s immunization program and if validated cold chain procedures are in place in accordance with the manufacturer's instructions and CDC’s guidance on COVID-19 vaccine storage and handling. There must be a signed CDC Supplemental COVID-19 Vaccine Redistribution Agreement for the facility/organization conducting redistribution and a fully completed CDC COVID-19 Vaccination Provider Profile Information form (Section B of the CDC COVID-19 Vaccination Program Provider Agreement) for each receiving vaccination location.

Based on information to date from the manufacturer, for the Pfizer-BioNTech COVID-19 Vaccine, immunization planners should consider the following:

o Jurisdictions should only start the redistribution process for product that will be used as soon as it arrives at the new location. You should not redistribute product to a new location for long term storage.

o Move only the amount of vaccine that is needed at the satellite locations/clinics.

o Once a vaccine vial has been removed from the tray, the thawing process has begun. The vial cannot be returned to the thermal shipping container or to an ultra-cold freezer.

o Vaccine, after thawing, is viable for up to 31 days at 2°C - 8 °C. Any number of hours (maximum 12 hr.) used for transporting a refrigerated vaccine counts against the 31 days limit.

o Individual vials of Pfizer vaccine can be transported at refrigerated temperatures of 2° C to 8° C or at a frozen temperature ranging from -25°C to -15°C. Ultra-cold shipper or an ultra-cold portable freezer at -90°C to -60°C or frozen temperatures of - 25° C to -15° C may be used to transport a full tray of Pfizer vaccine.

o If needed, ultra-frozen vaccine may be transported in its original shipping container with dry ice or in a portable ultra-cold freezer that can maintain a temperature of -80º C, however, only full trays of vaccine can be redistributed using this method in order to reduce the likelihood of damaging the vaccine vials in transit.

The parties to this agreement are CDC and healthcare organizations, third-party vendors, and vaccination providers that redistribute COVID-19 vaccine. CDC cannot reimburse costs of redistribution beyond the initial designated primary CDC ship-to site(s), or for purchase of any vaccine-specific refrigerators or qualified containers. Therefore, organizations planning for redistribution of COVID-19 vaccine must carefully assess the associated risks and costs (e.g., vaccine loss due to temperature excursions, purchase of vaccine-specific portable refrigerators and/or containers) before planning this activity.

Required fields are marked with an asterisk.(*)

Organization Information

Organization/Facility Name:

Primary Address and Contact Information of COVID-19 Vaccination Organization

Street Address 1:

Street Address 2:

City:

County:

State:

Zip Code:

Telephone Number (XXX-XXX-XXXX):

Fax Number (XXX-XXX-XXXX):

Responsible Officers

Medical Director (or Equivalent) Information

Last Name:

First Name:

Middle Initial:

Title:

Licensure State:

Licensure Number:

Telephone Number (XXX-XXX-XXXX):

Email:

Street Address 1:

Street Address 2:

City:

County:

State:

Zip Code:

Chief Executive Officer (or Chief Fiduciary) Information

Last Name:

First Name:

Middle Initial:

Telephone Number (XXX-XXX-XXXX):

Email Address:

Street Address 1:

Street Address 2:

City:

County:

State:

Zip Code:

Shipping Site:

Facility Name:

Street Address 1:

Street Address 2:

City:

County:

State:

Zip Code:

Primary Contact:

Last Name:

First Name:

Middle Initial:

Telephone Number (XXX-XXX-XXXX):

Email Address:

Receiving Site:

Facility Name:

Street Address 1:

Street Address 2:

City:

County:

State:

Zip Code:

Primary Contact:

Last Name:

First Name:

Middle Initial:

Telephone Number (XXX-XXX-XXXX):

Email Address:

PA DOH Supplemental information

Redistribution Justification:

Allow a minimum of seven days for approval of the redistribution request.

Date when distribution will occur (MM/DD/YYYY):

Number of doses to be redistributed:

Why does the vaccine need to be redistributed?

Can the vaccine be administered and comply with cold chain requirements i.e. number of days before the vaccine will be administered, type of storage unit the vaccine will be transferred to?

Check if applicable:

If yes, please explain.

Receiving site will provide PADOH with the cold chain history to ensure the efficacy of the vaccine has not been compromised and agree to proper packing and temp monitoring during the transport process, date of redistribution, receiving date, lot numbers, and the transferring and receiving sites will be required to adjust their vaccine inventory to reflect the vaccine transfer.

Check for confirmation:

ELECTRONIC SIGNATURE:

Under penalty of perjury I certify that I am the person accessing this web page and submitting this form. By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be prosecuted if I provide false or misleading information.

I agree to submit this complaint by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

I certify the above information is true and correct and that by entering my name I certify that I am the person submitting the information.

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