Vaccine Order Form

Order Monday – Pick up Thursday or Friday of the same week - Transportation cooler must be between 2-8°C Please submit (with this order) a copy of your temperature log book since your last order. You may provide a scan or photo of your log book using the link at the bottom of the page. Any temperature outside of 2 - 8°C MUST be reported immediately - 625-5900 or toll-free 1-888-294-6630

Hepatitis A

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High risk patients only. 1 dose/pkg

Hepatitis B

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High risk patients only. 1 dose/pkg

Hib

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Haemophilus influenza type b Vaccine. 1 dose/pkg

HPV4

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Gardasil 4 Human Papillomavirus vaccine. Eligible for MSM 26 yrs or younger previously immunized with HPV4. 1 dose/pkg

HPV9

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Gardasil 9 Human Papillomavirus vaccine. Eligible for MSM 26 yrs or younger with no previous HPV immunization. 1 dose/pkg

IPV

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Polio vaccine. 1 dose/pkg

MMR

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Measles, Mumps, Rubella vaccine, live, attenuated. 10 doses/pkg

MMRV

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Measles, Mumps, Rubella, Varicella vaccine, live, attenuated. 10 doses/pkg

Men-C-C (Menjugate)

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Meningococcal group C conjugate vaccine. 10 doses/pkg

Pneu-C-13

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Pneumococcal 13- valent conjugate vaccine. 10 doses/pkg

Pneu-P-23

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Pneumococcal polysaccharide vaccine. 10 doses/pkg

Rotarix

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Rotavirus, live, attenuated vaccine ORAL. 10 doses/pkg

Td

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Tetanus & diphtheria toxoids adsorbed. 5 doses/pkg

Tdap

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Tetanus & diphtheria toxoids combined with Acellular pertussis vaccine. 5 doses/pkg

Tdap-IPV 4-6 year booster

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Tetanus toxoid, reduced diphtheria toxoid & Acellular pertussis vaccine adsorbed combined with inactivated Poliomyelitis vaccine. 10 doses/pkg.

Tuberculin (Manitoux)

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Tuberculin purified protein derivative (5TU); Date when opened. TB skin testing solution. 10 doses/pkg

Varicella

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Varicella vaccine. 10 doses/pkg

Zoster Vaccine

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Herpes Zoster vaccine. Eligible for 65-70 yrs. 1 dose/pkg

Menactra Quadrivalent Conjugate Meningococcal 0.5 mL IM

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Females and Males in Grade 7 - one dose series
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