New Provider Enrollment

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If you are a new provider enrolling in the pediatric Connecticut Vaccine Program (CVP), please fill out the New Provider Enrollment Form and e-mail to In addition, please complete the online Application for Electronic Reporting to CT WiZ (HL7/UI). Once we receive this form, a member of our staff will review the information and contact you. In order to be an approved CVP provider, you must receive a new enrollment visit by a DPH staff member. This visit will review the following:


  • All requirements of the program per CDC and the State of Connecticut (Blue Folder)
  • All storage units that will store CVP vaccines: Refrigerator(s) and Freezer(s)
  • A data logger in each unit as well as a backup data logger.
  • At least 72 hours of stable temperatures. If this is not available at the time of the visit, temperature logs will be required to be sent to DPH before approval of clinic.

If you are a new provider enrolling in the Connecticut Vaccine for Adults (CVFA) Program, please complete the Adult New provider Enrollment Form. Once approved, clinics can request access to CT WiZ and complete the enrollment process. A DPH staff member will contact you for CT WiZ training. The CVFA provides certain adult vaccinations at no cost to healthcare providers for uninsured adults ages 19 years and olderVaccines purchased and administered through this program are funded using limited federal 317 funds.


PLEASE NOTE: Influenza vaccines are not available through the CVFA program. Local Health Departments can access the state of Connecticut Department of Administrative Services (DAS) influenza vaccine contract here.


If you were invited to join the Bridge Access Program, which will provide free COVID-19 vaccines for uninsured adults for a limited time, please complete the adult new provider enrollment form above.


Supporting Documentation


Enrollment and Re-Enrollment