JYNNEOS Transfer Request

JYNNEOS Transfer Request

For providers enrolled in the Mpox Vaccine Program: CDC has released the Mpox Vaccination Program Provider Agreement located here.

Providers administering JYNNEOS are required to follow all conditions outlined in the agreement, with use of the vaccine, the provider and provider’s organization will be deemed to have agreed to comply with these requirements.

What is today's date?*

Has your site previously completed this NC DHHS Mpox Vaccine Enrollment and Capacity Survey?

Yes

Parent Organization

Contact Name*

Contact Phone Number*

Contact Email*

Please select your county from the dropdown list.*

Please select your county from the dropdown list.

Select or enter value

JYNNEOS Requested Vials (Next two weeks)*

Please request vials needed for the next two week period.

JYNNEOS Doses on hand.*

How many doses of JYNNEOS do you currently have on hand?

What type of vaccine do you need?*

SNS National Stockpile JYNNEOS State-Issued Vaccine- Expiring August 2026.

317-Funded JYNNEOS Vaccine- I am a part of the 317 Vaccine Program. Expiring 2026. (There is a current waitlist for this vaccine.)

Notes?

Transporting JYNNEOS*

Can you assist with transporting the vaccine to your location? Vaccine Transportation Guidelines

Yes

Confirmation of understanding.*

By clicking this box, I understand that we must have vaccine administrations recorded into the North Carolina Immunization Registry (NCIR) within 24 hours of administration. On behalf of the Parent Organization, I certify that we will act in good faith and to the best of our abilities to comply with all expectations.

Send me a copy of my responses

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