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1|Page Thank you for your consideration to enroll or re-enroll to receive state supplied vaccine from the Alaska Immunization Program in[removed]Providers are required to submit both the VacTrAK Provider Application and t
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Document Date: 2014-03-19 17:55:13


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Facility

Facility Address / Facility Comments / Facility Type / Facility Name / /

MedicalCondition

zoster / /

MedicalTreatment

Immunization / immunizations / /

Organization

Federally Qualified Health Center / /

Person

DO / /

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Position

Governor / Vaccine Coordinator / Lot Number Manager / The Vaccine Coordinator / /

Technology

PDF / /

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