Vaccines for Children (VFC) Program Supply Order Form

The VFC Program provides supplies at no cost to VFC-enrolled clinics. Once your order is processed, the VFC Program will mail your supplies directly to your clinic.

For assistance, you can contact the VFC Program at 303-692-2650 or via email at cdphe_VFC@state.co.us.

Additionally, you can visit the VFC web page at www.coloradovfc.com for more forms and resources.

Date * +

VFC PIN *

Clinic Name *

Contact Name *

Contact Direct Number *

Contact's Email Address *

Clinic Mailing address *

City *

Zip Code *

Refrigerator, Freezer, and Breaker Box Tags

Label your Refrigerator, Freezer, and Breaker Box.
Enter the quantity needed in the blank box located to the right of the image.

	Yellow Refrigerator/Freezer Tags "Do Not Unplug" English/Spanish, Heavy card to attach above wall plug.
	Pink Breaker Box Warning Stickers to affix to the breaker box, 4"x2".
	Orange Backup Battery "Do Not Unplug" Warning Tags to affix to backup battery power source. Comes with a zip tie.

Funding Source Labels

Label your vaccine boxes with the appropriate funding source labels.
Enter the quantity needed in the blank box located to the right of the image.

	VFC Sticker Rolls (250 stickers per roll, limit 3 per order). These are orange "dot" stickers, 1 inch in diameter, intended to label VFC vaccine boxes.
	317 Sticker Rolls (250 stickers per roll, limit 1 per order). These are green "dot" stickers, 1 inch in diameter, intended to label 317 vaccine boxes. *Only for LPHAs, FQHCs, RHCs, and IHS
	State Sticker Rolls (250 stickers per roll, limit 1 per order). These are blue "dot" stickers, 1 inch in diameter, intended to label State vaccine boxes. *Only for LPHAs, FQHCs, RHCs, and IHS

Data Logger and Supplies

VFC 800-Wifi Data Loggers
Enter the quantity needed in the blank box located to the right of the image.

VFC 800-WiFi Single Channel Data Logger
VFC 800-WiFi Dual Channel Data Logger

*Please note this data logger requires connection to WiFi and a power outlet. Each DDL will come with a 2 year cloud subscription to LogTag Online. A VFC team member will be in touch after shipping to assist with WiFi data logger setup. Wall bracket and glycol bottle(s) are included.

	VFC 800-WiFi Single Channel Data Logger (Stand Alone Fridge/Freezer Units)
	VFC 800-WiFi Dual Channel Data Logger (Combo Storage Units)

Only answer the questions below if ordering a data logger

Is your current data logger(s) expired?

Yes

Are you requesting a data logger for a new storage unit?

Yes

Vaccine Storage Guidelines: Magnets and Static Clings

Attach a vaccine storage guideline magnet or static cling to your storage unit. *Check whether you are ordering magnets or static clings.

Static clings adhere well to surfaces such as glass, stainless steel, wood, painted walls, mirrors, cloth, monitors, and aluminum.

Enter the quantity needed in the blank box located to the right of the image.

	REFRIGERATOR Vaccine Storage Guideline Magnets
	REFRIGERATOR Vaccine Storage Guideline Static Cling
	FREEZER Vaccine Storage Guideline Magnets
	FREEZER Vaccine Storage Guideline Static Cling