Thank you for taking the time to fill out this short request form to indicate your interest in receiving flu vaccine from AmeriCares.
A few important reminders:
•AmeriCares-donated products must be dispensed for free to eligible patients. Eligible patients are individuals who are under 200% of the Federal Poverty Level and uninsured or underinsured.
•After submitting your request, you must set up an AmeriCares account in order to become an approved partner and receive this donation. You can do this at http://usaccess.americares.org. (If you are already an approved partner, you do not need to do anything after submitting your request.)
•As soon as your request is submitted and your account is approved, we will send your request to our donor for immediate shipment to you.
•There is no cost involved with partnership and all product orders are shipped at no cost to your facility.