https://www.phcdocs.org/Programs/CalVaxGrant
Qualifications:
As California continues its efforts to vaccinate all eligible residents against COVID-19, the state is offering providers up to $55,000 to support vaccination efforts. To be eligible for the CalVaxGrant, organizations must:
- Be one of the following types of medical provider (routine or non-routine vaccinator):
- Medical practice* with no more than 200 physicians
- *Medical group/private practice, Federally Qualified Health Centers (FQHC), Rural Health Clinic (RHC), community health center, migrant or refugee health center, STD/HIV clinic health center, tribal health center, Indian Health Service (IHS) or urgent care
- Independent pharmacy organization
- Student vaccine clinic, which includes student health centers, university health centers and K-12 schools
- Medical practice* with no more than 200 physicians
- Be enrolled in myCAvax
- Need help with the myCAVax application? Email [email protected] for one-on-one application support
- Expend or plan to expend award on allowable expenses, which includes staffing and training (most common expenses), technology, infrastructure, supplies/equipment and administrative overhead
- Have not received money from the State Innovation Fund
Application checklist follows-looks doable and says funding is for efforts between 11/1 21-11/1/22.
Application Checklist Ready to apply? This list will help you gather the necessary information and documents to apply for CalVaxGrant, California’s physician practice vaccine support grants program.
ALL APPLICANTS NEED:
Completed section A of the myCAvax application
NOTE: Applicants only need to complete Section A to start their CalVaxGrant application, which can be submitted after they’ve completed Section B
Completed Standard (STD) 204 Form
Section 1 – Payee Information
Confirm the name, mailing address and organization email
Section 2 – Entity Type
Review the options that best represent your organization, and select from the drop-down menu
Section 3 – Tax Identification Number
Depending on what you selected for the “entity type” in section 2, please provide a Federal Employer Identification Number (FEIN) or Social Security Number (SSN)/ Individual Tax Identification Number (ITIN) FEIN is required for tax purposes and will be within your application file
Section 4 – Payee Residency Status
Please review the payee residency information to decide on your organization’s residency status. The applicant will select either “California Resident” or “California Nonresident” based on the information provided on the STD 204 form.
Section 5 – Certification
STD 204 Form: Please confirm that all information is correct in Sections 1-4. The authorized individual will then certify the STD 204 form by providing their name, title, email, and phone number. To electronically sign the STD 204 form, use your cursor and hold down the left mouse key to draw a signature. Press the save button below the signature box to move onto the next document. Once the signature is complete, please select “Save” then hit “Next” to move onto the awardee agreement.
myCAvax registered physician organization and site information
Organization legal name
Address
Primary email
Impact statement of 250 words or less on how the organization intends to use these grant funds to increase COVID-19 vaccine access
One of the responsible parties to provide contact information and e-sign the Awardee Agreement and STD 204 form.
Responsible parties include the Chief Medical Officer (CMO), Chief Executive Officer (CEO) or equivalents)
Contact information includes: name, title, phone, email and mailing address
NEXT STEPS POST-SUBMISSION:
Completed allowable cost document showing an estimate on how the organization intends to spend or plans to spend the funds between November 1, 2020, and November 1, 2021
Staffing: Personnel directly involved in acquiring or administering the COVID-19 vaccine
Training: Training and development
Technology: IT upgrades, electronic health record (EHR) modifications, etc.
Infrastructure: Developing policies and procedures, managing medical equipment, building modifications, etc.
Supplies and Equipment: To store, handle and administer
Administrative Overhead: Expenditures for general items that support the operational needs of the organization in administering and supplying the COVID-19 vaccine
