Pharma-Vac Form

New expressions of interest

We are currently ONLY accepting expressions of interest from pharmacy contractors who wish to become community pharmacy Local Vaccination Service sites in specific localities where all pharmacies have been contacted by their NHS England and NHS Improvement regional team. Applications from other areas will not be reviewed.

Previous expressions of interest (Section 2)

Contractors who submitted an expression of interest in February had a choice whether to complete section 2 if they were not in a priority area. If you have been contacted by your regional team with a request to submit Section 2 information then you should complete the form HERE. You will need to use the Entry ID given to you by the person who requested that you complete the form.

All fields with a * are mandatory.
Please use the ‘Save and Continue Later’ feature available at the end of the form to save your application so far and return later.
If you wish to upload additional information in support of your application, please note that permitted file types are PDF, Word and Excel.

Step 1 of 4

Section 1
Lead contact
Name*
Preferred e-mail*
Enter Email Confirm Email
Telephone number*
About your pharmacy
Name of pharmacy*
Pharmacy telephone number*
Pharmacy premises ODS code*
Pharmacy premises GPhC number*
Name of Pharmacy Superintendent*
GPhC number of Pharmacy Superintendent*
About the vaccination service premises
Is your proposed vaccination site on the pharmacy registered premises?*
- Yes
- No
Sites will require approval from NHS England, who may on occasion suggest an alternative site based on rental costs, suitability, access etc.
Do you have access to this site already?*
- Yes
- No
Name of site*

This would usually be the pharmacy name if on the registered premises. Use location to differentiate between branches i.e. A Pharmacy - Formby,
Or the site name with pharmacy name in brackets i.e. St Michaels Church Hall (A Pharmacy) if not on the pharmacy premises.
Address*
Address Line 1 Address Line 2 Address Line 3 City ZIP / Postal Code
Indicative number of vaccinations per week from this site*
How many vaccines could safely be administered bearing in mind social distancing, access and other footfall. Please note the preferences for particular volumes stated HERE
Will you be able to provide this service without impacting usual pharmaceutical services?*
- Yes
- No
The regional team is able to give contractors permission to extend opening hours on registered premises so as to reduce the impact on usual pharmaceutical provision if necessary.
Have you read, and are confident that you can meet the requirements in the LES?*
- Yes
- No

Save and Continue Later

Site set-up information
If you know the answer to this information then you may wish to provide it now. It will help us to prepare if your expression of interest is successful, but it will not be used in the assessment process.
Name of registrant who will receive the vaccine
Professional registration number for registrant who will receive the vaccine
IT Administrator Name
First Last
IT administrator personal NHSmail address
This must not be a shared mailbox
Enter Email Confirm Email
Is the IT administrator a registrant?
Would you like to give us additional contact details?
- Yes - Vaccine
- Yes - IT
- Not at this point
If yes - Name of second registrant who will receive the vaccine
If yes - Professional registration number for second registrant who will receive the vaccine
If yes - IT Administrator 2 name
First Last
If yes - IT administrator 2 personal NHSmail address
Enter Email Confirm Email

This must not be a shared mailbox
If Yes - Is the IT administrator 2 a registrant?
Please only submit an expression of interest if your proposed site would be in a location listed on page 1. Submissions for sites in other areas will not be reviewed.
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Save and Continue Later

Call for Pharmacy-led Local Vaccination Service expressions of interest

Step 1 of 4

General Location

Please only submit an expression of interest if you have been contacted by your regional team. Submissions for sites in other areas will not be reviewed.

Section 1

Lead contact

About your pharmacy

About the vaccination service premises

Section2

Please only submit an expression of interest if your proposed site would be in a location listed on page 1. Submissions for sites in other areas will not be reviewed.

Supporting information for assessment of your application

Site set-up information

Please only submit an expression of interest if your proposed site would be in a location listed on page 1. Submissions for sites in other areas will not be reviewed.