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2022-159
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2022-159
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Last modified
8/30/2022 3:13:46 PM
Creation date
8/30/2022 3:00:44 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Memorandum of Understanding
Approved Date
08/16/2022
Control Number
2022-159
Agenda Item Number
15.A.3.
Entity Name
Florida Dept. of Health, Indian River Health Dept. &
Indian River County Emergency Services District
Subject
Memorandum of Agreement to Provide Routine Immunization Services
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ATTACHMENT II <br />Florida Department of Health in Indian River County <br />Immunization Schedule <br />Vaccine Name <br />Description <br />CPT <br />ICD10 <br />FEE <br />Code <br />Havrix / Vagta <br />Hepatitis A vaccine, adult dosage, intramuscular use <br />90632 <br />Z23 <br />$57.73 <br />Engerix-B / <br />Hepatitis B vaccine, adult dosage, intramuscular use <br />90746 <br />Z23 <br />$60.92 <br />Recombivax <br />HB <br />Twinrix <br />Hepatitis A and B vaccine, adult dosage, intramuscular <br />90636 <br />Z23 <br />$99.22 <br />use <br />Adacel (TDAP) <br />Tetanus, Diphtheria Toxoids and Acellular Pertussis <br />90715 <br />Z23 <br />$58.33 <br />vaccine <br />Pfizer- <br />COVID -19 vaccine, adult dosage, intramuscular <br />91300 <br />Z23 <br />$0.00 <br />BioNTech <br />Moderna <br />COVID-19 vaccine, Adult dosage, intramuscular 1 <br />91301 <br />Z23 <br />$0.00 <br />*Vaccines may be from a variety of manufacturers depending on availability <br />Disclaimer: Immunization fees are set at cost. Price may vary if pharmaceutical fees change. <br />
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