Select a time for your vaccine appointment.
Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you have Medicare Part B? (This is your red, white and blue Medicare Card.)
*
Yes
No
Please enter your Medicare Number:
*
Choose your vaccine(s):
*
Flu Vaccine (6-64 years) $30
Pediatric COVID Vaccine (6-11 years) $140
COVID Vaccine (12+) $170
Other
Choose your vaccine(s):
*
Flu Vaccine (No charge for Medicare Part B)
COVID Vaccine (No charge for Medicare Part B)
Total
Book your appointment
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