*Company Name
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Type
See definitions below to select the type that best describes your company or use Other and describe what you do.
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Agriculture
Food processing facilities
Food production
Food retail (grocery)
Manufacturing
Other, please describe
*Describe type not in the list
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Agriculture: Agriculture comprises establishments or individuals primarily engaged in, or in support of, growing crops, raising animals, harvesting timber, and harvesting fish and other animals from a farm, ranch, or their natural habitats. Food processing facilities: Workers, including migrant and seasonal workers, who work in meatpacking facilities and other food-processing plants. Food production: Food production includes food distributors, food banks, migrant farm workers, and other food supply chain support. Food retail (grocery): Food retail includes workers in grocery stores, convenience stores, food shelves, farmers markets, and other specialty food stores like bakeries, meat, seafood, and produce markets. Manufacturing: Workers manufacturing food and beverages, textiles and apparel, leather products, wood and paper products, printing, petroleum products, chemicals, plastic and rubber products, metallic and nonmetallic mineral products, fabricated metals, machinery, computers, electrical equipment, transportation equipment, furniture, and other miscellaneous manufacturing.
*First Name
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*Last Name
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*Email
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*Confirm email
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*
Warning: Emails don't match
*Phone
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*How many facility locations do you have with employees who need vaccination? (If you have more than 10 facilities, please just enter data about 10 of them)
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Facility 1
Name, address, city, zip
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*
Facility 2
Name, address, city, zip
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*
Facility 3
Name, address, city, zip
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*
Facility 4
Name, address, city, zip
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*
Facility 5
Name, address, city, zip
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*
Facility 6
Name, address, city, zip
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*
Facility 7
Name, address, city, zip
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*
Facility 8
Name, address, city, zip
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*
Facility 9
Name, address, city, zip
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*
Facility 10
Name, address, city, zip
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*How many employees do you have who want to be vaccinated? (Total, including all of your locations)
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*Has your company already made arrangements with a vaccine provider to get your employees vaccinated?
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Yes
No
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What is the name of the provider who will be doing the vaccinations?
MDH will use this information to confirm this partner is fully registered as a COVID-19 vaccine provider and so we know where to send vaccine doses when doses are available and your employees are eligible to be vaccinated.
* must provide value
A&E Pharmacy Avera Long Term Care Pharmacy Beltrami County Public Health Benton County Public Health Bluestone Physician Services Brown County Public Health Carlton County Public Health Carris Health LLC - Rice Memorial Casey Drug Centracare Health System - Long Prairie CentraCare Melrose Care Center CentraCare Monticello Care Center CentraCare Paynesville Care Center CentraCare Sauk Centre Care Center Chisago County Public Health Clay County Public health Coborn's Countryside Public Health Cuyuna Regional Medical Center CVS Dodge County Public Health Essentia Health Fosston Eventide Falk's Nursing Service Pharmacy Fillmore County Public Health Geritom Goodrich Pharmacy Guardian Pharmacy Hennepin Healthcare Horizon Public Health Hy-Vee Pharmacy Itasca County Public Health Kanabec County Community Health Kandiyohi County Public Health Keaveny Drug Kittson Memorial Hospital Assn. Koochiching County Public Health Le Sueur County Public Health Lewis Family Drug Lifecare Public Health M Health Fairview (Fairview LTC Pharmacy) Mayo Clinic Rochester Meeker County Public Health Mille Lacs County Public Health MN Dept of Veteran Homes Pharmacy Nord's Pharmacy Norman-Mahnomen Public Health North Shore Health Center Otter Tail County Public Health Perham Health Pine County Public Health Polaris Pharmacy Services Ramsey County Public Health/Open Cities/MINI (M Health)/PresbyHomes Strike Team Renville County Public Health Rice County Public Health Sherburne County Public Health Southwest Health and Human Services St. Benedicts Senior Community St. Joseph's Community Health Steele County Public Health Sterling Drug The Cook Hospital Thrifty White Todd County Health & Human Services Wadena County Public Health Walgreens Watertown Pharmacy Winona Health Services Other, please describe
*Name of vaccinator not on the list
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*Street Address
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*City
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*Zip Code
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*Contact Name, first and last
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Full name
*Contact Email
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*Contact Phone
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*The Department of Health will call or email you to discuss what options may be feasible for your company.
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