CDC COVID-19 Vaccine Card Replacement - Skippack Pharmacy

  • CDC COVID-19 Vaccine Replacement Card Request

     

    We appreciate you choosing Skippack Pharmacy to receive your COVID-19 vaccine and look forward to continue serving you.  Use this form if you would like to request the CDC COVID-19 vaccine card mailed to you.  The CDC COVID-19 vaccine card is provided at no charge; however, the patient is responsible for shipping/processing costs based on how soon you need the card.

    Skippack Pharmacy can only send you a CDC card with the vaccine you received through our pharmacy or clinic.  You may reach out to any other provider to get the information for your card for other doses.  I.e. if you received your 1st dose through Skippack Pharmacy, 2nd dose through another provider - your replacement card will only have the information relevant to the dose we have administered.

    If you are scheduled to received or scheduling your 2nd dose or booster dose through Skippack Pharmacy, you do not need to fill out this form.  We will provide a free replacement card in person when you check-in for your vaccine.  If you live near the pharmacy, you can also walk into the pharmacy Monday-Friday 11AM-5PM and request a replacement card in person.  If you need the card any sooner, you can continue with the steps herein.


    Please click NEXT to get started.

  • PATIENT INFORMATION

  •  - -
  • Format: (000) 000-0000.

  • Information about the vaccine(s) and date(s) of your vaccine(s).

    • Consent & acknowledgments 
    • Clear
    •  - -

  • Payment

    The cost of the replacement CDC COVID-19 Vaccine Card is free; however, the fee below is for the cost of shipping and processing. It will take our team 1 business day to process the request and create the CDC replacement card and then the respective shipping speeds below for the card to get to you.
  • prevnext( X )
              VERY URGENT - 1 Day ** PLEASE TEXT THE PHARMACY AFTER COMPLETING THIS, 267-766-0076 **

              Priority Mail Express with Tracking

              $32.00
                
              URGENT - 1 to 3 Days ** PLEASE TEXT THE PHARMACY AFTER COMPLETING THIS, 267-766-0076 **

              Priority Mail with Tracking

              $15.00
                
              FIRST CLASS - 3 to 7 Days ** PLEASE TEXT THE PHARMACY AFTER COMPLETING THIS, 267-766-0076 **

              First Class

              $8.00
                
              NOT URGENT - 7 to 10 Days ** PLEASE TEXT THE PHARMACY AFTER COMPLETING THIS, 267-766-0076 **

              First Class

              $5.00
                
              CDC Plastic Cardholder

              Select if you'd like us to include a CDC Plastic Cardholder with your shipment.

              $1.00
                
              Total
              $0.00

              Credit Card

            • PLEASE CLICK THE SUBMIT BUTTON TO SUBMIT & GET A CONFIRMATION. IF YOU DO NOT SEE A GREEN CHECKMARK ON THE NEXT PAGE OR GET AN ERROR, YOUR SUBMISSION DID NOT GO THROUGH & WE DID NOT RECEIVE YOUR SUBMISSION. ON A RARE OCCASSION, YOU MAY SUBMIT THIS, GET A CHECK MARK, AND A CHARGE WON'T PROCESS ON YOUR CREDIT CARD. IN THAT CASE, WE WILL CALL YOU TO ASK YOU FOR YOUR CREDIT CARD INFORMATION OVER THE PHONE.

            • Should be Empty: