Rules to receive the
COVID Vaccine Location: 100 East Main St Lititz PA 17543
THIS FORM IS ONLY FOR MODERNA AGES 3-5 YEAR OLDS. While Vaccine is approved for 6 months to 4 years old, we can only administer vaccines to ages 3-4 year olds at the pharmacy.
UPDATE (6-18-2022): FDA Authorizes & CDC/ACIP expands eligibility for COVID-19 vaccines to infants and children 6 months and older
Added guidance for a two dose primary series of the Moderna pediatric COVID-19 vaccine (25-microgram each dose) for infants and children 6 months through 5 years of age (two doses separated by 28 days).
CDC will consider use of the Moderna COVID-19 vaccine in children 6 – 17 years old at its June 21-23, 2022, meeting.
- Once you hit “Submit” you will be prompted to print a form and bring the form with you to your appointment. The form will be emailed to you at the email address you provided and can be printed from your email later, if desired. It is very important that you bring this form with you to the event as it is required for vaccination.
- There will be a PDF that will be provided on the "Thank You" email please PRINT and provide this to the intake team.
- We ask that Only one parent per child should be present inside the facility
- Please arrive no earlier than 5 minutes prior to your appointment time. This is to avoid proper workflow and improve efficiency
- Please bring ID of the parent the child is with along with all medical insurance information.
- Please reframe from calling the pharmacy as we are inundated with questions. If you can email your questions to info@Lititzrx.com we will get back to you.
- Dress appropriately for the vaccine in order to allow your upper arm to be easily accessed.
We need your cooperation in order to successfully administer Covid-19 vaccines to as many people as possible. Non-compliance to the above instructions significantly affects our ability to work efficiently.