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FY 12 -13 Proposed Vaccine Fees <br />Support Staff <br />Vaccine Cost Supply Cost Time <br />Item Description Per dose Per Item per 15 min <br />25x1 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />MMR <br />25x5/8 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Rotateq Oral Rotavirus <br />No needle used <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Varivax Chickenpox <br />25x5/8 Integra Needle w /syringe <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Engerix -B Hep B Adult <br />25x1 Safety Glide Needle <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />Prevnar 13 Pneumoccocal <br />25x1 Safety Glide Needle <br />Jr. Bandaid <br />Alcohol Pad <br />2x2 gauze ( non - sterile) <br />Copy of Shot Record <br />Staff Time <br />104.73 <br />0.56 <br />) I <br />0.02 <br />0.01 <br />0.01 <br />0.01 <br />5.13 - <br />Nursing Time Admin Time Total Price of <br />per 15 min per 15 min Vaccine <br />_ -- 8.45 - - -_ - 7.61 <br />52.02 <br />0.61 <br />j 0.02 <br />If <br />I <br />0.01 <br />0.01 <br />0.01 <br />v <br />- - <br />74.00 <br />- -- _ <br />5.13 <br />8.45 7.61 I 7 -i <br />72.27 <br />- <br />0.00 <br />0.00 <br />j 0.00 <br />r 0.00 <br />0.01 <br />f <br />94.00 <br />1 <br />5.13 <br />8.45 7.61 _93,47_1 <br />.. <br />28.93 .-- - - - -._ .I <br />_ 0.19 <br />I <br />0.02 <br />0.01 l <br />- 0.01 it <br />---- --.,1- ° ` ----- - -- - - - - -- --- ------ 51.00 <br />5.13 8.45 7.61 <br />134.95 <br />--- - - -- - - "0 19 --- 7i - <br />I <br />0.02 <br />0.01 <br />_- - t = � -- - - - - - -- -- - - - - -- --- 157.00 <br />5.13 8.45 7.61 1 _ 156.37 1 <br />We are requesting the fee in the green block. The price under the green block <br />is the acutual cost to provide the vaccine. page 2 of 2 <br />