Hi-School Pharmacy Forms Get Started HOME Hi-School Pharmacy 2026-27 Vaccine Prebook Form Step 1 of 2 50% Name(Required) First Last Pharmacy Name(Required)HSP Store #(Required)DEA #(Required)Email(Required) Shipping Address:(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Trivalent Flu VaccineEnter the number of DOSES for each Flu Vaccine presentation below. If you do not have a brand preference, insert your volume into "Best Price and Terms". Volume will default to increments of 10 (10 Doses = 1 Box).Trivalent PFS Flu Vaccine - BEST PRICE and TERMS Sanofi Fluzone PFS (Egg Based) GSK Fluarix/Flulaval PFS (Egg Based)Seqirus Flucelvax PFS (Cell Based)Sanofi Flublok PFS (Cell Based; Age 9+)Add Notes for the Trivalent Vaccine Prebook?Please SelectYesNoTrivalent Flu Vaccine Notes:Total Trivalent Flu Shots:65+ Flu VaccineEnter the number of DOSES for each Flu Vaccine presentation below. If you do not have a brand preference, insert your volume into "Best Price and Terms". Volume will default to increments of 10 (10 Doses = 1 Box).65+ PFS Flu Vaccine - BEST PRICE and TERMS Seqirus Fluad PFS (65+)Sanofi Fluzone High Dose PFS (65+)Add Notes for the 65+ Flu Vaccine Prebook?Please SelectYesNo65+ Flu Vaccine Notes:Total 65+ Flu Shots:Adult (12+) COVID VaccineEnter the number of DOSES for each Covid Vaccine presentation below. If you do not have a brand preference, insert your volume into "Best Price and Terms". Volume will default to increments of 10 (10 Doses = 1 Box).Adult COVID Vaccine - BEST PRICE and TERMSModerna mNEXSPIKE PFSModerna mSPIKEVAX PFSPfizer Comirnaty PFSNovavax Nuvaxovid PFSAdd Notes for the Adult (12+) COVID Vaccine Prebook?Please SelectYesNoAdult COVID Vaccine Notes:Total Adult (12+) COVID Shots:Pediatric-Based COVID VaccinesEnter the number of DOSES for each Covid Vaccine presentation below. If you do not have a brand preference, insert your volume into "Best Price and Terms". Volume will default to increments of 10 (10 Doses = 1 Box).Pediatric COVID Vaccine - BEST PRICE and TERMSModerna PFS (Pediatric 6mo - 11yr)Pfizer SDV (Pediatric 5yr - 11yr)Add Notes for the Pediatric COVID Vaccine Prebook?Please SelectYesNoPediatric COVID Vaccine Notes:Total Pediatric COVID Shots:Consent(Required)I understand that this is a prebook commitment to aggregate our group volume for the RFP bid process directly with the vaccine manufacturers. I acknowledge that the specific vaccine brand(s) I have requested may not be the vaccine(s) that is awarded the preferred contract. I acknowledge that the price and terms will be determined during the RFP bid process and will be disclosed after I have submitted my pharmacy's volume for the vaccine(s). I hereby agree to not disclose the confidential pricing, terms and conditions. I understand that the Vaccine Suppliers favor the Prebook fulfillment as priority, and the vaccines(s) will be distributed in allocated quantities during the season. I acknowledge that I am responsible for ensuring that I meet all legal requirements to purchase and administer immunizations and release Hi-School Pharmacy Services, LLC and its subsidiaries from all liability. If at any point I request to decrease, increase or cancel my submitted volume, or am unable to accept my entire volume commitment for any reason, Hi-School Pharmacy Services, LLC will in good faith attempt to work with the vaccine suppliers to honor any requests to adjust the remaining volume commitment. In the event that a vaccine supplier does not honor such request, then I acknowledge that I am still financially liable for my remaining volume commitment, and the vaccine supplier reserves the right to pursue any outstanding financial compensation/penalties if my pharmacy declines or defaults on their remaining volume commitment. I agree to the above Terms and Conditions.CAPTCHA