If your municipality is interested in applying for the reimbursable costs for hepatitis B vaccinations , the following will be required in a letter format :
1 ) The name of the municipality , along with address , contact person and phone number on municipal stationary .
2 ) The total amount expended for the inoculations in each of the individuals specified below ( Number # 3 ).
3 ) The total composition of the municipality ’ s emergency services personnel including : a . Number of volunteer emergency medical technicians - ambulance . b . Number of volunteer firefighters . c . Number of paid EMTs - ambulance . d . Number of paid firefighters . e . Number of police officers .
4 ) The total amount sought for reimbursement including actual costs incurred for inoculations of each individual specified in number 3 , and the cost of fees for professional medical services for administration of the vaccine .
5 ) A statement certifying that the reimbursement applied for represents actual costs incurred and that such costs are not eligible for coverage and have not been covered through any other source , nor has the cost for each individual been reimbursed by these funds in the past .
Please send your application to :
Mr . Howard Cohen New Jersey Department of Health , Division of Epidemiology , Environmental and Occupation Health Office of Assistant Commissioner Post Office Box 369 Trenton , New Jersey 08625-0369
All applications must be postmarked by October 1 , 2020 . If you have any questions regarding this matter , please call me at ( 609 ) 913-5302 or reach me by email at Howard . Cohen @ doh . nj . gov
Sincerely ,
Howard J . Cohen Contract Administrator
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