COVID Vaccine at FOWH


We can provide the vaccine ONLY to our own established patients. Everyone who gets their 1st dose of Moderna vaccine is required and expected to get a 2nd dose of the same vaccine 4 weeks later. We will notify you.

Note: the vaccine is free, but we will bill your insurance for the administration fee . However, there is NO out-of-pocket cost to the patient.

click here for CDC guidelines on this issue - scroll down to FAQ #12 (Who is paying for the COVID-19 vaccines?)


(click the date for Online Registration):

Wed. May 19, 2021, 8 am to 11:30 am - Moderna

Friday May 21, 2021, 8 am to 11:30 am - Moderna

Friday May 21, 2021, 1:30 pm to 4:45 pm - Moderna

Vaccine billing error

We have learned that our billing service has sent incorrect statements to some patients.

The vaccine is free of cost to us and to you, and we are not supposed to bill anyone for the cost of the vaccine. The only thing we are billing for is the vaccine administration fee, which is $40 per dose, and we submit the bill to your insurance. There is NO out-of-pocket cost to you. See below.

click here for CDC guidelines on this issue.

If you received a COVID19 vaccine from us, you should see the following codes on your statements:

  • Code 0011A which is the administration fee for the first dose of Moderna vaccine and
  • Code 0012A which is the administration fee for the second dose of Moderna vaccine

New corrected statements are being sent. Thank you for your understanding, and we are sorry for this error. See below for CDC comments. For any questions, call Mercedes at our office: 626-696-2728.

According to the CDC:

The federal government is providing the vaccine free of charge to all people living in the United States, regardless of their immigration or health insurance status.

COVID-19 vaccination providers cannot:

  • Charge you for the vaccine
  • Charge you directly for any administration fees, copays, or coinsurance
  • Deny vaccination to anyone who does not have health insurance coverage, is underinsured, or is out of network
  • Charge an office visit or other fee to the recipient if the only service provided is a COVID-19 vaccination
  • Require additional services in order for a person to receive a COVID-19 vaccine; however, additional healthcare services can be provided at the same time and billed as appropriate

COVID-19 vaccination providers can seek appropriate reimbursement from the recipient’s plan or program (e.g., private health insurance, Medicare, Medicaid) for a vaccine administration fee (which we are doing).

However, providers cannot charge the vaccine recipient the balance of the bill. There is NO out-of-pocket cost to the patient.

Doctor's Note: OK to receive vaccine

Click here if you need a signed doctor's note. This page is password protected. Call us at 626-304-2626 for the password, or send an e-mail to

CAIR Immunization Notices

Our practice is required to inform all patients that their vaccine data is entered into a California State database called CAIR (Calif. Immunization Registry).

Here are disclosure documents for your information: