Retail pharmacies, urgent care providers: How to provide flu shots to eligible Veterans this flu season

Are you one of the 70,000+ retail pharmacies and urgent care/walk-in locations in VA’s community care network? If so, you are in an excellent position to join us in protecting our nation’s Veterans this flu season by providing no-cost flu shots.

To be eligible for this benefit, Veterans must: (1) be enrolled in the VA health care system, and (2) have received care through VA from either a VA or a community provider within the past 24 months.

Here are six steps for in-network retail pharmacies and urgent care/walk-in locations to successfully provide a flu shot to eligible Veterans:

Determine which Community Care Network (CCN) region you are part of:

• If you are located in the following U.S. states and/or territories: AL, AR, CT, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NY, OH, OK, PA, PR, RI, SC, SD, TN, VA, VI, VT, WI, WV, you are part of CCN Regions 1-3, administered by Optum®/CVS Caremark®. Contact Optum at 800-364-6331 if you need to confirm you are in-network.
• If you are a retail pharmacy or urgent care provider located in one of the following U.S. states: AK, AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA, WY, you are part of CCN Regions 4-5, administered by TriWest Healthcare Alliance®/Express Scripts®. Contact TriWest at 800-922-1557 if you need to confirm you are in-network.

Confirm the Veteran’s identity by checking their government-issued ID.

Check to make sure they are eligible for the flu vaccine, paid for by VA.

To do this:

• Ask for the Veteran’s 10-digit Veteran ID number, then check their eligibility electronically.
• If you can’t check their eligibility electronically you can call the following numbers:
  • Optum at 888-901-6609 (Regions 1-3)
  • TriWest at 833-483-8669 (Regions 4-5). The system will indicate urgent care eligibility, which includes receiving a flu vaccine.

If the Veteran doesn’t have or know their 10-digit Veteran ID number, ask for their Social Security Number (SSN), then call Optum at 888-901-6609 (Regions 1-3) or TriWest at 833-483-8669 (Regions 4-5) to confirm eligibility. The system will indicate urgent care eligibility, which includes receiving a flu vaccine.

Enter the electronic billing information below according to the CCN region in which you are located:

• Regions 1-3 (Optum/CVS Caremark™)
  • Step 1: Enter BIN: 004336
  • Step 2: Enter PCN: ADV
  • Step 3: Enter Rx Group: Flu Shot or COVID-19 Vaccine: Rx3841
  • Step 4: Enter Veteran ID: 10-digit Veteran ID or SSN
  • Step 5: Enter Veteran’s date of birth (YYMMDD format)
  • If you need help, call the CVS Caremark™ Pharmacy Help Desk at 800-364-6331 (24/7).
• Regions 4-5 (TriWest/Express Scripts)
  • Step 1: Enter BIN: 003858
  • Step 2: Person Code: 01
  • Step 3: Enter PCN: A4
  • Step 4: Enter Rx Group: Flu Shot or COVID-19 Vaccine: VAPC3RX
  • Step 5: Enter Veteran ID: 10-digit Veteran ID or SSN
  • Step 6: Enter Veteran’s date of birth (YYYYMMDD format)
  • If you need help, call the Express Scripts Pharmacy Help Desk at 800-922-1557 (24/7).

Administer the flu vaccine.

Provide documentation of the flu vaccination:

• For retail pharmacies, provide a copy of the flu vaccine documentation to the Veteran and recommend they provide it to their VA primary care provider’s office.
• For urgent care providers, ask the Veteran for the name and location of their home VA Medical Center and submit the flu vaccine documentation to that facility within 30 calendar days of the date of service.

Remember: Do not charge eligible Veterans any type of fee or copayment for receiving the flu vaccine.

Don’t wait until it’s too late! Help Veterans protect themselves and those they love from getting sick from flu this season.

More information

• Billing Information Card
• Flu Shots – Community Care
• Flu Shots – Billing
• Influenza (Flu) – VA National Center for Health Promotion and Disease Prevention
• Influenza (Flu) – Centers for Disease Control and Prevention (CDC)