In Montezuma County, the Public Health Department holds a virtual monopoly over providing vaccines to children and adults, but it's not because they prefer it that way.
There is simply nowhere else to go.
Across the county line in Durango, a mere 50 miles away, multiple pediatric clinics administer vaccinations. This alleviates the load on San Juan Basin Health Department, which serves La Plata and Archuleta counties.
In some places, hospitals also fill in the gaps.
But here, Dr. Hope Barkhurst, who only vaccinates her own patients - no walk-ins - options are meager.
"Some of our clients go to pediatricians in Durango for their care. They are giving vaccinations. We don't have that option available," said county health director Lori Cooper.
Kent Helwig, CEO of Southwest Memorial Hospital, said Tuesday he hadn't yet spoken with Cooper directly about vaccines, but is open to "exploring" the idea.
He was scheduled to meet with Cooper today, but didn't specify if vaccines were on the agenda.
"(The hospital) offered vaccines in the past. The reason we stopped - the reason a lot of hospitals stopped - was the federal documentation requirements. We had to hire some extra people to do the paperwork," he said. "Lately some of those requirements have been relaxed, so I'd consider it, especially for childhood immunizations."
With vaccine access already limited, changes to state policy starting in January could cause further angst among some parents.
According to Cooper, until now the health department has given free vaccines to underinsured kids - those whose parents have insurance but whose deductibles are prohibitively high, or whose policy only covers select vaccines.
After the new year, only Medicaid patients and those strictly without insurance will be eligible, under the federal Vaccines for Children program. Parents with insurance, no matter how unreliable, will have to pay for vaccines up front and hope to be reimbursed later.
Vaccine prices are highly variable, according to the Center for Disease Control. They range from $10 to $30 dollars for a hepatitis or tetanus shot - to more than $100 for rotavirus and MMR. For families on a tight budget with multiple children, the costs can add up.
Right now the health department contracts with Child Health Plan Plus, a public program, and two private insurers - Rocky Mountain Health Plans and Anthem Blue Cross Blue Shield- and can bill them directly for vaccine costs. Contracts with two other insurance companies are pending, Cooper said. She estimated that 80 percent of the county's kids are covered either by one of the "big three" or Medicaid, but that still leaves a minority of patients without recourse but to shell out money up front.
"Our concern is (the parents) won't have the cash to pay. Consequently some kids may not get immunized," she said.
Office manager Laurel Schafer said the health department might start accepting credit card payments to give parents time to work with their insurance companies.
Schafer added that completing contracts is time-consuming because the contracts are designed for primary care offices where physicians have a broader scope of practice.