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Texas Medicaid/CHIP Pharmacy Contracting Process Application Application Review Process Upon receipt in our office, your completed application will be reviewed initially to determine if the ownership is eligible to be a provider in the Program and if all participating pharmacists are eligible to fill Medicaid prescriptions. The Program will review the criminal history, if any, of the owners and pharmacists, and also review any disciplinary orders from the Texas State Board of Pharmacy. If your pharmacy is tentatively determined eligible, a vendor number will be assigned and two copies of the contract will be mailed to you for the appropriate signature. Out of State Pharmacies If your pharmacy is located outside Texas it must be in a bordering state and must be within thirty miles of the border, or you must be able to show that your pharmacy can provide additional benefits to the recipients. If your pharmacy is located more than thirty miles from the border, you must attach a statement to your application detailing the additional benefits. Contracts are not granted to these applicants unless additional benefits to the recipient are established. For pharmacies outside of Texas who want to provide medications to Texas Medicaid clients outside of Texas, please refer to the appropriate Medicaid Out of State Procedures link regarding this issue. Claims for in-state clients will not be paid to out-of-state pharmacies that are not contracted with VDP.Contract Effective Date and Retention of Records The contract effective date will be determined by VDP when the pharmacy's application is deemed complete. VDP will not contract with a pharmacy retroactively. In cases of a change of ownership, claims with service dates on or after the established effective date for the new owner cannot be paid under the previous owner's vendor number. The VDP contract is not transferable or assignable. VDP is unable to perform retroactive changes-of ownership in regards to the contract, therefore VDP must be notified at least ten days before the effective date of the change, as required in Section II F of the contract. If VDP determines that a pharmacy has had a change of ownership before the pharmacy has notified VDP of the change, payments to the pharmacy will be placed on hold, and will not be released until VDP has received an application from the new owners. Records for the previous owner are subject to audit and must be retained for a period of three years and 90 days after the end of the Federal fiscal year in which the service was provided or until any audit discrepancies are resolved. Signature on Documents All documents must be executed by persons authorized to execute legal instruments for the pharmacy. Business Organization Documentation Corporations: State law requires for-profit
corporations to submit a franchise tax "Certificate of Account
Status" as part of the application. These certificates are
available from the Texas State Comptroller's Office and may be requested
by letter, in person, or by accessing the Comptroller’s Internet site.
A link is provided below. When calling, you should have the taxpayer's
name, identification number, and charter number. The certificate will be
valid for a specific period of time and may be obtained by contacting
the State Comptroller's Tax Assistance Section, Telephone Bank
Operations, Interstate WATS 1-800-252-5555 (Austin number 512-463-4600).
Corporations will also need to provide a copy of their Certificate of
Incorporation, for Texas corporations, or a Certificate of Authority to
do Business in Texas, for non-Texas corporations. Both certificates are
available from the Texas Secretary of State’s Office at
512-463-5555. A
chart of organizational structure is also required. The chart must show all business
organizations which have an ownership in the pharmacy. Limited Liability Companies: (LLC) are required to submit
their “Certificate of Account Status”, a copy of the Articles of
Organization, and a copy of the Certificate of Organization. You should
receive the Certificate of Organization when you file your Articles of
Organization with the Secretary of State. A
chart of organizational structure is also required. Partnerships: Partnerships are required to submit their Partnership Agreement. If there is no partnership agreement, then we require a written statement declaring that there is no agreement. In addition, we require a statement that indicates which partner is responsible for any amounts owed to VDP if the pharmacy ceases business or stops accepting Medicaid. In the case of partnerships with a corporation or LLC as a partner, the corporate or LLC documentation indicated above is also necessary for each corporation or LLC. In addition, the partnership must submit a notarized statement indicating which individual has authority to sign the VDP contract. A chart of organizational structure is also required. Governmental
agencies or entities:
A statement must be enclosed indicating which individual has authority
to sign the VDP contract. The
statement must show the individual’s position within the entity or
agency. Mailing Addresses All completed forms should be returned to the Texas Medicaid/CHIP Contract Management unit. Maintaining Your Contract Your pharmacy enrollment contract is with the Texas Health and Human Services Commission (HHSC) and requires that the HHSC Contract Management section be notified in writing of any changes in status, key personnel, physical/business/e-mail addresses, or phone/fax numbers (please refer to your contract for all aspects/requirements of contract update submissions). Please fax any updates that pertain to your pharmacy contract to Medicaid/CHIP Contract Management at (512) 491-1972. Failure to update your contract information could result in your claims being placed on vendor hold or termination of your contract. If you have any questions regarding the application process or the contract, or you would like to receive a list of software providers who have tested and are registered with Vendor Drug, please contact the Pharmacy Resolution Desk at 1-800-435-4165 and ask for Pharmacy Contracts. |
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