Medicaid/CHIP Contract Management is responsible for managing over 4,000 pharmacy contracts including reviewing applications, assigning fees, recommending and imposing sanctions, and resolving compliance issues.
Texas Pharmacies that want to participate in the Medicaid Vendor Drug Program must be contracted prior to providing outpatient prescription services. Applications will be effective the date the contract is fully executed by both parties, and contracts will not be back-dated. Pharmacies can only submit claims for prescriptions filled on or after the effective date of the contract. Learn about the Vendor Drug contracting process.
Texas Pharmacies that want to participate in the Children's Health Insurance Program (CHIP), Kidney Health Care (KHC) program, or Children with Special Health Care Needs (CSHCN) Services Program must first have a Medicaid contract. An additional agreement(s) must be signed and returned to Medicaid/CHIP Contract Management unit in order to participate in each of the other programs.
Any active Texas Medicaid or CHIP recipient maintaining state residence is eligible for services provided outside the state. Learn more about applying as an out-of-state provider.
Contracts will be terminated for pharmacies that have been inactive (had no claim payment) within a continuous six-month period. If a contract is terminated because of inactivity, the provider must reapply to the Vendor Drug Program by submitting a new contract application for reinstatement.
Any providers performing medical services that wish to be eligible for reimbursement for Title XIX (Medicaid) benefits must contact the Texas Medicaid & Healthcare Partnership (TMHP). To enroll, complete an application from the TMHP “Provider Enrollment” website. For further assistance about completing the application contact the TMHP Contact Center at 1-800-925-9126, or visit the TMHP “Regional Support” website to find contact information for the local TMHP provider relations representative in your area.
Maintaining Your Contract
In accordance with the terms and conditions of your contract with HHSC, all contracted pharmacies must notify Medicaid/CHIP Contract Management in writing of any changes, such as:
- Your billing and/or physical addresses.
- Your phone and fax numbers.
- Key personnel, such as pharmacists.
- A change of financial information (e.g., direct deposit).
- Store closure.
Please refer to your contract for all requirements of contract update submissions. Pharmacies can verify information via the Medicaid Pharmacy search. If the information is incorrect or incomplete, you run the risk of not receiving a copy of the RxUpdate and other correspondence from Vendor Drug. Failure to update your contract information could result in your claims being placed on vendor hold or the termination of your contract. Please submit corrections on your pharmacy letterhead by fax to Medicaid/CHIP Contract Management.