March 31, 2020

  • Updated April 2

Beginning April 1, Texas pharmacies, as well as any out of state pharmacy, can temporarily enroll with the Vendor Drug Program using our expedited enrollment application (HHS Form 1350). The expedited form and enrollment process allows pharmacies to quickly provide pharmaceutical services to people enrolled in Texas Medicaid during the COVID-19 pandemic. In addition, CMS has waived the collection of the enrollment application fee during the state of emergency.

Upon completion of form 1350, pharmacies can submit claims to VDP for fee-for-service Medicaid and the CSHCN, KHC, and HTW programs. Once enrolled with VDP, pharmacies can contract with MCOs to submit claims for people enrolled in Medicaid managed care or CHIP.

Pharmacy staff will still need to complete the following forms in addition to form 1350:

  • Form 74-176 for direct deposit
  • Form AP-152 for payee identification number
  • Form 1317 for access to the eligibility verification portal
  • Form 1316 for access to weekly pharmacy payment files

Temporary enrollment will remain active through the end of the state of emergency. Fax completed forms to 512-206-3948.

Notes

  • Pharmacies wanting to provide outpatient prescription drug services after the state of emergency ends will need to complete the Pharmacy Provider Enrollment Application (HHS Form 1340) and follow the established enrollment process
  • Pharmacies with a current pending application with VDP are not eligible to submit Form 1350

All enrollment forms are available online.

Contact us at vdp-enrollment@hhsc.state.tx.us for questions about the expedited process.

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Enrollment