P-3.1. Participation

A pharmacy with a current license or registration with the Texas State Board of Pharmacy (TSBP) or is licensed under the laws of another state and is free from any pharmacy board restriction may apply to become a Texas Medicaid pharmacy provider. As defined and limited by federal and state laws, prescribing providers authorized and licensed to practice the healing arts and choose to provide pharmaceuticals may also apply to become pharmacy providers. HHSC maintains open enrollment for in-state pharmacies licensed as Class A or C by the TSBP. Pharmacies holding any other class of pharmacy license may be subject to special application procedures.

Providers who prescribe to clients enrolled in Medicaid fee-for-service, the CSHCN Services Program, Healthy Texas Women Program, and KHC Program enroll through TMHP. Federal law requires HHSC to deny fee-for-service claims for drugs or products prescribed by non-enrolled providers. Providers enroll through the TMHP Provider Enrollment and Management System (PEMS).

Refer to 1 TAC Section 354.1801 (Requirements for Participation) on the VDP website Rules and Statutes page (txvendordrug.com/about/rules).