Pharmacy providers enroll, re-enroll, revalidate, and submit change of ownership requests through the TMHP Provider Enrollment and Management System (PEMS) as of April 1, 2021.
TMHP provides PEMS computer-based training modules on the TMHP Learning Management System (LMS). An LMS account, including a username and password, is required to access training courses. Instructions on creating an LMS account are available on the TMHP LMS Account Login web page. Refer to the TMHP Online Resources section for more information.
All pharmacy providers pay an application fee to offset the cost of the required background checks. This fee is paid to TMHP during the enrollment process. HHSC does accept payments or applications sent to HHSC or VDP offices.
The fee for applications submitted between Jan. 1 and Dec. 31, 2023, is $688.00.
Pharmacies participating in Medicare or in another state’s Medicaid program may submit proof of payment of the fee to satisfy the application fee requirement in Texas.
Refer to the Enrollment Forms for the following supplemental forms used during the enrollment process:
- Application for Texas Identification Number (HHS Form 4109)
- Direct Deposit Authorization (CPA Form 74-176)
- Ownership Transfer Affidavit (HHS Form 1332)
- Required only when pharmacy providers request a change in ownership. Pharmacy providers must submit the form when initiating an application through PEMS.
Refer to the Eligibility Forms for the following form:
- Pharmacy Eligibility Verification Portal Access Form (HHS Form 1317)
Refer to the Payment Forms for the following form:
- Pharmacy Electronic Remittance Advice Agreement (HHS Form 1316)
TMHP may require other supporting documents depending on the pharmacy's business organization. PEMS will alert applicants to which supporting documentation is required.
Pharmacy providers must submit all required enrollment information to determine if the pharmacy meets the requirements for participation. The enrollment process typically takes 60 business days after receiving all information necessary to process the application. Requests for exceptions to the enrollment process, risk category (according to the MCS Medicaid Provider Enrollment Compendium), and provider types requiring additional state approval may extend the length of the application process. Refer to the TMHP Provider Enrollment Frequently Asked Questions (PDF) for more information.
TMHP will send the applying provider an email to confirm enrollment and instructions to sign the Pharmacy Enrollment Agreement. The document will outline the terms and conditions agreed to in the application process. The date a pharmacy receives this email constitutes the enrollment effective date. Enrollment is not retroactive, transferable, or assignable. Pharmacies can only submit claims on or after the enrollment date.
The HHSC Master Provider File is the list of all providers approved to provide Medicaid services and is maintained by TMHP. A pharmacy should allow up to 2 weeks to appear on the Master Provider File after being notified by TMHP of successful enrollment. Once TMHP includes a pharmacy on the Master Provider File, the pharmacy is eligible to contract with MCOs.