Enrollment Forms

Pharmacies enroll using the Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). Refer to the Provider Enrollment section of tmhp.com for instructions. Change in ownership requests are not currently processed through PEMS. Refer to tmhp.com for instructions on submitting requests to TMHP.

The information below each form identifies the action when pharmacy staff must submit the form.

Delivery Sign

Medicaid-enrolled pharmacies approved to offer no-cost delivery services to people eligible for Medicaid are eligible to receive the HHS delivery incentive. VDP-approved delivery pharmacies must display the HHSC-approved pharmacy delivery sign (PDF) in a prominent place within the store. Refer to the Enrollment chapter of the Pharmacy Provider Procedure Manual for more information.