Enrollment Forms

Pharmacies enroll using the Texas Medicaid and Healthcare Partnership (TMHP) Provider Enrollment and Management System (PEMS). Refer to the TMHP Provider Enrollment 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.