Pharmacies enroll using the 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.
- Pharmacy Eligibility Verification Portal Access Form (HHS Form 1317)
- Pharmacy Electronic Remittance Advice Agreement (HHS Form 1316)
- Pharmacy Ownership Transfer Affidavit (HHS Form 1332)
- Direct Deposit Authorization (CPA Form 74-176)
- Application for Payee Identification Number (CPA AP-152)