A pharmacy with a current license or registration with the Texas State Board of Pharmacy, 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. Pharmacies must enroll before providing outpatient Medicaid prescription services.
Pharmacies enroll using the Provider Enrollment and Management System (PEMS):
- The entire application process can typically take up to 60 business days after receiving all information necessary to process the application. TMHP may extend the timeline in particular circumstances. Requests for exceptions to the enrollment process, risk category, and provider types that require additional state approval may extend the length of the application process.
- TMHP sends pharmacies their enrollment effective dates in a confirmation email.
- Pharmacies can only submit claims on or after the enrollment date. Enrollment is not retroactive.
- HHSC requires pharmacy providers to enroll in Medicaid before participating in any other state program administered by HHSC or involvement in any Medicaid or CHIP MCO pharmacy network.
- HHSC will terminate pharmacies without claim payment within a continuous twelve-month period. The pharmacy must reapply by submitting a new application for reinstatement using PEMS.
- The fee for applications submitted between Jan. 1 and Dec. 31, 2022, is $631.00.
Refer to the Enrollment section of the Pharmacy Provider Procedure Manual for information about the enrollment process and expectations.
Providers performing medical services must enroll with Texas Medicaid for reimbursement for Title XIX (Medicaid) benefits. Refer to TMHP Provider Enrollment for an application. Refer to TMHP Provider Support Services to find contact information for TMHP provider relations representatives in your area.
Maintaining Your Enrollment
Refer to the Maintaining Enrollment section of the ;Pharmacy Provider Procedure Manual for notifying HHSC about changes to the information submitted in your application.
- 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 Texas Identification Number (HHS Form 4109)