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. Texas pharmacies must enroll with the Texas Vendor Drug Program prior to providing outpatient Medicaid prescription services.
- The enrollment process requires a minimum of 30-60 business days, excluding holidays and weekends. Additional review time may be required if further documentation is needed.
- Enrollment is effective the date the Pharmacy Provider Enrollment Agreement (Form 1341) is executed by HHSC. Enrollment is not retroactive.
- Pharmacies can only submit claims filled on or after the enrollment date.
- Enrollment as a Medicaid provider is a prerequisite for participation in any other state program administered by HHSC, and for participation in any Medicaid or Children's Health Insurance Program (CHIP) managed care pharmacy network.
- Pharmacies without claim payment within a continuous twelve-month period will be terminated. The pharmacy must reapply to HHSC by submitting a new application for reinstatement.
- The fee for applications submitted between Jan. 1 and Dec. 31, 2020, is $595.00.
Providers performing medical services must enroll with the Texas Medicaid and Healthcare Partnership (TMHP) 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
In accordance with the terms and conditions of enrollment, all pharmacies must notify Texas Medicaid in writing of any changes of the following:
- Billing and/or physical addresses
- Phone and fax numbers
- Key personnel (i.e. owners, control interests, pharmacists)
- Financial information (i.e. direct deposit)
- Store closure
Please refer to your Agreement for all requirements of enrollment update submissions. Pharmacies can verify information via the pharmacy search. If the information is incorrect or incomplete, you run the risk of not receiving correspondence from HHSC. Failure to update your enrollment information could result in your claims being placed on vendor hold or the termination of your enrollment. Please submit corrections via fax on your pharmacy letterhead.
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