Downloading a Form to Your Computer

Fillable forms cannot be viewed on mobile or tablet devices. Follow the steps below to download and view the form on a desktop PC or Mac.

  1. Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
  2. Select the folder you want to save the file in and then click "Save."
  3. Navigate to the folder you saved the file in and Right Click for PC or Ctrl + Click for Mac, then select "Open With" from the menu and select Adobe Acrobat Reader DC.

    Note: Open the PDF file from your desktop or Adobe Acrobat Reader DC. Do not click on the downloaded file at the bottom of the browser since it will not open the PDF in Adobe Acrobat Reader DC. It will try to open the file in the browser that results in the same browser error message.

    If still having trouble viewing or downloading a form, click here.

Effective Date: 
4/2019

Documents

 

Instructions

Updated: 6/2019

 

Purpose

For pharmacies to enroll with the Texas Vendor Drug Program.

Detailed Instructions

  • Pharmacy staff must complete all fields that are applicable to your pharmacy type.
  • The Pharmacy Provider Enrollment Application and the Pharmacy Provider Enrollment Agreement (HHS Form 1341) are to be completed and submitted at the same time.
  • Full instructions are available at the Texas Vendor Drug Program website

Transmittal

  • Fax: 512-730-7477
  • Mail: Vendor Drug Program (MC-2250)
             Texas Health and Human Services
             4900 North Lamar Blvd.
             Austin, TX 78751

Questions

Questions about this form should be sent by email to vdp-enrollment@hhsc.state.tx.us.