Effective Date: 
6/2019

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 (HHS Form 1340) and the Pharmacy Provider Enrollment Agreement 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.

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