For pharmacies to enroll with the Texas Vendor Drug Program.
- 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.
- Fax: 512-730-7477
- Mail: Vendor Drug Program (MC-2250)
Texas Health and Human Services
4900 North Lamar Blvd.
Austin, TX 78751
Questions about this form should be sent by email to firstname.lastname@example.org.