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.

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Effective Date: 
12/2020

Documents

 

Instructions

Updated: 12/2020

 

When to Prepare

Drug manufacturers wanting to participate in the Children with Special Health Care Needs (CSHCN) Services Program Drug Rebate Program must complete two copies of this form and return both copies to the CSHCN Services Program.

 

Transmittal

Staff sends the completed agreement to the CSHCN Services Program:

Office of Primary and Specialty Health
Health and Developmental Services
CSHCN Drug Rebate Program
1100 W. 49th St, Mail Code 1938
Austin, TX 78756