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: 
3/2020

Documents

 

Instructions

Update: 3/2020

 

Purpose

This form is used by managed care organization (MCO) staff to provide updates or corrections to the managed care pharmacy resources available at txvendordrug.com, specifically the:

  • Pharmacy MCO Enrollment Chart
  • Pharmacy MCO Assistance Chart
  • Prescriber MCO Assistance Chart

When to Prepare

  • The form is only for use by MCO staff.

 

Detailed Instructions

  • Enrollment Information section:
    • Provide the phone number, fax number, email address or website pharmacies use for MCO pharmacy enrollment.
    • Provide the phone number or email address pharmacies use for MCO durable medical equipment enrollment.
  • Claims Billing section:
    • Provide the "BIN Number" (field 1Ø1-A1), "Processor Control Number" (1Ø4-A4), and "Group ID" (field 3Ø1-C1) pharmacy staff use to submit claims to the MCO.
  • Call Center section:
    • Provide the phone numbers for the pharmacy, prior authorization and member call centers.

Transmittal

MCO staff sends the form to the Vendor Drug Program via email at vdp_mco_solutions@hhsc.state.tx.us.

Questions