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Effective Date:
11/2019Documents
-
Document
Instructions
Updated: 11/2019
Purpose
For pharmacies enrolling with the Texas Vendor Drug Program.
Detailed Instructions
- Form 1340, Pharmacy Enrollment Application, and Form 1341, Pharmacy Enrollment Agreement, are to be completed and submitted at the same time as this form.
- Full instructions are available at the Texas Vendor Drug Program website.
Transmittal
| Fax: | 512-730-7477 |
| Mail: | Vendor Drug Program (Mail Code 2250) Texas Health and Human Services 4900 North Lamar Blvd. Austin, TX 78751 |
Questions about this form should be sent by email to vdp-enrollment@hhsc.state.tx.us.