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Downloading a Form to Your Computer
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- Right Click for PC or Ctrl + Click for Mac on the PDF link and click “Save link as” from the menu.
- Select the folder you want to save the file in and then click "Save."
- 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.
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For pharmacies enrolling with the Texas Vendor Drug Program.
- 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.
|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 firstname.lastname@example.org.