Learn about the Medicaid 1115 Transformation Waiver Renewal.
For information about COVID-19, call 2-1-1 and select Option 6.
Find a COVID-19 testing site | COVID-19 vaccine | More COVID-19 information
Some forms cannot be viewed in a web browser and must be opened in Adobe Reader on your desktop system. Click here for instructions on accessing your form.
Pharmacy providers already enrolled with Texas Medicaid utilize this form to notify HHSC of change in ownership.
The form must be submitted in conjunction with the VDP Pharmacy Enrollment Application (Form 1340) when an enrolled pharmacy changes ownership. The completed form must contain both the seller’s and buyer’s notarized signatures.
Refer comments or questions about this form to the Texas Medicaid & Healthcare Partnership at firstname.lastname@example.org.