Form 1341 Pharmacy Enrollment Agreement - Texas

What Is Form 1341?

This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form 1341?
A: Form 1341 is the Pharmacy Enrollment Agreement specific to the state of Texas.

Q: What is the purpose of Form 1341?
A: The purpose of Form 1341 is to establish and maintain a contractual relationship between a pharmacy and the Texas Medicaid Vendor Drug Program.

Q: Who needs to fill out Form 1341?
A: Pharmacies that wish to enroll or participate in the Texas Medicaid Vendor Drug Program need to fill out Form 1341.

Q: How should I fill out Form 1341?
A: Carefully read and complete all sections of Form 1341, providing accurate and up-to-date information about your pharmacy.

Q: Are there any fees associated with submitting Form 1341?
A: No, there are no fees associated with submitting Form 1341.

Q: What supporting documents do I need to include with Form 1341?
A: You need to include a copy of your pharmacy's current license and any other documentation required by the Texas Health and Human Services Commission.

Q: What is the submission process for Form 1341?
A: Once completed, Form 1341 should be submitted to the pharmacy provider enrollment unit either by mail or electronically.

Q: Can I make changes to the information provided on Form 1341?
A: Yes, you can make changes to the information provided on Form 1341 by submitting an updated form to the pharmacy provider enrollment unit.

Q: What happens after submitting Form 1341?
A: After submitting Form 1341, the Texas Health and Human Services Commission will review your application and notify you of your enrollment status.