Get the free Children’s Health Insurance Program Pharmacy Provider Agreement

This document outlines the agreement between the Texas Health and Human Services Commission and pharmacy providers participating in the CHIP program, detailing responsibilities, certifications, and

How to fill out childrens health insurance program

How to fill out Children’s Health Insurance Program Pharmacy Provider Agreement

1. Step 1: Obtain the Children’s Health Insurance Program Pharmacy Provider Agreement form from the official health department website or office.
2. Step 2: Carefully read the agreement terms and conditions before starting to fill it out.
3. Step 3: Fill in the pharmacy's name and address at the top of the form.
4. Step 4: Provide the pharmacy's National Provider Identifier (NPI) number and other required identification numbers.
5. Step 5: Include the pharmacy's contact information, such as phone number and email address.
6. Step 6: Indicate the type of services the pharmacy will provide under the program.
7. Step 7: Review the qualifications and credentialing section and ensure all necessary documentation is attached.
8. Step 8: Sign and date the agreement in the designated area.
9. Step 9: Submit the completed agreement form as instructed, either online or by mail.

Who needs Children’s Health Insurance Program Pharmacy Provider Agreement?

1. Any pharmacy that wishes to participate in the Children’s Health Insurance Program and provide pharmacy services to eligible children.
2. Pharmacists who want to ensure they can bill the program for medications provided to covered children.
3. Healthcare organizations that need to provide comprehensive services to families enrolled in the program.

For pdfFiller’s FAQs

What is Children’s Health Insurance Program Pharmacy Provider Agreement?

The Children’s Health Insurance Program Pharmacy Provider Agreement is a contract between pharmacies and state Medicaid agencies that outlines the terms and conditions under which pharmacies provide drug benefits to children enrolled in the Children's Health Insurance Program (CHIP).

Who is required to file Children’s Health Insurance Program Pharmacy Provider Agreement?

Pharmacies that wish to participate in the Children’s Health Insurance Program and provide medication services to eligible children are required to file the Pharmacy Provider Agreement.

How to fill out Children’s Health Insurance Program Pharmacy Provider Agreement?

To fill out the Children’s Health Insurance Program Pharmacy Provider Agreement, a pharmacy must provide accurate information about its business, including the pharmacy's name, address, ownership details, and relevant licensing information, and sign the agreement to comply with program requirements.

What is the purpose of Children’s Health Insurance Program Pharmacy Provider Agreement?

The purpose of the Children’s Health Insurance Program Pharmacy Provider Agreement is to establish the rules and regulations that pharmacies must follow when dispensing medications to children covered by CHIP, ensuring compliance with state and federal guidelines.

What information must be reported on Children’s Health Insurance Program Pharmacy Provider Agreement?

The information that must be reported on the Children’s Health Insurance Program Pharmacy Provider Agreement includes the pharmacy's identification details, contact information, ownership structure, and any existing agreements with other health care programs.