Get Tx Hhs Form 1317 2017-2025

This guide provides clear and supportive instructions for individuals looking to complete the TX HHS Form 1317 online. The form is essential for pharmacy eligibility verification, and following these steps will ensure accurate submission.

Follow the steps to successfully complete the form.

1. Click 'Get Form' button to obtain the form. This will allow you to open it within your preferred online platform.
2. Identify the reason for submitting the form by selecting one of the options: request for new access or request for update to information on file.
3. Classify your pharmacy by checking either 'Independent pharmacy' or 'Chain pharmacy/corporate headquarters'. Ensure you choose the correct classification for accurate processing.
4. Fill in the Pharmacy Provider Information section, providing details such as legal name, business address (street, city, state, and ZIP code), 'Doing Business As' (DBA) name, area code and telephone number, area code and fax number, and email.
5. Complete the EVP Administrative Information section by providing the name and title of the administrator, area code and telephone number, business address, area code and fax number, and email.
6. Include Additional EVP User Information, filling in the first name, last name, and phone number of an additional user, if applicable.
7. Review all information entered into the form for accuracy. Make corrections if necessary, ensuring all required fields are filled out.
8. Once you have completed the form, you can save your changes, download the document, print it, or share it, depending on your needs.

Start filling out the TX HHS Form 1317 online to ensure your pharmacy access is properly verified.