TX HHS Form 1332. Pharmacy Ownership Transfer Affidavit

The Texas Health and Human Services (HHS) Form 1332, Pharmacy Ownership Transfer Affidavit, is used to document the transfer of ownership for pharmacies enrolled with Texas Medicaid. This form is essential for ensuring a smooth transition of pharmacy ownership and maintaining compliance with HHS regulations.

This affidavit serves as a legal agreement between the seller and buyer of a pharmacy, outlining their respective responsibilities and obligations. The form requires notarized signatures from both parties, confirming the transfer of ownership and any outstanding vendor payments. Additionally, the seller is held accountable for any net audit exceptions that may have accrued during their period of ownership.

The Pharmacy Ownership Transfer Affidavit is a crucial document for pharmacies enrolled with Texas Medicaid, as it facilitates the transfer of ownership and ensures continuity of services. By completing this form, sellers and buyers can ensure a seamless transition and maintain compliance with HHS regulations. The form is available from the Texas Vendor Drug Program and must be completed in accordance with HHS guidelines.