We introduce the notion of 3-Hom-Lie-Rinehart algebra and systematically describe a cohomology complex by considering coefficient modules. Furthermore, we consider extensions of a 3-Hom-Lie-Rinehart algebra and characterize the first cohomology space in terms of the group of automorphisms of an $A$-split abelian extension and the equivalence classes of $A$-split abelian extensions. Finally, we study formal deformations of 3-Hom-Lie-Rinehart algebras.
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