Montana AIDS Drug Assistance Program

Montana

Contact Information
Ryan White Title II Coordinator, STD/HIV Section
Montana Department of Public Health & Human Services
1400 Broadway, Cogswell Building, RM. C211, PO Box 202951
Helena, MT 59620-9910
1-(800) 233-6668 (phone)
1-8002336668 (vanity_phone)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.
  • Click here to visit the program's web site.
  • Eligibility:
    ATTENTION: YOU MUST BE HIV POSITIVE TO BE ELIGIBLE FOR THIS PROGRAM. Must be an HIV+ Montana resident and have a prescription for a covered drug from a physician. Eighteen retail pharmacies throughout the state and mail order options are available.
    Other Information:
    Contact the ADAP administrator for more information.
    Product(s) covered by program:
    • 3TC
    • Abelcet®
    • Abilify®
    • Agenerase®
    • Anafranil
    • Androgel
    • Asendin
    • AZT
    • Bactrim
    • Biaxin® Filmtab
    • Biaxin® Granules
    • Biaxin® XL Filmtab
    • Biaxin® XL Pac
    • Buspar
    • Cancidas
    • Celexa
    • Combivir®
    • Crixivan®
    • d4T
    • Daraprim®
    • ddC
    • ddI
    • DDS
    • Depakene
    • Depakote® ER Tablets
    • Depakote® Sprinkle Capsules
    • Depakote® Tablets
    • Desyrel
    • Diflucan®
    • Diflucan® Suspension
    • Effexor
    • Effexor Tablets
    • Effexor XR Extended-Release Capsules
    • Elavil
    • Emtriva
    • Epivir®
    • Epivir-HBV®
    • EPOGEN®
    • Eskalith®
    • Fansidar
    • floinic acid
    • Fortovase
    • Foscavir
    • Fungizone
    • Gabitril
    • Geodon®
    • Geodon® for Injection
    • Haldol®
    • HIVID
    • Hydrea
    • INH
    • Kaletra®
    • Kaletra® Oral Solution
    • Lamictal®
    • Lexiva®
    • Lipitor®
    • Lopid®
    • Loxitane
    • Ludiomil
    • Luvox
    • Marplan
    • Megace
    • Megace Oral Suspension
    • Mellaril
    • Mepron®
    • Microsulfon
    • Moban
    • Myambutol
    • Mycobutin®
    • Mycolex Troches
    • Mycostatin
    • Nardil®
    • Navane®
    • NebuPent
    • NebuPent Inhalation Solution
    • Neupogen
    • Neurontin®
    • Norpramin
    • Norvir® Oral Solution
    • Norvir® Soft Gelatin Capsules
    • Orap
    • Pamelor
    • Parnate®
    • Paxil CR®
    • Paxil®
    • Pentam
    • Pravachol®
    • Prolixin elixir
    • Prozac®
    • Remeron
    • Remeron SolTab
    • Rescriptor®
    • Retrovir®
    • Reyataz
    • RIF
    • Rifater
    • Risperdal® Tablets and Oral Solution
    • Septra
    • Serentil
    • Seroquel®
    • Serzone
    • Sinequan®
    • Sparine
    • Sporanox®
    • Sporanox® Oral Solution
    • Stelazine
    • Sulfadiazine Tablets
    • Surmontil®
    • Sustiva
    • Tegretol XR
    • Tegretol®
    • Thorazine®
    • Tofranil
    • Topamax®
    • Trilafon
    • Trileptal®
    • Trizivir®
    • Valcyte
    • Valtrex®
    • Vesprin
    • Vfend®
    • Vfend® I.V.
    • Videx
    • Videx EC
    • Viracept®
    • Viramune
    • Viread
    • Vistaril®
    • Vivactil
    • Wellbutrin SR®
    • Wellbutrin XL™
    • Wellbutrin®
    • Zerit®
    • Ziagen®
    • Zithromax®
    • Zoloft®
    • Zovirax®
    • Zyprexa®