Programs & Services
AIDS Drug Assistance Program (ADAP)
The North Carolina HIV Medications Program, funded jointly by state and federal dollars, is designed to provide financial assistance to low-income state residents for the purchase of medications specifically used to combat HIV and the opportunistic infections which are specific to AIDS. Guidelines for participation in the program include a diagnosis of HIV infection and gross income at or below 300 percent of the Federal Poverty Level.
ADAP Information
- ADAP Fact Sheet - Feb 1, 2013 (PDF, 36KB)
- Client Information Sheet - Nov 7, 2012 - English (PDF, 59KB)
- Client Information Sheet - Nov 7, 2012 - Spanish (PDF, 21KB)
- NC DHHS: Purchase of Medical Care Services (POMCS) Manual (PDF, 121KB)
- ADAP Mail and Fax Procedures - May 24, 2012 (PDF, 28KB)
- Map of ADAP and SPAP Walgreens Locations - June 2012 (PDF, 1.44MB)
ADAP Applications and Forms
- 3014 ADAP Financial Eligibility Application Form (rev 11/2012) (PDF, 347KB / Word, 133KB)
- 3056 ADAP Authorization Request Form (rev 11/2012) (PDF, 274KB / Word, 87KB)
- ADAP Summer Recertification Signature Page - May 30, 2012 (PDF, 17KB / Word, 59KB)
- Ryan White Part B & ADAP Eligibility Checklist - June 20, 2012 (PDF, 58KB)
- Ryan White Part B & ADAP Eligibility Checklist Instructions - June 20, 2012 (PDF, 15KB)
- Ryan White Part B & ADAP Income Signature Card & Policy - June 20, 2012 (PDF, 62KB)
- Ryan White Part B & ADAP Verification of No/Low Income - June 20, 2012 (PDF, 12KB)
- Ryan White Part B & ADAP Declaration of Residency - June 20, 2012 (PDF, 8KB)
Medicare and Medicaid Information
Patient Assistance Programs
![North Carolina Government - nc[dot]gov](/library/images/ncGov.png){kind=small}
