​Maryland AIDS Drug Assistance Program

​Provider Resources​

Forms

MADAP 2022 Income Guidelines_01Feb2022

Full MADAP application - April​ 2022​

MADAP Annual one-page Recertification form  - *NEW*

A -1 MADAP Medical Eligibility Form_Feb 2022​

A- 2 No Income and or Homeless Verification Form

A - 3 Cash only verification form_Feb 2022

TAP Application_Feb 2022​

MADAP HCV PA Requirements

Extra Meds/Early refill requests

2020 PTC Main letter

2020 Net PTC Reimbursement Agreement - updated

MADAP Formulary

The MADAP Formulary additional Therapeutic Classification of Drugs can be viewed by clicking here.


Restricted Drug Forms & Guidelines​


NOTE: Provider manuals and bulletins are in PDF format used by Adobe Reader. Adobe Reader formats printed material for viewing on your computer monitor and allows you to print documents. The reader may be downloaded for free from the Adobe website.




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MADAP Home Page
MADAP-Plus Page

Contact Information:
Email: 
Client.servic​​​​​​es@maryland.gov
Phone: 410-767-6535
Fax: 410-333-2608


Mailing Address:​
​1223 W. Pratt Street​​
Baltimore, MD 21223​

Business Hours:
Monday - Friday
8:30 am - 4:30 pm​​
(Walk-In Hours: 8:30 am - 4:00 pm)​