Financial Assistance
Programs Offered
2022 Every Penny Counts Application Package
Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.
2022 Greater Minnesota Every Penny Counts Application Package
Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.
HOPWA Application Package
This form must be printed, filled out and faxed or mailed
Rental Form
Open this form online and type your responses; when complete save the file to your desktop and email it or print it out and fax or mail it.
Drug Co-pay Reimbursement Program
This form must be printed, filled out and faxed or mailed
Instructions
Please return these forms in person, by mail, or by fax to:
Rainbow Health
2577 Territorial Road
St. Paul, MN 55114
Fax: 612-341-4057
Contact Us
In order to serve our clients, we are required to collect some information to determine eligibility. If you are interested in Every Penny Counts Emergency Financial Assistance, please complete and return the forms below. You can also request an application packet by calling 612–331–7733 or 800–565–9028.
AIDSLine
The Minnesota AIDSLine is Minnesota’s statewide information and referral service that can answer your questions about HIV and link you to help. You may reach AIDSLine by phone, text, e-mail, or live chat.