Wic Eligible Formula And Nutritionals Food Listing

ADVERTISEMENT

WIC ELIGIBLE FORMULA AND NUTRITIONALS FOOD LISTING
 Non-Contract Formulas/Nutritionals will only be provided with the diagnoses of a medical condition from a
health care provider that warrants the requested formula/nutritional.
 A Medical Documentation form must be completed for prescribing formula/nutritionals with a qualifying
medical condition(s). WIC Eligible Formulas or Nutritionals
cannot not be issued by WIC solely for the purpose
Maximum approval length is six months.
of enhancing nutrient intake or managing body weight.
 Ready-to-feed (RTF) products may only be issued in cases where there is an unsanitary/restricted water supply,
poor refrigeration, when the patient’s caregiver has difficulty diluting concentrated or powdered formula, or
when ready-to-feed is the only available product form.
Wyoming WIC Contract Infant Formulas - No Prescription Required
Similac Advance
Gerber Good Start Soy
Non-Contract INFANT Formulas – Prescription Required
 Enfaport DHA/ARA
 Similac Expert Care Alimentum
 Calcilo XD
 Human Milk Fortifier
 Similac Expert Care NeoSure
 EleCare Infant
 Neocate Infant DHA/ARA
 Similac for Spit-Up (19 Cal)
 Enfacare
 Nutramigen w/Enflora LGG
 Similac PM 60/40
 Gerber Graduates Soy
 Periflex Infant
 Similac Sensitive (19 Cal)
 Enfamil Premature 20 Cal with Iron
 Pregestimil DHA & ARA
 Similac Special Care 24
 Enfamil Premature 24 Cal with Iron
 PurAmino
 Similac Special Care 30
 Enfamil Premature High Protein 24 Cal
 RCF
 Similac Total Comfort (19 Cal)
 Enfamil Premature 30 Cal
Non-Contract Nutritionals for CHILDREN and WOMEN – Prescription Required
 MCT Oil
 Peptamen
 Boost Breeze
 Microlipids
 Peptamen 1.5
 Boost Kid Essentials
 Neocate Junior
 Peptamen Junior
 Boost Kid Essentials 1.5
 Nutren Junior
 Peptamen Junior 1.5
 Boost Kid Essentials w/Fiber 1.5
 Nutren Junior Fiber
 Peptamen Junior with Fiber
 Boost Original
 PediaSure
 Peptamen Junior with Prebio
 Bright Beginnings Soy Pediatric Drink
 PediaSure with Fiber
 Peptamen with Prebio
 Compleat Pediatric
 PediaSure 1.5
 Periflex Junior
 Compleat Pediatric Reduced Calorie
 PediaSure 1.5 with Fiber
 PhenylAde 40
 E028 Splash
 PediaSure Enteral Formula 1.0 Cal
 Portagen
 EleCare Junior
 PediaSure Enteral Formula 1.0 Cal
 Scandishake
 Gerber Graduates Soy
 Suplena
with Fiber
 Ensure
 Vivonex Pediatric
PediaSure Peptide 1.0 Cal
 KetoCal 3:1
 Xlys, XTrp Maxamaid
PediaSure Peptide 1.5 Cal
 KetoCal 4:1

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical
Go
Page of 2