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