Indiana Wic Authorized Formulas Page 5
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6INDIANA WIC AUTHORIZED FORMULAS
(Print in COLOR for ease in reading)
Exempt
Product
Unit of Measure
or
Yield/
****Women
(*IFF)
Infant Fully Formula
&
Infant BF Mostly (***IBPm)
Concentrate
WIC
Unit
&
Infant BF some
(**IBPs)
Formula Name
A
B
C
D
Eligible
in
Children
RTU
A
B
C
0 to 1/ 1-3/ 4-5/ 6-11
0-3mo / 4-5mo / 6-11mo
(Fd. Pkg. III)
Nutritio
fluid
Powder
nals
ounces
Metabolic Formulas Requiring
MAX
MAX CONTAINERS
MAX CONTAINERS
Medical Documentation
CONTAINERS
ProPhree
5-8
6-9
4-6
1 can / 4
/ 5
/ 3
8
WEN
14.1-oz powdered
102
W-I-C
Abbott Nutrition
Propimex-1
5-9
6-10
5- 7
1
1-4/
1-5/
1-4
9
14.1-oz powdered
E
96
W-I-C
Abbott Nutrition
Propimex 2
11
WEN
14.1-oz powdered
82
W-C
Abbott Nutrition
ProViMin
5
WEN
W-C
Abbott Nutrition
5.3-oz powdered
167
Tyrex-1
5-9
6-10
5- 7
1
1-4/
1-5/
1-4
9
14.1-oz powdered
E
96
W-I-C
Abbott Nutrition
Tyrex-2
11
WEN
14.1-oz powdered
82
W-C
Abbott Nutrition
TYROS 1
4-7
5-8
4-6
1 can / 3
/ 4
/ 3
8
16-oz powdered
E
113
W-I-C
MeadJohnsonNutritionals
TYROS 2
9
WEN
16-oz powdered
93
W-C
MeadJohnsonNutritionals
WND 1
4-7
5-8
4-6
1 can / 3
/ 4
/ 3
8
16-oz powdered
E
113
W-I-C
MeadJohnsonNutritionals
WND 2
9
WEN
16-oz powdered
93
W-C
MeadJohnsonNutritionals
XLEU Maxamum
13
WEN
16-oz powdered
69
W
Nutricia North America
XLys, XTrp Maxamum
13
WEN
16 oz powdered
69
W
Nutricia North America
XMET Maxamum
13
WEN
16-oz powdered
69
W
Nutricia North America
MMA-PA Anamix Early Years
5-9
6-10
5- 7
1
1-4/
1-5/
1-4
9
14.1-oz powdered
E
90
W-I-C
Nutricia North America
XMTVI Maxamum
13
WEN
W
Nutricia North America
16-oz powdered
69
XPhe Maxamum
13
WEN
16-oz powdered
69
W
Nutricia North America
XPTM Analog
9
5-9
6-10
5- 7
1
1-4/
1-5/
1-4
14.1-oz powdered
E
95
W-I-C
Nutricia North America
5
Revised September 2017
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