Indiana Wic Authorized Formulas Page 6

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INDIANA 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
Age and Formula Amount Information for
IFF, IBPs, IBPm, Women & Children
*IFF
Snap Shot Amounts
*IFF-A: 0-3 mo.; B: 4-5 mo.; C: 6-11 mo.
Conc./
RTU/ Powder
A: 806 oz.¥ Concentrate OR 832 oz. RTU OR 870 oz.¥ Powder.
31 cans
26
9
B: 884 oz.¥Concentrate OR 913 oz. RTU OR 960 oz.¥ Powder.
34 cans
28
10
C: 624 oz. ¥Concentrate OR 643 oz. RTU OR 696 oz. ¥ Powder.
24 cans
20
7
**IBPs--Snap Shot Amounts
**IBPs--A: 0 to 1mo; B: 1-3 mo; C: 4-5 mo; D: 6-11 mo
A:130oz/5cns-780oz/30cns ¥Concentrate OR 128oz/4cns-800oz/25cns RTU OR 208/2cns-832oz/8cns ¥Pwd
B:390oz/15cns-780oz/30cns ¥Concentrate OR416oz/13cns-800oz/25cns RTU OR 520oz/5cns-832oz/8cns ¥Pwd
C:468oz/18cns-858oz/33cns ¥Concentrate OR 480oz/15cns-864oz/27cns RTU OR 624oz/6cns-936oz/9cns ¥Pwd
D:338oz/13cns-598oz/23cns ¥Concentrate OR 352oz/11cns-608oz/19cns RTU OR 520oz/5cns-624oz/6cns ¥Pwd
***IBPm
***IBPm--A: 0 to 1 mo.; B: 1-3 mo.; C: 4-5 mo.; D: 6-11 mo.
Snap Shot Amounts
Conc./
RTU/ Powder
A:104 oz. ¥Concentrate, OR RTU OR ¥Pwd
104 fluid ounces
B:364oz. ¥Concentrate OR 384oz RTU OR 435 oz ¥Pwd.
14 cans
12
4
C:442oz ¥Concentrate OR 474 oz RTU OR 522 oz ¥Pwd.
17 cans
14
5
D:312oz ¥Concentrate OR 338 oz RTU OR 384 oz ¥Pwd.
12 cans
10
4
****Women & Children (W & C) on Food Package III-Formula Amounts Includes:
910 fl oz of reconstituted liquid concentrate; OR 910 fl oz RTU; OR 910 fl oz reconstituted powder--plus the foods included in
food package IV, V, VI or VII.
¥=Reconstituted
NOTE:
Infants >6 mo., on Food Pkg. III, who cannot consume foods orally,
may receive increased formula at maximum level for 4-5 mo. olds. This does not
include Standard Contract Formula.
6
Revised September 2017

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