Transcription of Michigan WIC Authorized Formulas
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Michigan WIC Authorized Formulas
Michigan WIC Authorized FormulasEffective December 1, 2020 Enfamil oz canPowderMJN11 233R1I, C1-C4I13 fl oz canConcentrateMJN11 002R1I, C1-C4I32 fl oz bottleRTF4 MJN11 021R1I, oz canPowderMJN11 039R1I, C1-C4 IEnfamil NeuroPro Infant8 fl oz bottleRTF4 MJN11 065R6I, C1-C4 IEnfamil oz canPowderMJN11 037R1I, C1-C4I8 fl oz bottleRTF4 MJN11 251R6I, C1-C4I32 fl oz bottleRTF4 MJN21 117R1I, C1-C4I13 fl oz canConcentrateMJN11 007R1I, C1-C4I32 fl oz bottleRTF4 MJN11 025R1I, oz canPowderMJN11 038R1I, C1-C4 IEnfamil oz canPowderMJN21 101 R1I, C1-C4 IBoost 8 fl oz bottleRTFN estle41 173R6, 12 WIIIB oost Breeze8 fl oz drink boxRTFN estle41 289I1W, C1-C4 IIIB oost Glucose Control 8 fl oz bottleRTFN estle41 174R6 WIIIB oost High Protein 8 fl oz bottleRTFN estle41 226R6, 12W, C1-C4 IIIB oost Kid Essentials fl oz drink boxRTFN estle41 224I1C1-C4 IIIB oost Kid Essentials CAL8 fl oz drink boxRTFN estle11 245I1C1-C4 IIIB oost Kid Ess.
1. Special Formula/Food Request form as well as revisions to the List of Authorized WIC Formulas are available at michigan.gov/wic medical providers tab. 6. These formulas require a qualifying condition of prematurity or low birth weight. See MI-WIC Policy 7.03 for requirements. Similac NeoSure6 This institution is an equal opportunity provider.
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