Transcription of Michigan WIC Authorized Formulas
1 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.
2 CAL w/ Fiber8 fl oz drink boxRTFN estle11 246I1C1-C4 IIIB oost Plus8 fl oz bottle RTFN estle41 172R6, 12 WIIIC ompleat Ped. Organic fl oz pouchRTFN estle41 355I1C1-C4 IIIC ompleat Pediatric250 ml tetra prismaRTFN estle41 181I1C1-C4 IIIC ompleat Pediatric Reduced Calorie250 ml tetra prismaRTFN estle41 290I1C1-C4 IIIEleCare oz canPowderAbbott11 244I1I, C1 IIIEleCare oz canPowderAbbott31 074I1C1-C4 IIIE nfamil NeuroPro oz canPowderMJN11 235R1I, C1 IIIE nfamil Premature 24 Cal52 fl oz bottleRTFMJN31 070I6 IIIIE nfaport76 fl oz bottleRTFMJN41 304I6, 24I, C1 IIIE nsure8 fl oz bottleRTFA bbott11 200R6 WIIIE nsure Plus8 fl oz bottleRTFA bbott11 203R6 WIIIK etocal 4:1300 g (11 oz) canPowderNutricia41 057I1W, C1-C4 IIIK etocal 4:1 Liquid8 fl oz tetra prismaRTFN utricia41 276I27W, C1-C4 IIIN eocate Infant7400 g ( oz) canPowderNutricia11 231I1I, C1 IIIN eocate Syneo Infant7400 g ( oz) canPowderNutricia31 102I1I, C1 IIICONTRACT Formulas (Require Medical Documentation1 only for a Child 12 Months)SPECIAL Formulas (Require Medical Documentation1) WIC Eligible CategoryCat &Subcat formula Size R/I2 Purchase Quantity3 FormManufacturerClassEnfamil InfantEnfamil ProSobee Enfamil NeuroPro Gentlease1 WIC Eligible CategoryCat &Subcat formula Size R/I2 Purchase Quantity3 FormManufacturerClassNeocate Junior (w/ or w/out Prebiotics)400 g ( oz)
3 CanPowderNutricia11 237I1C1-C4 IIIN eocate Splash8 fl oz tetra prismaRTFN utricia11 236I1, 27C1-C4 III13 fl oz canConcentrateMJN11 111R1I, C1-C4II32 fl oz bottleRTF4 MJN11 112R1I, C1-C4 IINutramigen w/ Enflora oz canPowderMJN11 248R1I, C1-C4 IINutren Junior250 ml tetra prismaRTFN estle11 238I1C1-C4 IIIN utren Junior Fiber250 ml tetra prismaRTFN estle11 239I1C1-C4 IIIP ediasure 8 fl oz bottleRTFA bbott11 218R6, 16C1-C4 IIIP ediasure w/ Fiber 8 fl oz bottleRTFA bbott11 226R6C1-C4 IIIP ediasure 8 fl oz canRTFA bbott41 256I1, 24C1-C4 IIIP ediasure w/ Fiber 8 fl oz canRTFA bbott41 257I1, 24C1-C4 IIIP ediasure Peptide fl oz bottleRTFA bbott41 296I1, 24C1-C4 IIIP ediasure Peptide fl oz bottleRTFA bbott41 258I1, 24C1-C4 IIIP eptamen Junior250 ml tetra prismaRTFN estle11 230I1C1-C4 IIIP eptamen Junior Fiber 250 ml tetra prismaRTFN estle41 303I1C1-C4 IIIP eptamen Junior 250 ml tetra prismaRTFN estle41 302I1C1-C4 IIIP regestimil 16 oz (1 lb) canPowderMJN11 120R1I, oz canPowderMJN31 069I1I, C1 IIIP uramino oz canPowderMJN41 331I1C1-C4 IIIRCF13 fl oz canConcentrateAbbott11 220I1I, oz canPowderAbbott11 101R1I, C1-C4II32 fl oz bottleRTF4 Abbott11 102R1I, oz canPowderAbbott11 232R1I, C1 III32 fl oz bottleRTF4 Abbott31 071R1I, C1 IIIS imilac PM 60 oz (400 g) canPowderAbbott11 221I1I, C1 IIIS imilac Special Care 245 2 fl oz bottleRTFA bbott31 040R8 IIIIF ootnotes2.
4 In general, retail products ("R") are likely shelf stock items available via WIC grocery vendors. Institutional products ("I") may require a special order and are more likely available via WIC pharmacy Purchase Quantity: WIC staff should inform the client that these are the quantities the formula is packaged ( 6 pack). The maximum food package may not be evenly divided by the purchase quantitiy. If "1" is not listed, individual bottles are not allowed. ( Pediasure)4. RTF Formulas , when available in other forms, require one or more of the conditions in policy or in policy to be These Formulas require a qualifying condition of prematurity and can be issued until the infant reaches a body weight of 8 These Formulas can be issued in cases of prematurity up to one year adjusted age. See MI-WIC Policy for requirements. Similac AlimentumNutramigen 1. Special formula /Food Request form as well as revisions to the List of Authorized WIC Formulas are available at medical providers These Formulas require a qualifying condition of prematurity or low birth weight.
5 See MI-WIC Policy for requirements. Similac NeoSure6 Abbreviations:C1-C4: Child 1-4 years old I: Infant MJN: Mead Johnson Nutrition R/I: Retail/Institutional RTF: Ready to Feed W: Woman This institution is an equal opportunity provider.
