New York State WIC Approved Formulas
- New York State WIC Approved Formulas is also available in Portable Document Format (PDF, 16KB, 2pg.)
Effective February 2012
| New York State WIC Contract - Infant Formula | ||
|---|---|---|
| Infant Formula | Size and formulation** | Approved for: |
| Enfamil A.R.® | 12.9 oz. pwdr., 32 oz. RTU | I / C |
| Enfamil Gentlease® | 12.4 oz. pwdr, 32 oz. RTU | I / C |
| Enfamil® PREMIUM® INFANT | 13 oz. conc., 12.5 oz. pwdr., 32 oz. RTU | I / C |
| Enfamil ProSobee® | 13 oz. conc., 12.9 oz. pwdr., 32 oz. RTU | I / C |
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
| Other Formulas for Infants and Children - Medical Documentation Required* | ||
| Hypoallergenic Formula | Size and formulation** | Approved for: |
| Similac® Expert CareTM Alimentum® | 16 oz. pwdr., 32 oz. RTU | I / C |
| Enfamil Nutramigen® | 13 oz. conc., 32 oz. RTU | I / C |
| Enfamil Nutramigen® with Enflora TM LGG® | 12.6 oz. pwdr. | I / C |
| Neocate® Infant with DHA and ARA | 14 oz. pwdr. | I / C |
| EleCare® with DHA/ARA | 14.1 oz. pwdr. | I / C |
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
| Formula for Premature Infants | Size and formulation** | Approved for: |
| Enfamil EnfaCare® (22 Calories/fl oz.) | 12.8 oz. pwdr., 32 oz. RTU | I only |
| Similac® Expert CareTM Neosure® (22 Calories/fl oz.) | 13.1 oz. pwdr., 32 oz. RTU | I only |
| Enfamil Premature LIPIL with Iron (20/24 Calories/fl oz.) | 6 pack -2 oz. RTU | I < 4 months |
| Enfamil Premature LIPIL Low Iron (20/24 Calories/fl oz.) | 6 pack -2 oz. RTU | I < 4 months |
| Similac® Special Care® 24 | 8 pack -2 oz. RTU | I < 4 months |
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
| Specialized Formula | Size and formulation** | Approved for: |
| Enfamil Pregestimil® | 16 oz. pwdr. | I / C |
| Enfaport | 8 oz. RTU | I |
| Similac® PM 60/40 | 14.1 oz. pwdr. | I / C |
| Enfamil Human Milk Fortifier*** | 200 packets - 5mL vial liquid | Fully and Mostly Breastfeeding Women |
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
| Enteral Formulas for Women & Children - Medical Documentation Required* | ||
| Product | Size and formulation** | Approved for: |
| Boost®/Boost High Protein | 6 pack -8 oz. RTU | C / W |
| Boost Kid Essentials | 4 pack -8.25 oz. RTU | C |
| Ensure® | 6 pack -8 oz. RTU, 32 oz. RTU | C / W |
| Ensure Plus | 6 pack -8 oz. RTU | C / W |
| Pediasure® with DHA/Pediasure with Fiber and DHA | 6 pack -8 oz. RTU | C only |
| Pediasure Enteral/Pediasure Enteral with Fiber | 6 pack -8 oz. RTU | C only |
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
| Modular Products - Medical Documentation Required* | ||
| Product | Size and formulation** | Approved for: |
| MCT oil | 32 oz. RTU | I / C / W |
| MSUD Analog® | 14 oz. pwdr. | I only |
| MSUD Maxamaid® | 16 oz. pwdr. | C only |
| MSUD Maxamum® | 16 oz. pwdr. | W only |
| Osmolite® | 8 oz. RTU | C / W |
| Phenex™-1 | 14.1 oz. pwdr. | I / C |
| Phenex™-2 | 14.1 oz. pwdr. | C / W |
| Phenyl-Free®1 | 16 oz. pwdr. | I / C |
| Phenyl-Free 2 | 16 oz. pwdr. | C / W |
| PKU 2 | 17.5 oz. pwdr. | C only |
| PKU 3 | 17.5 oz. pwdr. | W only |
| Polycose® | 12.3 oz. pwdr. | I / C / W |
| Portagen® | 16 oz. pwdr. | C / W |
| Periflex Infant | 14 oz. pwdr. | I only |
| XPhe Maxamaid | 16 oz. pwdr. | C only |
| XPhe Maxamum | 16 oz. pwdr. | W only |
| *Medical documentation required - Please provide the appropriate diagnosis or medical reason for the formula, ICD-9 code, quantity (ounces/day), duration of formula and food restrictions. | ||
| **The need for ready-to-use formula will be addressed by the WIC Program. | ||
| ***Only available for issuance through SFFI. | ||
| Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman | ||
