New York State WIC Approved Formulas

Effective September 2014

New York State WIC Contract - Infant Formula
Contract Infant Formulas Size and formulation Approved for:
Enfamil A.R. 12.9 oz. powder, 32 oz. RTU I / C
Enfamil Gentlease 12.4 oz. powder, 32 oz. RTU I / C
Enfamil Infant 13 oz. concentrate, 12.5 oz. powder, 32 oz. RTU I / C
Enfamil ProSobee 13 oz. concentrate, 12.9 oz. powder, 32 oz. RTU I / C

EXEMPT FORMULAS/WIC-ELIGIBLE NUTRITIONALS FOR INFANTS, CHILDREN & WOMEN
Hypoallergenic Formulas Size and formulation Approved for:
EleCareFor Infants 14.1 oz. powder I / C
Nutramigen 13 oz. concentrate, 32 oz. RTU I / C
Nutramigen with EnfloraLGG 12.6 oz. powder I / C
Neocate Infant with DHA and ARA 14.1 oz. powder I / C
Similac Expert Care Alimentum 16 oz. powder, 32 oz. RTU I / C
Formulas for Premature Infants Size and formulation Approved for:
Enfamil EnfaCare (22 Calories/fl oz.) 12.8 oz., 32 oz. RTU I only
Similac Expert Care Neosure (22 Calories/fl oz.) 13.1 oz. powder, 32 oz. RTU I only
Specialized Formulas Size and formulation Approved for:
Pregestimil 16 oz. powder I / C
Enfaport 8 oz. RTU I only
Similac PM 60/40 14.1 oz. powder I / C
Calorie and Nutrient Dense Products Size and formulation Approved for:
Boost/Boost High Protein 6 pack -8 oz. RTU W only
Boost Kid Essentials 4 pack -8.25 oz. RTU C only
Ensure 6 pack -8 oz. RTU W only
Ensure Plus 6 pack -8 oz. RTU W only
PediaSure/PediaSure with Fiber 6 pack -8 oz. RTU C only
PediaSure Enteral/PediaSure Enteral with Fiber 8 oz. RTU C only
Modular Products Size and formulation Approved for:
MCT oil 32 oz. RTU I / C / W
Phenex-1 14.1 oz. powder I / C
Phenex-2 14.1 oz. powder C / W
Phenyl-Free1 16 oz. powder I / C
Phenyl-Free 2 16 oz. powder C / W
Portagen 16 oz. powder C / W

Please note:

  • Medical documentation is required for:
    • exempt formula, WIC-Eligible Nutritionals, and/or
    • greater amounts of contract formula for infants 6 months or older unable to tolerate solid infant foods
  • Medical documentation includes an appropriate qualifying medical condition/medical reason for the formula, quantity (ounces/day), duration of formula and food restrictions/referral.

The need for Ready-To-Use (RTU) formula will be addressed by the WIC Program.

Legend

  • I = infant < 1 year
  • C = child 1 to ≤ 5 years
  • W = woman