Approved Formulas in the New York State WIC Program

Formulary

Effective October, 2020

New York State WIC Contract - Infant Formula
Contract Infant Formulas Size and formulation Approved for:
Enfamil Infant 12.5 oz. powder, 13 oz. concentrate, 32 oz. ready-to-use I / C
Enfamil NeuroPro Infant 32 oz. ready-to-use I / C
Enfamil A.R. 12.9 oz. powder I / C
Enfamil Gentlease 12.4 oz. powder I / C
Gerber Good Start Soy 12.9 oz. powder, 8.1 oz. concentrate, 4 pack (8.45 oz.) ready-to-use I / C

EXEMPT FORMULAS/WIC-ELIGIBLE NUTRITIONALS FOR INFANTS, CHILDREN & WOMEN

Hypoallergenic Formulas Size and formulation Approved for:
EleCare for Infants 14.1 oz. powder I / C
EleCare Jr. 14.1 oz. powder C only
Nutramigen 13 oz. concentrate, 32 oz. ready-to-use I / C
Nutramigen with Enflora LGG 12.6 oz. powder I / C
Neocate Infant with DHA and ARA 14.1 oz. powder I / C
Neocate Jr. 14.1 oz. powder C only
Similac Alimentum 12.1 oz. powder, 32 oz. ready-to-use I / C
Formulas for Premature Infants    
Enfamil NeuroPro EnfaCare 12.8 oz. powder I only
Similac Neosure 13.1 oz. powder, 32 oz. ready-to-use I only
Specialized Formulas    
Pregestimil 16 oz. powder I / C
Enfaport 6 pack -6 oz. ready-to-use I only
Similac PM 60/40 14.1 oz. powder I / C
Calorie and Nutrient Dense Products    
Boost 6 pack (8 oz.) ready-to-use W only
Boost High Protein 6 pack (8 oz.) ready-to-use W only
Boost Kid Essentials 8 oz. ready-to-use C only
Bright Beginnings Soy Drink 6 pack (8 oz.) ready-to-use C only
Ensure 6 pack (8 oz.) ready-to-use W only
Ensure Plus 6 pack (8 oz.) ready-to-use W only
PediaSure 6 pack (8 oz.) ready-to-use C only
PediaSure with Fiber 6 pack (8 oz.) ready-to-use C only
PediaSure Enteral 8 oz. ready-to-use C only
PediaSure Enteral with Fiber 8 oz. ready-to-use C only
Modular Products    
MCT oil (Nestle) 32 oz. ready-to-use I / C / W
Phenex-1 14.1 oz. powder I / C
Phenex-2 14.1 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), length of use, and food restrictions.
  • All flavors are approved for NYS WIC eligible formula products

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

Legend

  • I = infant less than 1 year
  • C = child less than 5 years
  • W = woman