Approved Formulas in the New York State WIC Program
Formulary
Effective April, 2020
| 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
