Approved Formulas in the New York State WIC Program

Formulary

Effective September 2022

Contract Formulas
Contract Infant Formulas Size and Formulation Temporarily available as a substitute
at the point of purchase		 Approved for
Enfamil Infant 12.5 oz. powder Enfamil Infant 21.1 oz. powder,
Enfamil Infant 29.4 oz. powder,
Enfamil NeuroPro Infant 20.7 oz. powder,
Enfamil NeuroPro Infant 28.3 oz. powder,
Enfamil NeuroPro Infant 31.4 oz. powder,
Parents Choice Infant 12.5 oz. powder,
Parents Choice Infant 22.2 oz. powder,
Parents Choice Infant 36 oz. powder,
Well Beginnings Infant 22.2 oz. powder,
Well Beginnings Infant 34 oz. or 35 oz. powder,
CVS Health Infant 34 oz. powder,
Up & Up Infant 22.2 oz. powder
Up & Up Infant 35 oz. powder,
Always My Baby Infant 22.2 oz. powder,
Signature Care Infant 22.2 oz. powder,
Signature Care Infant 34 oz. or 35 oz. powder,
Tippy Toes Infant 22.2 oz powder,
Tippy Toes Infant 34 oz. powder,
Kendamil Classic First Infant Milk Stage 1 900 g (31.8 oz.) powder 		I / C
Enfamil Infant 13 oz. concentrate I / C
Enfamil Infant and Enfamil NeuroPro Infant 32 oz. ready-to-use Enfamil NeuroPro Infant 6 pack (8 oz.) ready-to-use I / C
Enfamil A.R. 12.9 oz. powder Enfamil A.R. 19.5 oz. powder,
Enfamil A.R. 27.4 oz. powder,
Enfamil A.R. 30.4 oz. powder,
Parents Choice A.R. 21.5 oz. powder,
Parents Choice A.R. 32.2 oz. powder,
Up & Up A.R. 32.2 oz. powder		 I / C
Enfamil Gentlease 12.4 oz. powder Enfamil Gentlease 19.9 oz. powder,
Enfamil Gentlease 27.7 oz. powder,
Enfamil NeuroPro Gentlease 19.5 oz. powder,
Enfamil NeuroPro Gentlease 27.4 oz. powder,
Enfamil NeuroPro Gentlease 30.4 oz. powder,
Parents Choice Gentle 12 oz. powder,
Parents Choice Gentle 21.5 oz. powder,
Parents Choice Gentle 34 oz. powder,
Well Beginnings Gentle 21.5 oz. powder,
CVS Health Gentle 21.5 oz. powder,
CVS Health Gentle 33.2 oz. powder,
Up & Up Gentle 21.5 oz. powder,
Up & Up Gentle 33.2 oz. powder,
Always My Baby Gentle 21.5 oz. powder,
Signature Care Gentle 21.5 oz. powder,
Tippy Toes Gentle 21.5 oz. powder,
Tippy Toes Gentle 33.2 oz. powder,
Bubs Supreme Infant Formula Stage 1 800 g (28.2 oz.) powder,
Bubs Supreme Follow On Formula Stage 2 800 g (28.2 oz.) powder 		I / C
Enfamil Reguline 12.4 oz. powder Enfamil Reguline 19.5 oz. powder I / C
Similac Soy Isomil 12.4 oz. powder Similac Soy Isomil 30.8 oz. powder,
Enfamil Prosobee 12.9 oz. powder,
Enfamil Prosobee 20.9 oz. powder,
Gerber Good Start Soy 12.9 oz. powder,
Gerber Good Start Soy 20 oz. powder,
Parents Choice Soy 22 oz. powder,
Well Beginnings Soy 22 oz. powder,
CVS Health Soy 22 oz. powder,
Up & Up Soy 36 oz. powder,
Always My Baby Soy 22 oz. powder,
Tippy Toes Soy 22 oz. powder		 I / C
Similac Soy Isomil 13 oz. concentrate, 32 oz. ready-to-use I / C
Exempt Formulas
Hypoallergenic Formulas Size and Formulation Temporarily available as a substitute
at the point of purchase		 Approved for
Alfamino Infant 14.1 oz. powder I / C
EleCare for Infants 14.1 oz. powder I / C
EleCare Jr. 14.1 oz. powder C only
Gerber Good Start Extensive HA 14.1 oz. powder I / C
Nutramigen 13 oz. concentrate, 32 oz. ready-to-use I / C
Nutramigen with Probiotic LGG 12.6 oz. powder Nutramigen with Probiotic LGG 19.8 oz. powder,
Nutramigen with Probiotic LGG 27.8 oz. powder		 I / C
Neocate Infant with DHA and ARA 14.1 oz. powder Neocate Syneo Infant 14.1 oz. powder I / C
Neocate Jr. 14.1 oz. powder C only
PurAmino Infant 14.1 oz. powder I / C
Similac Alimentum 12.1 oz. powder, 32 oz. ready-to-use I / C
Formulas for Premature Infants Size and Formulation Temporarily available as a substitute
at the point of purchase		 Approved for
Enfamil NeuroPro EnfaCare 13.6 oz. powder Enfamil NeuroPro EnfaCare 23 oz. powder I only
Similac Neosure 13.1 oz. powder, 32 oz. ready-to-use I only
Specialized Formulas Size and Formulation Temporarily available as a substitute
at the point of purchase		 Approved for
Pregestimil 16 oz. powder,
6 pack (2 oz.) ready-to-use
available 6/17/2022 		I / C
Enfaport 6 pack (6 oz.) ready-to-use I only
Similac PM 60/40 14.1 oz. powder I / C
WIC-Eligible Nutritionals
Calorie and Nutrient Dense Products Size and Formulation Approved for
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 Size and Formulation Approved for
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
  • Medical documentation is required for:
    • Infants 6 months or older with greater amounts of contract formula in lieu of infant foods
    • Infants and children with exempt formula
    • Children with contract formula
    • Children and women with infant foods
    • Children and women with WIC-eligible nutritionals
  • Medical documentation includes an appropriate qualifying medical condition for the formula, quantity (ounces/day), length of use, and food restrictions. The Medical Documentation Form is available at: https://www.health.ny.gov/forms/doh-4456.pdf
  • Premature formulas may be provided to premature infants up to their corrected age of 12 months.
  • All flavors are approved for NYS WIC eligible formula products.
  • The need for Ready-To-Use formula will be addressed by the WIC Program

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