Approved Formulas in the New York State WIC Program
Formulary
Effective October, 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