Approved Formulas in the New York State WIC Program
Formulary
Effective July 2016 - Revised
| Contract Infant Formulas | Size and formulation | Approved for: |
|---|---|---|
| Enfamil A.R. | 12.9 oz. powder, 6 pack -8oz. 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 |
| Gerber Good Start Soy |
12.1 oz. concentrate, 12.9 oz powder, 4 pack - 8.45 oz RTU | I / C |
| 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 Alimentum | 12.1 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. powder, 6 pack -8oz. RTU | I only |
| Similac 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 | 6 pack - 6oz. 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 | Issued by State Level Approval Only | 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-Free 1 | 16 oz.powder | I / C |
| Phenyl-Free 2 | 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
