Approved Formulas in the New York State WIC Program
Formulary
Effective August 2023
| Contract Infant Formulas | Size and Formulation | Approved for |
|---|---|---|
| Enfamil Infant | 12.5 oz. powder | I / C |
| Enfamil Infant | 13 oz. concentrate | I / C |
| Enfamil Infant and 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 |
| Enfamil Reguline | 12.4 oz. powder | I / C |
| Similac Soy Isomil | 12.4 oz. powder, 13 oz. concentrate, 32 oz. ready-to-use |
I / C |
| Hypoallergenic Formulas | Size and Formulation | 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 |
| 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 | I / C |
| Neocate Infant with DHA and ARA and 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 | Approved for |
| Enfamil NeuroPro EnfaCare | 13.6 oz. powder | I only |
| Similac Neosure | 13.1 oz. powder, 32 oz. ready-to-use | I only |
| Specialized Formulas | Size and Formulation | Approved for |
| Pregestimil | 16 oz. powder, 6 pack (2 oz.) ready-to-use |
I / C |
| Enfaport | 6 pack (6 oz.) ready-to-use | I only |
| Similac PM 60/40 | 14.1 oz. powder | I / C |
| Pareve Infant Formula | Size and Formulation | Approved for |
|---|---|---|
| Gerber Good Start Soy (PAREVE for religious exemptions only) |
20 oz. powder | I / C |
| 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 |
| 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 | 4 pack (7.4 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
