New York State WIC Approved Formulas

New York State WIC Contract - Infant Formula
Infant Formula Size and formulation** Approved for:
Enfamil® LIPIL® with Iron 13 oz. conc., 12.9 oz. pwdr., 32 oz. RTU I / C
Enfamil Gentlease® LIPIL 12 oz. pwdr. I / C
Nestle Good Start® Soy Plus 13 oz. conc., 12.9 pwdr., 32 oz. RTU I / C
Enfamil A.R.® LIPIL 12.9 oz. pwdr., 32 oz. RTU I / C
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman

Other Formulas for Infants and Children - Medical Documentation Required*
Hypoallergenic Formula Size and formulation** Approved for:
Similac® Alimentum® 16 oz. pwdr., 32 oz. RTU I / C
Enfamil Nutramigen® LIPIL 13 oz. conc., 32 oz. RTU I / C
Neocate® Infant 14 oz. pwdr. I / C
Neocate® Infant with DHA and ARA 14 oz. pwdr. I / C
EleCare® (Unflavored) 14.1 oz. pwdr. I / C
EleCare® with DHA/ARA 14.1 oz. pwdr. I / C
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman
Formula for Premature Infants Size and formulation** Approved for:
Enfamil EnfaCare® LIPIL (22 Calories/fl oz.) 12.8 oz. pwdr., 32 oz. RTU I only
Similac Neosure® (22 Calories/fl oz.) 12.8 oz. pwdr., 32 oz. RTU I only
Enfamil Premature LIPIL with Iron (20/24 Calories/fl oz.) 6 pack -2 oz. RTU I < 4 months
Enfamil Premature LIPIL Low Iron (20/24 Calories/fl oz.) 6 pack -2 oz. RTU I < 4 months
Similac® Special Care® 24 8 pack -2 oz. RTU I < 4 months
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman
Specialized Formula Size and formulation** Approved for:
Enfamil Pregestimil® LIPIL 16 oz. pwdr. I / C
Similac® PM 60/40 14.1 oz. pwdr. I / C
Enfamil Human Milk Fortifier*** 200 packets -.025 oz. pwdr. I only
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman

Enteral Formulas for Women & Children - Medical Documentation Required*
Product Size and formulation** Approved for:
Boost®/Boost High Protein 6 pack -8 oz. RTU C / W
Boost Kid Essentials 6 pack -8.25 oz. RTU C only
Ensure® 6 pack -8 oz. RTU, 32 oz. RTU C / W
Ensure Plus/Ensure with Fiber 6 pack -8 oz. RTU C / W
Pediasure® with DHA/Pediasure with Fiber and DHA 6 pack -8 oz. RTU C only
Pediasure Enteral/Pediasure Enteral with Fiber 6 pack -8 oz. RTU C only
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman

Modular Products - Medical Documentation Required*
Product Size and formulation** Approved for:
MCT oil 32 oz. RTU I / C / W
MSUD Analog® 14 oz. pwdr. I only
MSUD Maxamaid® 16 oz. pwdr. C only
MSUD Maxamum® 16 oz. pwdr. W only
Osmolite® 8 oz. RTU C / W
Phenex™-1 14.1 oz. pwdr. I / C
Phenex™-2 14.1 oz. pwdr. C / W
Phenyl-Free®1 16 oz. pwdr. I / C
Phenyl-Free 2 16 oz. pwdr. C / W
PKU 2 17.5 oz. pwdr. C only
PKU 3 17.5 oz. pwdr. W only
Polycose® 12.3 oz. pwdr. I / C / W
Portagen® 16 oz. pwdr. C / W
XPhe Analog 14 oz. pwdr. I only
XPhe Maxamaid 16 oz. pwdr. C only
XPhe Maxamum 16 oz. pwdr. W only
*Medical documentation required - Please provide the appropriate diagnosis or medical reason for the formula, ICD-9 code, quantity (ounces/day), duration of formula and food restrictions.
**The need for ready-to-use formula will be addressed by the WIC Program.
***Only available for issuance through SFFI.
Legend: I = infant < 1 year; C = child 1 to < 5 years; W = woman