WIC Retailer Application Information

For currently authorized retailers, the contract to accept Washington Women, Infant and Children (WIC) checks expires at 11:59 pm on March 31, 2012. You must apply if you want to be considered for a contract to accept WIC checks for the 2012-2015 contract period beginning April 1, 2012.

Please send written notification by January 1, 2012 if you want a store to be newly authorized prior to April 1, 2012. The written notice can be sent by mail to the WIC retailer management team (address below) or by email and does not have to include a completed application. Please tell us the location and anticipated opening date. This way we can be sure to have resources available to process the request when you need it.

Retailer authorization requests received without timely notice will be considered for authorization for the contract period beginning April 1, 2012.

Read all the materials carefully and fill out the forms completely. There are important changes and new requirements for the upcoming contract period. Please read the following before starting the applications:

Highlights of Changes (Word, 68KB)
Owner/Retailer Application Instructions (Word, 290KB)
Food Price List Instructions (Word, 78KB)
Selection Criteria (Word, 96KB)
Formula Supplier List (PDF, 220KB)
Minimum Inventory Requirements (PDF, 429KB)

Application Forms

The requirements to become an authorized retailer are listed in the revised WAC section 246-790-075. To be considered for authorization each business must submit:

One completed Owner Application Form (Word, 177KB).
A complete Retailer Application Form (Word, 221KB) for each retail store location
A Food Price List (Word, 163KB) for each price structure and for each store not in a price structure
A copy of a recent invoice for WIC approved formula
A Presumptive Payment Form (PDF, 237KB) for each store location, even if you have completed one before.

For example, a business operating a single store location would submit both an owner and retailer application. A business operating nine stores would submit one owner application and nine retailer applications.

The application forms can be completed electronically but cannot be submitted electronically at this time.

Please return your completed application materials as soon as possible. It takes approximately forty-five (45) days to process an application. We may not be able to process applications received after January 31, 2012 in time for the beginning of the April 1, 2012 contract period. Please note that completing the application packet does not mean your retail store(s) will be authorized. You’ll receive a written decision from us by return mail.

Your application forms, price list, presumptive payment forms, and infant formula invoices must be mailed to:

WIC State Nutrition Program
Attn: Retailer Management Team
PO Box 47886
Olympia, WA 98501

If you have questions, call 1-800-841-1410, ext 3620 for our Customer Service Specialist.

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