Infant Formula

(effective February 1, 2012)

What you can find...

Unless otherwise noted, all materials and forms on this page are in PDF format.

WIC Approved Formulas

Washington State WIC Approved Formulas List (56KB)

Standard Formulas

Standard formulas are for infants less than one year old. Children one year and older must have a prescription to get a standard formula.

Formula labels change often. The newest labels are shown below.

 

Similac Advance

Similac Soy

Similac Sensitive
Fussiness & Gas

Similac for
Spit-Up

 

Therapeutic Formulas

Therapeutic formulas are for infants and children with special nutrition needs. They must have a medical diagnosis listed on the WIC Prescription Form to get this type of formula. The medical provider must use the WIC Prescription Form to prescribe one of these formulas. See the WIC Prescription Form for the list of diagnoses and formulas.

Formula labels change often. The newest labels are shown below.

 

Similac
NeoSure

Similac
Alimentum

Good Start
Gentle

 

 

Nutramigen

Enfamil
EnfaCare

PediaSure

 

WIC Prescription Forms

• Women (71KB)
• Infants (72KB)
• Children (90KB)

Formula Resources

• Pictures of WIC Approved Formulas (1.7MB)
• Can Sizes, Yields and Maximum Amounts of WIC Approved Formulas Table (65KB)
• WIC Clinic Response to Formula Requests (flow chart) (23KB)

Links to Find Formulas

• Abbott Products
  • Similac Alimentum
  • Similac NeoSure
  • PediaSure
• Mead Johnson Products
  • Enfamil EnfaCare LIPIL
  • Nutramigen LIPIL
• Gerber Products
  • Good Start Gentle

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Getting Medical Formulas & Foods That WIC Doesn't Provide

If a client is not eligible for the WIC Program or the WIC Program cannot meet the client's formula or enteral nutrition product needs, the client may seek assistance from Medicaid if they are eligible. The following information may help in the search for assistance.

• WIC Clinic Response to Formula Requests (flow chart) (23KB)
• Process to Request Formula from Medicaid (47KB)
• WIC/Medicaid Nutrition Form (29KB)
• Medical Foods and Medical Formulas Form (63KB)

Additional Medicaid contact information:

• Medicaid Clients and Health Professionals:  Call the phone number on the reverse side of the ProviderOne Services Card:  800-562-3022
• Medicaid (Health and Recovery Services Administration) Enteral Nutrition Billing Instructions (438KB)

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Return to WIC Foods

Links to external resources are provided as a public service and do not imply endorsement by the Washington State Department of Health.

Documents posted in PDF, Word, and other formats on the Department of Health Web site will be made available on request to users who are unable to download or view them. For persons with disabilities, PDF documents will be made available on request in other formats. To submit a request, contact the Web Coordinator. Download the free viewers here.

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Washington State Department of Health WIC Nutrition Program
111 Israel Rd SE, P.O. Box 47886
Olympia, Washington, 98504-7890

Last Update:  February 06, 2012
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