Infant Formula

(effective October 1, 2009)

What you can find...

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

WIC Approved Formulas

The Washington State WIC Approved Formula List (32.78 KB) contains a complete list of WIC approved infant formulas.

Formulas Currently Approved for Washington WIC

Standard	Standard	Standard	Standard
Therapeutic	Therapeutic	Therapeutic	Therapeutic
Therapeutic	Therapeutic	Therapeutic	Therapeutic

WIC Prescription Forms

• Women (55.90 KB)
• Infants (82.02 KB)
• Children (92.08 KB)

Formula Resources

• Can Sizes, Yields and Maximum Amounts of Formula Table (22.81 KB)
• WIC Clinic Response to Formula Requests (flow chart) (23.48 KB)

Links to locate hard to find formulas:

• Similac Sensitive R.S.
• Similac Sensitive NeoSure
• PediSure
• Other Abbott products
• Enfamil EnfaCare LIPIL
• Nutramigen LIPIL
• Other Mead Johnson products

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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 (Health and Recovery Services Administration) if they are eligible. The following information may help in the search for assistance.

• WIC Clinic Response to Formula Requests (flow chart) (23.48 KB)
• Process to Request Formula from Medicaid (47.17 KB)
• WIC/Medicaid Nutrition Form (29.25 KB)
• Medical Foods and Medical Formulas Form (85.99 KB)

Additional Medicaid contact information:

• Medicaid Clients and Health Professionals:  Call the phone number on the reverse side of the Medical Information card (medical coupon):  800-562-3022
• Medicaid Enteral Nutrition Billing Instructions (438 KB)

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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 version 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 WIC's Web Coordinator. Download the free PDF viewer here.

In accordance with Federal law and U.S. Department of Agriculture policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age, or disability. To file a complaint, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410 or call 800-795-3272 (voice) or 202-720-6382 (TTY). USDA is an equal opportunity provider and employer.

Washington WIC does not discriminate.

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WIC Program
Washington State Department of Health
PO Box 47886
Olympia, Washington, 98504-7886

Last Update:  10/23/2009 01:40 PM
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