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You are Here: Home Page > WIC > New York State WIC Approved Formulas  

New York State WIC Approved Formulas

• New York State WIC Approved Formulas is also available in Portable Document Format (PDF, 78KB, 2pg.)

New York State WIC Contract - Infant Formula

Infant Formula	Size and formulation**	Approved for
Enfamil® LIPIL® with Iron	13 oz. concentrated, 12.9 oz. powder, 32 oz. ready-to-use	Infants Children
Enfamil Gentlease® LIPIL	12 oz. powder	Infants Children
Nestle Good Start ® Soy Plus	13 oz. concentrated, 12.9 powder, 32 oz. ready-to-use	Infants Children
Enfamil A.R.® LIPIL	12.9 oz. powder, 32 oz. ready-to-use	Infants Children

Other Formulas For Infants And Children

Medical Documentation Required*

Infant Formula	Size and formulation**	Approved for
Hypoallergenic Formula
Similac® Alimentum®	16 oz. powder, 32 oz. ready-to-use	Infants Children
Enfamil Nutramigen® LIPIL	13 oz. concentrated, 32 oz. ready-to-use	Infants Children
Neocate® Infant	14 oz. powder	Infants Children
Neocate® Infant with DHA and ARA	14 oz. powder	Infants Children
EleCare® (Unflavored)	14.1 oz. powder	Infants Children
EleCare® with DHA/ARA	14.1 oz. powder	Infants Children
Formula for Premature Infants
Enfamil EnfaCare® LIPIL (22 Calories/fl oz.)	12.8 oz. powder, 32 oz. ready-to-use	Infants only
Similac Neosure® (22 Calories/fl oz.)	12.8 oz. powder, 32 oz. ready-to-use	Infants only
Enfamil Premature LIPIL with Iron (20/24 Calories/fl oz.)	6 pack -2 oz. ready-to-use	Infants less than 4 months
Enfamil Premature LIPIL Low Iron (20/24 Calories/fl oz.)	6 pack -2 oz. ready-to-use	Infants less than 4 months
Similac® Special Care® 24	8 pack -2 oz. ready-to-use	Infants less than 4 months
Specialized Formula
Enfamil Pregestimil® LIPIL	16 oz. powder	Infants Children
Similac® PM 60/40	14.1 oz. powder	Infants Children
Enfamil Human Milk Fortifier	200 packets -.025 oz. powder	Infants only

Enteral Formulas for Women & Children

Medical Documentation Required*

Product	Size and formulation**	Approved for
Boost®/Boost High Protein	6 pack -8 oz. ready-to-use	Children Women
Ensure®	6 pack -8 oz. ready-to-use, 32 oz. ready-to-use	Children Women
Ensure Plus/Ensure with Fiber	6 pack -8 oz. ready-to-use	Children Women
Pediasure® with DHA/Pediasure with Fiber and DHA	6 pack -8 oz. ready-to-use	Children only
Pediasure Enteral/Pediasure Enteral with Fiber	6 pack -8 oz. ready-to-use	Children only

Modular Products

Medical Documentation Required*

Product	Size and formulation**	Approved for
MCT oil	32 oz. ready-to-use	Infants Children Women
MSUD Analog®	14 oz. powder	Infants only
MSUD Maxamaid®	16 oz. powder	Children only
MSUD Maxamum®	16 oz. powder	Women only
Osmolite®	8 oz. ready-to-use	Children Women
Phenex™-1	14.1 oz. powder	Infants Children
Phenex™-2	14.1 oz. powder	Children Women
Phenyl-Free®1	16 oz. powder	Infants Children
Phenyl-Free 2	16 oz. powder	Children Women
PKU 2	17.5 oz. powder	Children only
PKU 3	17.5 oz. powder	Women only
Polycose®	12.3 oz. powder	Infants Children Women
Portagen®	16 oz. powder	Children Women
XPhe Analog	14 oz. powder	Infants only
XPhe Maxamaid	16 oz. powder	Children only
XPhe Maxamum	16 oz. powder	Women only

Footnotes

1. Infant: Less than 1 year
2. Child: 1 - less than 5 years
3. *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.
4. ** The need for ready-to-use formula will be addressed by the WIC Program.