Virginia wic special formula form 2014-2025

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The document outlines the Virginia Women, Infants, and Children (WIC) Program's policies on breastfeeding and formula provision. It emphasizes breastfeeding as the preferred feeding method while detailing the specific formulas available through a contract with Abbott Nutrition. The document also explains the process for issuing special food prescriptions for infants and children with medical conditions requiring alternative formulas or foods, including guidelines for completing the WIC-395 request form.
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What routine infant formula does Virginia WIC offer? The current Virginia WIC infant formula contract is with Abbott, the maker of Similac formula. The following infant formulas are available without medical documentation- Similac Advance, Similac Sensitive, Similac Total Comfort, and Similac Soy Isomil.
Virginia WIC provides the following contract infant formulas- Similac Advance, Similac Soy Isomil, Similac Sensitive, and Similac Total Comfort. Non-contract brand formulas, such as Enfamil, Good Start, and store brands, cannot be provided. WIC-395 forms must be fully complete.
maximum monthly allowance (MMA): 3 containers of powder infant formula x 90 reconstituted fluid ounces = 270 fl. oz. This is below the MMA of 435 fl. oz.
WIC will usually cover specialty formulas as long as they are under the brand umbrella for whatever brand the state contracts with. If your state covers Similac and Enfamil, they should cover Alimentum or Nutramigen with a prescription from the doc.
maximum monthly allowance (MMA): 14 containers of liquid concentrate infant formula x 26 reconstituted fluid ounces = 364 fl. oz.

what formula does wic cover in va

Virginia wic special formula form 2014 printable Virginia wic special formula form 2014 pdf Virginia wic special formula form 2014 online Virginia WIC formula List 2024 wic-395 form 2024 Virginia WIC approved formula list Special formula WIC form WIC form 2024

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Through a unique partnership between Virginia WIC and Virginia Medicaid, WIC participants can obtain their full formula needs via their WIC benefits versus having to order any additional formula needed from a pharmacy or DME provider.
Enfamil ProSobee Soy-Based (12.9 oz. powder or 13 fl. oz. liquid concentrate)

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