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Extensively hydrolyzed casein-based formulasEnfamil Nutramigen(Mead Johnson Nutrition)Neocate Infant DHA/ARA(Nutricia)Neocate Syneo Infant(Nutricia)PurAmino DHA and ARA(Mead Johnson Nutrition)8 more rows
maximum monthly allowance (MMA): 14 containers of liquid concentrate infant formula x 26 reconstituted fluid ounces = 364 fl. oz.
California WIC is Switching Formulas Brands California WIC is switching from Enfamil brand formula to Similac brand, as of August 1, 2022. This change is due to CDPH/WIC starting a new infant formula contract. This is because WIC is required to provide the infant formula with the best contract price.
As of October 1, 2023 the North Carolina state WIC contract for standard infant human milk substitute will be transitioning to Abbot Similac products. The following Gerber formula products will no longer be available through WIC program benefits (regardless of if a formula prescription is provided).
Formerly Nestle Good Start Gentle Plus Powder An excellent formula choice for babies 0 to 12 months Milk-based formula with our unique 100% whey COMFORT PROTEINS@ for easy digestion and DHA ARA to support brain and eye development.

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The WIC Program has entered into a contract with Abbott Laboratories to be the primary provider of infant formula for the WIC Program. The contract brand of infant formula is Similac Advance and Similac Soy Isomil.
South Carolina WIC has a contract with Nestl for participants to purchase the following Gerber Good Start formulas: Gerber Good Start Gentle Pro. Gerber Good Start Soy. Gerber Good Start Soothe Pro.

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Medical Documentation for Formula and Food

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nys medicaid program- enteral formula prior authorization

Please note: This form should only be used as a guide when accessing the automated system. Do not submit this form as a prior approval request or as medical

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WIC Pediatric Referral - Health Net Provider Library

SECTION I: Complete this section to assist the patient with WIC eligibility, WIC services, and appropriate referrals. Whenever a therapeutic formula is

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