Formulas Provided by the Washington State WIC Nutrition ProgramFormulas offered by Washington State WIC may be available in Powder, Concentrate and, in limited situations, Ready-to-Feed

Only sell what is written on the check | Effective May 2019

Standard Formulas:Infants don’t need a WIC Medical Documentation Form for these formulas. Children and women do need a Medical Documentation Form.

Alternate Contract Formulas:A WIC Medical Documentation Form must be on file at the WIC clinic for all infants, children, and women for these formulas.

PediaSure

Therapeutic Formulas: A WIC Medical Documentation Form must be on file at the WIC clinic for all infants, children, and women for these formulas. PediaSure with Fiber

or

www.doh.wa.gov/YouandYourFamily/WIC/WICFoods/InfantFormula.aspx

Washington State WIC Nutrition Program does not discriminate.

This institution is an equal opportunity provider.

WIC supports breastfeeding.

DOH 960-326 May 2019

For persons with disabilities, this document is available upon request in other formats. To submit a request, please call 1-800-841-1410 (TDD/TTY 711).