Prescription Required Infant Formulas - State of Indiana
Prescription Required Infant Formulas - State of Indiana
Prescription Required Infant Formulas - State of Indiana
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W-C<br />
WIC Eligible<br />
Formula Name<br />
Pediasure Peptide 1.0 Cal.(Any flavor)--<br />
(formerly Vital Jr.)<br />
Formula<br />
Company<br />
Container Size<br />
Concentrate<br />
RTU<br />
Powder<br />
INDIANA WIC AUTHORIZED FORMULAS<br />
(Print in COLOR for ease in reading)<br />
Fully Formula Fed<br />
(*FFF)<br />
A B C<br />
0-3mo / 4-5mo / 6-11mo<br />
Some BreastFeeding<br />
(**SBF)<br />
A B C D<br />
0 to 1/ 1-3/ 4-5/ 6-11<br />
Mostly BreastFed (***MBF)<br />
A B C D<br />
0 to 1/ 1-3/ 4-5/ 6-11<br />
****Women<br />
&<br />
Children<br />
(Fd. Pkg. III)<br />
Abbott 8-oz Nutrition RTU, 24/cs 4 cs MF 192<br />
W Peptamen OS Nestlé 8-oz. HealthCare RTU, Nutrition 27/cs 4 cs MF 216<br />
W-C Peptamen with Prebio 1 Nestlé 8.45-oz HealthCare RTU, Nutrition 24/cs 4 cs MF 202<br />
W-C Peptamen<br />
Nestlé 8.45-oz HealthCare RTU, Nutrition 24/cs 4 cs MF 202<br />
C Peptamen Jr. Nestlé 8.45-oz HealthCare RTU Nutrition 24/cs 4 cs MF 202<br />
C Peptamen Jr. Fiber Nestlé 8.45-oz HealthCare RTU Nutrition 24/cs 4 cs MF 202<br />
C Peptamen Jr.w/Prebio 1(Any Flavor)<br />
Nestlé 8.45-oz HealthCare RTU Nutrition 24/cs 4 cs MF 202<br />
C Peptamen Junior 1.5 Nestlé 8.45-oz HealthCare RTU Nutrition 24/cs 4 cs MF 202<br />
W-I-C Pregestimil 20 calorie [LIPIL]<br />
W-I-C Pregestimil 20 calorie [LIPIL]<br />
W-I-C Pregestimil 24 calorie [LIPIL]<br />
W-I-C Similac Expert Care Alimentum<br />
W-I-C Similac Expert Care Alimentum<br />
MeadJohnsonNutritionals<br />
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1can / 3 / 4 / 3 8 cans E 112<br />
MeadJohnsonNutritionals<br />
2-oz bottles, 48/cs. 8 cs / 9 / 6 2-7cs/5-7 / 5-8 / 4-5 1 cs / 4 / 4 / 3 9 cs E 96<br />
MeadJohnsonNutritionals<br />
2-oz bottles, 48/cs. 8 cs / 9 / 6 2-7cs/5-7 / 5-8 / 4-5 1 cs / 4 / 4 / 3 9 cs E 96<br />
Abbott 16-oz Nutrition powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E 113<br />
Abbott 1-quart NutritionRTU<br />
Bottle 26bottles/ 28 / 20 4-25/13-25/ 15-27/ 11-19<br />
W-I-C Similac Expert Care for Diarrhea(Isomil DF) Abbott 1-quart NutritionRTU<br />
26 / 28 / 20 4-25/ 13-25 / 15-27/ 11-19<br />
W-I-C Similac Expert Care NeoSure<br />
W-I-C Similac Expert Care NeoSure<br />
W-I-C Similac PM 60/40<br />
I Similac Special Care w/Iron 24<br />
Exempt<br />
or<br />
Medical<br />
Food<br />
Product<br />
Yield/<br />
Unit<br />
in<br />
(fl. oz.)<br />
3bottles/ 12 / 14 / 10 28 E 32<br />
3 cans/ 12 / 14 / 10 28 E 32<br />
Abbott 13.1-oz Nutritionpowdered<br />
10 cans / 11 / 8 2-9 / 6-9 / 7-10 / 6-7 1 can / 5 / 6 / 5 10 cans E 87<br />
Abbott 1-quart NutritionRTU<br />
Bottle 26bottles/ 28 / 20 4-25/ 13-25/ 15-27/ 11-19<br />
3bottles/ 12 / 14 / 10 28 bottles E 32<br />
Abbott 14.1 Nutrition oz powdered 8 cans / 9 / 6 2-7 / 5-7 / 6-8 / 4-5 1 can / 4 / 5 / 3 8 E 102<br />
Abbott 2-oz Nutrition RTU, 6-8Pk/cs 8 cs / 9 / 6 2-7 / 5-7 / 5-8 / 4-5 1cs / 4 / 4 / 3 E 96<br />
3 Revised January 2013
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