Prescription Required Infant Formulas - State of Indiana

WIC Eligible
Formula
Company
INDIANA WIC AUTHORIZED FORMULAS
(Print in COLOR for ease in reading)
Container Size
Product
Fully Formula Fed Some BreastFeeding
Mostly BreastFed (***MBF)
****Women Exempt Yield/
Concentrate
(*FFF)
(**SBF)
&
or
Formula Name
A B C A B C D
A B C D
Unit
RTU
Children Medical
0-3mo / 4-5mo / 6-11mo 0 to 1/ 1-3/ 4-5/ 6-11 0 to 1/ 1-3/ 4-5/ 6-11
Food in
(Fd. Pkg. III)
Powder
(fl. oz.)
W MSUD Maxamum Nutricia 16-oz North powdered America
13 cans MF 69
W-C MSUD 2 Nutricia 17.6-oz North America powdered 12 cans MF 75
W-I-C OA 1 MeadJohnsonNutritionals
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E/MF 113
W-C OA 2 MeadJohnsonNutritionals
16-oz powdered 9 cans MF 93
W-C OS 2 Nutricia 17.6-oz North America powdered 12 cans MF 75
W Periflex Advance Nutricia 16-oz North powdered America
10 cans MF 83
I Periflex Infant Nutricia 14.1-oz North America powdered 10 cans / 11 / 8 2-9 / 6-9 / 7-10 / 5-7 1 can / 5 / 6 / 4 E 84
W-C Periflex Junior Nutricia 16-oz North powdered America
10 cans MF 84
W-I-C PFD Toddler (formerly PFD 1) MeadJohnsonNutritionals
16-oz powdered 7 cans / 8 / 5 1-6 / 4-6 / 5-7 / 4 1 can / 3 / 4 / 3 7 cans E/MF 120
W-C PFD 2
I Phenex-1
MeadJohnsonNutritionals
16-oz powdered 10 cans MF 91
Abbott 14.1-oz Nutritionpowdered
9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 E 96
W-C Phenex 2 Abbott 14.1 Nutrition oz powdered 11 cans MF 82
W-C Phlexy-10 Drink Mix
Nutricia .7oz North pkts. America (30/cs.) 303 pkts. MF 3
W-C Phenylade-40 Drink Mix Applied 25gm.pkt.Pwd(20pkt/cs) Nutrition
182 pkts. MF 5
W-C Phenylade-60 Drink Mix Applied 16-oz Nutrition powdered 8 cans MF 106
W-C Phenylade Drink Mix Applied 16-oz Nutrition powdered 10 cans MF 90
W-C PhenyladeEssentialDrinkMix Applied 16-oz Nutrition powdered 10 cans MF 90
I-C Phenyl Free 1
MeadJohnsonNutritionals
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E 113
W-C Phenyl Free 2 MeadJohnsonNutritionals
16-oz powdered 9 cans MF 93
W-C Phenyl Free 2 HP
MeadJohnsonNutritionals
16-oz powdered 10 cans MF 88
W-C PKU 2 Nutricia 17.6-oz North America powdered 12 cans MF 72
W PKU 3
Nutricia 17.6-oz North America powdered 13 cans MF 70
W PKU Express Vitaflo25 gm. powder (packet/s) 303 pkts. MF 3
C PKU Gel Vitaflo24 gm. powder (packet/s) 303 pkts. MF 3
W-I-C Product 3232A
MeadJohnsonNutritionals
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E 113
W-I-C ProPhree
Abbott 14.1-oz Nutritionpowdered
8 cans / 9 / 6 2-7 / 5-7 / 6-8 / 4-5 1 can / 4 / 5 / 3 8 cans MF 102
W-I-C Propimex-1 Abbott 14.1-oz Nutritionpowdered
9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 96
W-C Propimex 2 Abbott 14.1-oz Nutritionpowdered
11 cans MF 82
W-C ProViMin
Abbott 5.3-oz Nutritionpowdered
5 cans MF 167
W-C TYR 2 Nutricia 17.6-oz North America powdered 12 cans MF 75
W-I-C Tyrex-1 Abbott 14.1-oz Nutritionpowdered
9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 96
W-C Tyrex-2 Abbott 14.1-oz Nutritionpowdered
11 cans MF 82
W-I-C TYROS 1 MeadJohnsonNutritionals
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E/MF 113
5 Revised January 2013