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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WIC Eligible<br />
Formula<br />
Company<br />
INDIANA WIC AUTHORIZED FORMULAS<br />
(Print in COLOR for ease in reading)<br />
Container Size<br />
Product<br />
Fully Formula Fed Some BreastFeeding<br />
Mostly BreastFed (***MBF)<br />
****Women Exempt Yield/<br />
Concentrate<br />
(*FFF)<br />
(**SBF)<br />
&<br />
or<br />
Formula Name<br />
A B C A B C D<br />
A B C D<br />
Unit<br />
RTU<br />
Children Medical<br />
0-3mo / 4-5mo / 6-11mo 0 to 1/ 1-3/ 4-5/ 6-11 0 to 1/ 1-3/ 4-5/ 6-11<br />
Food in<br />
(Fd. Pkg. III)<br />
Powder<br />
(fl. oz.)<br />
W-C TYROS 2 MeadJohnsonNutritionals<br />
16-oz powdered 9 cans MF 93<br />
W-C UCD 2 Nutricia 17.6-oz North America powdered 12 cans MF 72<br />
W-I-C WND 1 MeadJohnsonNutritionals<br />
16-oz powdered 7 cans / 8 / 6 1-6 / 4-6 / 5-7 / 4-5 1 can / 3 / 4 / 3 8 cans E 113<br />
W-C WND 2 MeadJohnsonNutritionals<br />
16-oz powdered 9 cans MF 93<br />
W-I-C XLEU Analog Nutricia 14.1-oz North America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
W-C XLEU Maxamaid Nutricia 16-oz North powdered America<br />
12 cans MF 73<br />
W XLEU Maxamum Nutricia 16-oz North powdered America<br />
13 cans MF 69<br />
W-I-C XLys, XTrp Analog Nutricia 14.1 North oz America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
W-C XLys, XTrp Maxamaid<br />
Nutricia 16 North oz powdered America<br />
12 cans MF 73<br />
W XLys, XTrp Maxamum Nutricia 16 North oz powdered America<br />
13 cans MF 69<br />
W-I-C XMET Analog Nutricia 14.1-oz North America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
W-C XMET Maxamaid Nutricia 16-oz North powdered America<br />
12 cans MF 73<br />
W XMET Maxamum Nutricia 16-oz North powdered America<br />
13 cans MF 69<br />
W-I-C XMTVI Analog Nutricia 14.1-oz North America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
W-C XMTVI Maxamaid Nutricia 16-oz North powdered America<br />
12 cans MF 73<br />
W XMTVI Maxamum Nutricia 16-oz North powdered America<br />
13 cans MF 69<br />
W-C XPhe Maxamaid Nutricia 16-oz North powdered America<br />
12 cans MF 73<br />
W XPhe Maxamum Nutricia 16-oz North powdered America<br />
13 cans MF 69<br />
W XPhe Maxamum Drink Nutricia 8.5 North oz RTU America pak 105 paks MF 8.5<br />
W-I-C XPhe, XTyr Analog Nutricia 14.1-oz North America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
W-C XPhe, XTyr Maxamaid Nutricia 16-oz North powdered America<br />
12 cans MF 73<br />
W-I-C XPTM Analog Nutricia 14.1-oz North America powdered 9 cans / 10 / 7 2-8 / 5-8 / 6-9 / 5-6 1 can / 4 / 5 / 4 9 cans E 95<br />
6 Revised January 2013
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