Common Formula Package Maximums Revised December 2021 Page 1 of 15 Fully Formula Fed (FFF) Infant Max Infant Age † at First Day to Use Date* Child Max** Woman Max** 0-3 m 4-5 m 6-12 m w/food 6-12 m No food Max Ounces Per Day Powder Concentrate Ready to Feed 29 oz 27.4 oz 28.1 oz 32 oz 29.8 oz 30.4 oz 23.2 oz 21 oz 21.4 oz 32 oz 29.8 oz 30.4 oz 30.3 oz 30.3 oz Max Ounces Per Month Powder Concentrate Ready to Feed 870 oz 823 oz 832 oz 960 oz 896 oz 913 oz 696 oz 630 oz 643 oz 960 oz 896 oz 913 oz 910 oz 910 oz Full Nutritional Benefit 806 oz 884 oz 624 oz 884 oz * Fully formula fed infants always receive the maximum amount of formula allowed for age. This amount must be no less than the full nutritional benefit and no greater than the maximum amount for age. ** Amount needed per day will be issued based on the amount requested on the Medical Documentation Form 1, but not to exceed the maximum allowed. † Infant age is rounded up to the next month on the 16th day of each month. For example, an infant that is 3 months and 16 days will receive formula in amounts for the 4 months issuance category. Formula Company Form Package Size Reconstitute Amount Containers/ Case Flavors Fully Formula Fed (FFF) Infant Max Container Amount for Infant Age at First Day to Use Child Max Woman Max 0-3 m 4-5 m 6-12 m w/food 6-12 m no food Alimentum – See Similac Alimentum Alfamino Infant State Order Only Nestlé Powder 14.1 oz (400 g) 96 oz 6 cans N/A 9 10 7 10 9 --- Alfamino Junior State Order Only Nestlé Powder 14.1 oz (400 g) 62 oz 6 cans Unflavored --- --- --- --- 14 --- Benecalorie K See Supplemental Formula Conversion Table for Amount of Formula Replaced State Order Only Nestlé RTF 1.5oz 1.5oz 24 cups Unflavored --- --- --- 606 606 Beneprotein K (1 scoop = 1 packet) See Supplemental Formula Conversion Table for Amount of Formula Replaced State Order Only Nestlé Powder 8 oz (227 g) NSD 6 cans Unflavored --- --- --- --- 18 18 7 g NSD 75 packets Unflavored --- --- --- --- 583 583 Boost Nestle RTF 8 oz 8 oz 27 briks Chocolate Strawberry Vanilla --- --- --- --- 113 113 Boost Kid Essentials (Retail version) K Nestlé RTF 8.25 oz 8.25 oz 16 prisms (4-4 packs) Vanilla --- --- --- --- 110 --- Boost Kid Essentials 1.0 K Nestlé RTF 8 oz 8 oz 27 briks Chocolate Strawberry Vanilla --- --- --- --- 113 ---
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Common Formula Package Maximums
Revised December 2021 Page 1 of 15
Fully Formula Fed (FFF) Infant Max Infant Age† at First Day to Use Date*
Child Max** Woman Max**
0-3 m 4-5 m 6-12 m w/food
6-12 m No food
Max Ounces Per Day Powder
Concentrate Ready to Feed
29 oz 27.4 oz 28.1 oz
32 oz 29.8 oz 30.4 oz
23.2 oz 21 oz
21.4 oz
32 oz 29.8 oz 30.4 oz
30.3 oz 30.3 oz
Max Ounces Per Month Powder
Concentrate Ready to Feed
870 oz 823 oz 832 oz
960 oz 896 oz 913 oz
696 oz 630 oz 643 oz
960 oz 896 oz 913 oz
910 oz 910 oz
Full Nutritional Benefit 806 oz 884 oz 624 oz 884 oz
* Fully formula fed infants always receive the maximum amount of formula allowed for age. This amount must be no less than the full nutritional benefit and no greater than the maximum amount for age.
** Amount needed per day will be issued based on the amount requested on the Medical Documentation Form 1, but not to exceed the maximum allowed.
† Infant age is rounded up to the next month on the 16th day of each month. For example, an infant that is 3 months and 16 days will receive formula in amounts for the 4 months issuance category.
Formula Company Form Package
Size Reconstitute
Amount Containers/
Case Flavors
Fully Formula Fed (FFF) Infant Max Container Amount for Infant Age at First
Day to Use
Child Max
Woman Max
0-3 m 4-5 m 6-12 m w/food
6-12 m no food
Alimentum – See Similac Alimentum
Alfamino Infant State Order Only
Nestlé Powder 14.1 oz (400 g)
96 oz 6 cans N/A 9 10 7 10 9 ---
Alfamino Junior State Order Only
Nestlé Powder 14.1 oz (400 g)
62 oz 6 cans Unflavored --- --- --- --- 14 ---
Benecalorie K
See Supplemental Formula Conversion Table for Amount of Formula Replaced
Nutricia Powder 20 g 3.38 oz 30 packets Black Currant/ Apple
Tropical Surprise
-- -- -- -- 269 269
Polycal See Supplemental Formula Conversion Table for Amount of Formula Replaced
Nutricia Powder 14.1 oz (400 g)
NSD 12 Unflavored --- --- --- --- --- ---
Portagen (Recommended for child > 1 yr.)
State Order Only
Mead Johnson
Powder 14.4 oz 64 oz Single cans N/A 13 15 10 15 14 14
Common Formula Package Maximums
Revised December 2021 Page 10 of 15
Formula Company Form Package
Size Reconstitute
Amount Containers/
Case Flavors
Fully Formula Fed (FFF) Infant Max Container Amount for Infant Age at First
Day to Use
Child Max
Woman Max
0-3 m 4-5 m 6-12 m w/food
6-12 m no food
Pregestimil State Order Only (2 oz)
Mead Johnson
Powder 16 oz 112 oz Single cans N/A 8 (0-1m) 7 (2-3m) 8 6 8 8 ---
RTF 2 oz 2 oz 48 nursettes N/A 416 456 321 456 455 ---
Pregestimil 24 State Order Only **Drop Ship
Mead Johnson
RTF 2 oz 2 oz 48 nursettes N/A 416 456 321 456 455 ---
ProMod Liquid Protein (modular: mix 1 oz (30 ml) with 1-2 oz H2O) See Supplemental Formula Conversion Table for Amount of Formula Replaced
State Order Only
Abbott Liquid 32 oz
(946 mL) 32 oz 6 containers Fruit Punch 26 28 20 28 28 28
Pro-Phree H
(Recommended infants & toddlers)
State Order Only
Abbott Powder 14.1 oz (400 g)
NSD 6 cans N/A 9 10 7 10 10 ---
Propimex-1 H
(Recommended for infants & toddlers)
State Order Only
Abbott Powder 14.1 oz (400 g)
NSD 6 cans N/A 9 10 7 10 10 ---
Propimex-2 H
(Recommended child > 1 yr. & adults)
State Order Only
Abbott Powder 14.1 oz (400 g)
NSD 6 cans N/A 9 10 7 10 10 10
ProViMin H K
State Order Only Abbott Powder
5.3 oz (150 g)
NSD 6 cans N/A 24 26 19 26 27 27
PurAmino (DHA & ARA)
Mead Johnson
Powder 14.1 oz 98 oz Order
Single cans N/A
9 (0-1m) 8 (2-3m)
10 (4 m) 9 (5 m)
7 10 (6 m)
9 (7-12 m) 9 ---
PurAmino Jr. (formerly PurAmino
Toddler) State Order Only **Dropship
Mead Johnson
Powder 14.1 oz 66 oz 4 cans Unflavored
Vanilla --- --- --- --- 13 ---
RCF (Ross CHO Free)H K State Order Only
Abbott Conc. 13 oz 26 oz 12 cans N/A 31 34 24 34 35 ---
RenalCal K
State Order Only Nestle RTF 250 mL 8.45 oz 24 cans Unflavored --- --- --- --- 107 107
Renastart State Order Only **Drop Ship
Vitaflo Powder 14.1 oz (400 g)
67.5 oz Single Cans N/A --- --- --- --- 13 13
Renastep State Order Only **Drop Ship
Vitaflo RTF 200 ml 6.7 oz 15 bottles Vanilla --- --- --- --- 135 135
Replete Fiber K
(Formerly Nutren Replete Fiber)
State Order Only Nestlé RTF 250 mL 8.45 oz 24 cans Vanilla --- --- --- --- 107 107
ScandiShake State Order Only
Aptalis Powder 3 oz
(85 g) 9 oz 4 pkts
Vanilla Strawberry
--- --- --- --- 101 101
Common Formula Package Maximums
Revised December 2021 Page 11 of 15
Formula Company Form Package
Size Reconstitute
Amount Containers/
Case Flavors
Fully Formula Fed (FFF) Infant Max Container Amount for Infant Age at First
Day to Use
Child Max
Woman Max
0-3 m 4-5 m 6-12 m w/food
6-12 m no food
Similac Alimentum (formerly Similac Expert Care Alimentum)
Abbott
Powder 12.1 oz 87 oz 6 cans N/A 10 11 8 11 10 ---
RTF 32 oz 32 oz 6 bottles N/A 26 28 20 28 28 ---
RTF 8 oz 8 oz 24 cans N/A 104 114 80 114 113 ---
Similac NeoSure H K
(formerly Similac Expert Care NeoSure)
Abbott
Powder 13.1 oz 87 oz Single Cans N/A 10 11 8 11 10 ---
RTF 1 qt 32 oz 6 bottles N/A 26 28 20 28 28 ---
RTF 2 oz 2 oz 48 nursettes N/A 416 456 321 456 455 ---
Similac Human Milk Fortifier H K Order Rxed amount only
(Not exceeding the max) State Order Only
Abbott Powder 0.9 g NSD 50
pack/carton N/A
MBF 1029
MBF 1135
MBF 823
MBF 1135
--- ---
Similac Human Milk Fortifier Hydrolyzed Protein Concentrated Liquid H K Order Rxed amount only (Not exceeding the max) State Order Only
Abbott Powder 0.9 g NSD 50
pack/carton N/A
MBF 1029
MBF 1135
MBF 823
MBF 1135
--- ---
Similac PM 60/40 H K
Abbott Powder 14.1 oz 102 oz Order
Single cans N/A 8 9
7 (6 mo) 6 (7-11
mo) 9 8 ---
Similac Special Care 20, 24, or 30 H K
State Order Only (Special Care 20 and 30) **Drop Ship (SC 30)
Abbott RTF 2 oz 2 oz
20 sold in 8-packs
24 sold in 4-packs, 30 sold in 48-pack
N/A 416 456 321 456 455 ---
SolCarb See Supplemental Formula Conversion Table #2 for Amount of Formula Replaced State Order Only **Drop Ship
Medica-Nutrition
Powder 16 oz
(454 g) NSD 6 cans
N/A --- --- --- --- --- ---
Suplena with Carb Steady H K
State Order Only Abbott RTF 8 oz 8 oz 24 cans Homemade
Vanilla --- --- --- --- 113 113
Tolerex K
Not recommended for infants 0-12 mo
State Order Only Nestlé Powder
2.82 oz (80 g)
10.15 oz 6 pkt/ cartons Unflavored 85
94 68
94 89 89
Tyrex-1 H (for infants & toddlers)
State Order Only Abbott Powder 14.1 oz NSD 6 cans N/A 9 10 7 10 10 ---
Tyrex-2 H (for children & adults)
State Order Only Abbott Powder 14.1 oz NSD 6 cans N/A 9 10 7 10 10 10
UCD Anamix Junior State Order Only
Nutricia Powder 14.1 oz (400 g)
56 oz 6 cans Unflavored
Vanilla --- --- --- --- 16 ---
Vivonex Pediatric K
State Order Only Nestlé Powder 1.7 oz 8.45 oz 36 packets
6 pkt/cartons Unflavored --- --- --- --- 107 ---
Common Formula Package Maximums
Revised December 2021 Page 12 of 15
Formula Company Form Package
Size Reconstitute
Amount Containers/
Case Flavors
Fully Formula Fed (FFF) Infant Max Container Amount for Infant Age at First
Day to Use
Child Max
Woman Max
0-3 m 4-5 m 6-12 m w/food
6-12 m no food
Vivonex RTF State Order Only
Nestlé RTF 250 mL 8.45 oz 24 cartons Unflavored --- --- --- --- 107 107
Formula Form:
Infant Maximum if no standard dilution (NSD) Child/Woman Maximum if no standard dilution
Birth- 3 months Age 4- 5 Months Age 6-11 Months Age 6-11 Months (no food)
Powder 128 oz / 3628 g 141 oz / 3997 g 102 oz / 2891 g 141 oz / 3997 g 144 oz / 4082 g (1 fluid ounce = 29.57 milliliters; 1 pound = 453.6 grams; 1 ounce = 28.35 grams)
Notes: NSD = No Standard Dilution K= Kosher; H= Halal Conc. = Concentrate MBF = Mostly breastfeeding **Drop shipped items may take 4-7 business days to arrive after SWO processing.
Common Formula Package Maximums
Revised December 2021 Page 13 of 15
SUPPLEMENTAL FORMULA CONVERSION TABLE - MODULARS
Displacement Method
Monthly RX
Amount of Formula Replaced
Concentrate 12 - 13 oz
Powder 12 - 16 oz
Powder 22 - 24 oz
Ready to Feed 32 - 34 oz
Duocal (14.1 oz powder) 1 can contains 48 TBSP/80 scoops/400 grams/2008 Calories
1 can 4 1 1 4
2 cans 8 2 1 7
3 cans 12 3 2 10
4 cans 16 4 2 13
SolCarb (16 oz) 1 can contains 76 TBSP/1740 Calories/454 g
1 can 2 1 1 2
2 cans 4 2 2 4
3 cans 6 3 3 6
4 cans 8 4 4 8
5 cans 10 5 5 10
BeneCalorie (1.5 oz cup) 1 cup contains 330 calories and 7 grams of protein
1-2 container(s) 1 1 1 1
3 containers 2 1 1 2
4-5 packets 3 1 1 3
6 packets 4 2 1 3
7-8 containers 5 2 1 4
9 containers 6 2 1 5
10-11 containers 7 2 1 6
12 containers 8 2 2 6
13-14 containers 9 2 2 7
15 containers 10 3 2 8
16-17 containers 11 3 2 9
18 containers 12 3 2 10
19-20 containers 13 3 2 10
21 containers 13 4 2 11
22-23 containers 14 4 2 12
24 containers 15 4 2 12
25-26 containers 16 4 3 13
27 containers 17 4 3 14
28-29 containers 18 5 3 15
30 containers 19 5 3 15
Common Formula Package Maximums
Revised December 2021 Page 14 of 15
Monthly RX
Amount of Formula Replaced
Concentrate 12 - 13 oz
Powder 12 - 16 oz
Powder 22 - 24 oz
Ready to Feed 32 - 34 oz
Human Milk Fortifier
If combining this with other formula, please call the Nutrition Unit for assistance 404-657-2884
BeneProtein (8 oz can) 1 can contains 810 calories and 194 grams of protein 1 can 2 1 1 1 2 cans 3 1 1 3 3 cans 5 2 1 4 4 cans 6 2 1 5
BeneProtein (7 gm packet) 1 packet contains 25 calories and 6 grams of protein