Formulas Provided by the Washington State WIC Nutrition Program Formulas 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
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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).
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