WIXLIB

Formula NameFormulaCompanyWIC EligibleINDIANA WIC AUTHORIZED FORMULAS(Print in COLOR for ease in reading)Container SizeConcentrateRTUPowderNestle12.7 oz powder9372527ABC0-3mo / 4-5mo / 6-11moContract (Milk Based Formulas)IIIIGerber Good Start GentleSome BreastFeeding(**SBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Fully Formula Fed(*FFF)CANSGerber Good Start GentleNestleGerber Good Start GentleNestle12.1 oz concentrate8.45-oz RTU, 4 pack34Gerber Good Start SootheNestle12.4 oz. powder9IContract (Soy Based Formulas)Gerber Good Start SoyNestleIIGerber Good Start SoyGerber Good Start Soy12.9 oz powder12.1 oz concentrate8.45-oz RTU, 4 pack93425*Age and Formula Amount InformationFFF-A: 0-3 mo.; B: 4-5 mo.; C: 6-11 mo.NestleNestleA: 806 oz. Concentrate OR 832 oz. RTU OR 870 oz. Powder.B: 884 oz. Concentrate OR 913 oz. RTU OR 960 oz. Powder.C: 624 oz. Concentrate OR 643 oz. RTU OR 696 oz. Powder.*** MBF--A: 0 to 1 mo.; B: 1-3 mo.; C: 4-5 mo.; D: 6-11 mo.A:104 oz. Concentrate, RTU OR PwdB:364oz. Concentrate OR 384oz RTU OR 435 oz Pwd.C:442oz Concentrate OR 474 oz RTU OR 522 oz Pwd.D:312oz Concentrate OR 338 oz RTU OR 384 oz Pwd.ABCD0 to 1/ 1-3/ 4-5/ 6-11CANS107 2-8 /(Fd. Pkg. III)ExemptorWIC EligibleNutritionalsProductYield/Unitin(fl. oz.)CANS4/6-33/ 17-33/ 20-36/ 14-255/16/19 5-24/ 13-24/ 15-26/ 11-184/12/14/101/4/5/49024.233.8907 2-8 / 5-8 / 6-9 / 5-6 1/6-33/ 17-33/ 20-36/ 14-25 5/2619 5-24/ 13-24/ 15-26/ 11-184/4/16/12/5/419/ 1314/ 109124.233.826107 2-8 /103727CANS****Women&Children1/Snap Shot AmountsConc./31 cans34 cans24 cansMostly BreastFed (***MBF)RTU/ Powder2692810207Snap Shot Amounts5-8 /5-8 /6-9 /6-9 /5-65-65/419/ 13Snap Shot Amounts**SBF--A: 0 to 1mo; B: 1-3 mo; C: 4-5 mo; D: 6-11 moA:130oz/5cns-780oz/30cns Concentrate OR 128oz/4cns-800oz/25cnsRTU OR 208/2cns-832oz/8cns PwdB:390oz/15cns-780oz/30cns ConcentrateOR416oz/13cns-800oz/25cnsRTU OR520oz/5cns-832oz/8cns PwdC:468oz/18cns-858oz/33cns Concentrate OR 480oz/15cns-864oz/27cnsRTU OR 624oz/6cns-936oz/9cns PwdD:338oz/13cns-598oz/23cns Concentrate OR 352oz/11cns-608oz/19cnsRTU OR 520oz/5cns-624oz/6cns Pwd104 fluid ounces------ 14 cans124 NOTE: Infants 6 mo., on Food Pkg. III, who cannot consume foods orally,17 cans145 may receive increased formula at maximum level for 4-5 mo. olds. This does not12 cans104 include Standard Contract Formula.****Women & Children (W & C) on Food Package III-Formula Amounts Includes:910 fl oz of reconstituted liquid concentrate; OR 910 fl oz RTU; OR 910 fl oz reconstituted powder--plus the foods included infood package IV, V, VI or VII.Not Available Reconstituted1Revised April 2015

W-CCFormula NameFormulaCompanyWIC EligibleINDIANA WIC AUTHORIZED FORMULAS(Print in COLOR for ease in reading)Container SizeConcentrateRTUPowderBoost (Any Flavor)RTU, 6pkNestlé8-ozHealthCareNutritionBoost Kid Essentials 1.0 Cal. (Any flavor)RTU,4 packNestlé8.25-oz.HealthCareNutritionW-C Boost Kid Essentials 1.5 Cal. (Any flavor)Fully Formula Fed(*FFF)ABC0-3mo / 4-5mo / 6-11moSome BreastFeeding(**SBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Mostly BreastFed (***MBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Nestlé8-ozHealthCareRTU, 27Nutritionpack(cs)W-C Boost Kid Essentials1.5 Cal.w/Fiber (Any Flavor) Nestlé8-ozHealthCareRTU, 27Nutritionpack(cs)W-C Bright Beginnings Soy Pediatric CCCCW-CPBM Products8-oz RTU,LLC6 pkEleCare for InfantsEleCare Jr (Any Flavor)Enfamil Enfacare [Lipil]Enfamil Enfacare [Lipil]Enfamil Enfacare [Lipil](Enfamil) Puramino DHA/ARA(Enfamil) Nutramigen DHA/ARA(Enfamil) Nutramigen DHA/ARAAbbott14.1-ozNutrition powdered(Enfamil)Nutramigen w/Enflora LGGEnfamil Premature 20Enfamil Premature 24Ensure(Any Flavor)Ensure Plus(Any Flavor)KetoCal 3:1KetoCal 4:1Neocate Splash (Any Flavor)Neocate Infant w/DHA & ARANeocate Junior(Any Flavor)Neocate Junior w/Prebiotics [Any Flavor]Nutren JuniorNutren Junior w/FiberPediasure(Any flavor)Pediasure w/Fiber (Any flavor)Pediasure 1.5 Cal (Any flavor)W-C Pediasure 1.5 Cal w/Fiber (Any flavor)Pediasure Peptide 1.0 Cal.(Any flavor)-W-C (formerly Vital Jr.)9 cans/ 10/72-8/ 5-8/ 6-9 / 5-61 can/ 4/ 5/4Abbott14.1-ozNutrition powdered2-oz bottles (48/cs)MeadJohnsonNutritionalsMeadJohnson12.6 oz powdered8 cs/ 926 cans / 2810 cans / 119 cans / 1031 cans / 3426 cans / 2810 cans/ 11/62087242082-oz bottles(48/cs) 8/6pksMeadJohnsonNutritionals8 cs/ 9/62-oz bottles(48/cs) 8/6pksMeadJohnsonNutritionals8 cs9/6MeadJohnsonNutritionals1-quart RTUMeadJohnsonNutritionals12.8-oz powderedMeadJohnsonNutritionals14.1 oz. powderedMeadJohnsonNutritionals13-oz concentrateMeadJohnsonNutritionals1-quart RTU///////2-7cs/5-7 / 5-8 / 4-51 cs/ 4 / 43 cans/ 12 / 141 can / 5 / 61 can / 4 / 54 cans/ 14 / 173 cans/ 12 / 141 can / 5 / 61 cs / 4/ 4/ 3/ 10/ 4/ 4/ 12/ 10/ 4/ 32-7cs/5-7 / 5-8 / 4-51 cs/ 32-7cs/ 5-7 / 5-8 / 4-54-25 / 13-25/ 15-27/ 11-192-92-8/ 6-9 / 7-10 / 5-7/ 5-8 / 6-9 / 5-65-30 / 15-30/ 18-33/ 13-234-25 / 13-25/ 15-27/ 11-192-9 / 6-9/7-10 / 5-7/4/ 4(Fd. Pkg. III)RTU, 6 Pk-24/cs.Abbott8-ozNutritionNutricia11-oz powderedNutricia11-oz powdered8-ozRTU27/caseNutriciaNorthAmerica9 cans / 10/72-8/ 5-8 / 6-9 / 5-61 can / 4/ 5Nutricia14.1-oz.North TU, 6 PackAbbott8-ozNutritionRTU, 6 PackAbbott8-ozNutritionAbbott8-oz RTU, 24/csAbbott8-oz RTU, 24/cs27 pks4 cs4 cs18 pks1414WEN33WEN216WEN216WEN48281193528 bottles10/ 44 csRTU, Unitin(fl. oz.)WEN15 cans14 cans4 cs4 cs18-6 pks18-6 pks4 cs4 csNutricia14.1-oz.North AmericapowderedExemptorWIC Eligible18 pks4 cs4 cs13 cans13 cans4 csRTU, 6 evised April 2015

Formula NameFormulaCompanyWIC EligibleINDIANA WIC AUTHORIZED FORMULAS(Print in COLOR for ease in reading)Container SizeConcentrateRTUPowderFully Formula Fed(*FFF)ABC0-3mo / 4-5mo / 6-11moSome BreastFeeding(**SBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Mostly BreastFed (***MBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11W-CPeptamenPeptamen Jr.C Peptamen Jr. FiberC Peptamen Junior 1.5W-I-C Pregestimil (DHA & utritionals16-oz powdered7 cans / 8/ 61-6 / 4-6 / 5-7 / 4-51can/ 3/ 4W-I-C Pregestimil 20 calorie (DHA & ARA)2-oz bottles, 48/cs.MeadJohnsonNutritionals8 cs/ 9/62-7cs/5-7 / 5-8 / 4-51 cs/ 4/ 4W-I-C Pregestimil 24 calorie (DHA & ARA)2-oz bottles, 48/cs.MeadJohnsonNutritionals8 cs/ 9/62-7cs/5-7 / 5-8 / 4-51 cs/ 4/ 4Abbott16-ozNutritionpowdered7 cans/ 8/ 61-6 / 4-6 / 5-7 / 4-51 can/3/ 4Abbott1-quartNutritionRTU Bottle26bottles/ 28/ 204-25/13-25/ 15-27/ 11-193bottles/ 12 / 14Abbott13.1-ozNutrition powdered10 cans // 82-9 / 6-9 / 7-10 / 6-71 canAbbott1-quartNutritionRTU Bottle26bottles/ 28/ 204-25/ 13-25/ 15-27/ 11-193bottles/ 12 / 14Abbott14.1Nutritionoz powdered8 cans/ 92-71 can / 4RTU, 6-8Pk/csAbbott2-ozNutrition8 cs/W-I-CW-I-CW-I-CW-I-CW-I-CISimilac Expert Care AlimentumSimilac Expert Care AlimentumSimilac Expert Care NeoSureSimilac Expert Care NeoSureSimilac PM 60/40Similac Special Care w/Iron sNestlé8.45-ozHealthCareNutrition11/ 69/36/ 5-7 / 6-8 / 4-52-7 / 5-7 / 5-8 / 4-51cs/ 5/ 4/ 6/ 5/ 4****Women&Children(Fd. Pkg. III)4 cs4 cs4 cs4 cs/ 38 cans/ 39 cs/ 39 cs/38 cans/ 1028/ 510 cans/ 1028 bottles/ 38/ 3ExemptorWIC EligibleNutritionalsProductYield/Unitin(fl. 2E102E96Revised April 2015

W-CIW-CIW-CIW-CW-CW-I-CWIW-CWW-CW-I-CW-CFormula NameRiley FormulasBCAD 1BCAD 2Calcilo-XDComplete Amino Acid MixComplex Essential MSD Drink MixCyclinex-1Cyclinex-2Essential Amino Acid MixGAGlutarAde GA-1 Amino Acid BlendGlutarAde Junior GA-1 Drink MixGlutarex-1Glutarex-2HCU ExpressHCY 1HCY 1Ketonex-2LipistartLMDLOPHLEXMSUD AnalogMSUD MaxamaidMSUD MaxamumMSUD 2OA 1OA 2FormulaCompanyWIC EligibleINDIANA WIC AUTHORIZED FORMULAS(Print in COLOR for ease in reading)Container oz powderedFully Formula Fed(*FFF)ABC0-3mo / 4-5mo / 6-11mo7 cans/ 8Some BreastFeeding(**SBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Mostly BreastFed (***MBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11/ 61-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 3/ 72-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4MeadJohnsonNutritionals16-oz powderedAbbott13.2-oz.Nutrition powder9 cans / 10Nutricia7 Northoz. edAbbott14.1-ozNutrition powdered8 cans/ 9/ 62-7/ 5-7 / 6-8 / 4-51 can / 4/ 5Nutricia7 Northoz. powderedAmerica(bottle)7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 3Applied1 NutritionLB (454 g) powderedApplied14.1Nutritionoz. (400 g) powderedAbbott14.1-ozNutrition powdered9 cans/ 10/ 72-8 / 5-8 / 6-9 / 5-61 can / 4/ 5(Fd. Pkg. III)8 cans9 cans9 cans28 bottles10 cans/ 3Abbott14.1-ozNutrition powderedMeadJohnsonNutritionals16 oz powdered****Women&Children10 cans29 bottles8 cans11 cans9 cans/ 4ExemptorWIC EligibleNutritionalsProductYield/Unitin(fl. 1019681Abbott14.1-ozNutrition powdered11 cansEWENVitaflo 25 gm. Pwd pkts.455 pkts.WEN28 cans9 cans12 cansEWEN113WEN729611 cansEWEN9611 cansEWENEWEN96MeadJohnsonNutritionals16-oz powdered7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 3MeadJohnsonNutritionals16-oz powderedNutricia17.6-ozNorth AmericapowderedAbbott14.1-ozNutrition powdered9 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4Abbott14.1-ozNutrition powderedAbbott14.1-ozNutrition powdered9 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4Abbott14.1-ozNutrition powderedAbbott14.1-ozNutrition powdered9 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4Abbott14.1-ozNutrition powderedVitaflo 400 gm. Powdered [14.11 oz]MeadJohnsonNutritionals16-oz powdered7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 39 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4455 pkts.Nutricia.5OZ.Pkt.Pwd(30North Americapkts./bx)Nutricia14.1-ozNorth h AmericapowderedMeadJohnsonNutritionals16-oz powdered11 cans9 cans8 cans7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-5MeadJohnsonNutritionals16-oz powdered41 can / 3/ 4/ 312 cans13 cans12 cans8 cans9 7393Revised April 2015

W-CFormula NameOS 2Periflex AdvancePeriflex InfantPFD Toddler(formerly PFD 1)PFD 2Phenex-1Phenex 2Phlexy-10 Drink MixPhenylade-40 Drink MixPhenylade-60 Drink MixPhenylade Drink MixPhenyladeEssentialDrinkMixPhenyl Free 1Phenyl Free 2Phenyl Free 2 HPPKU 2PKU 3PKU ExpressPKU GelProduct 3232AProPhreePropimex-1Propimex 2ProViMinTyrex-1Tyrex-2TYROS 1TYROS 2UCD 2WND 1WND 2XLEU AnalogXLEU MaxamaidFormulaCompanyWIC EligibleINDIANA WIC AUTHORIZED FORMULAS(Print in COLOR for ease in reading)Container SizeConcentrateRTUPowderFully Formula Fed(*FFF)ABC0-3mo / 4-5mo / 6-11moSome BreastFeeding(**SBF)ABCD0 to 1/ 1-3/ 4-5/ 6-11Mostly BreastFed (***MBF)ABCD0 to 1/ 1-3/ 4-5/ ozNorth Americapowdered10 cans / 11/ 8 2-9 / 6-9 / 7-10 / 5-71 can / 5/ 6/4MeadJohnsonNutritionals16-oz powdered7 cans / 8/ 5 1-6 / 4-6 /1 can / 3/ 4/ 39 cans/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 45-7 / 4MeadJohnsonNutritionals16-oz powdered/ 10Abbott14.1Nutritionoz -ozNutritionpowderedMeadJohnsonNutritionals16-oz powdered7 cans/ 8/ 6 1-6 / 4-6 / 5-7/ 4-51 can / 3/ 4/ 3MeadJohnsonNutritionals16-oz powderedMeadJohnsonNutritionals16-oz powderedNutricia17.6-ozNorth AmericapowderedNutricia17.6-ozNorth AmericapowderedVitaflo 25 gm. powder (packet/s)Vitaflo 24 gm. powder (packet/s)MeadJohnsonNutritionals16-oz powdered7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 3Abbott14.1-ozNutrition powdered8 cans/ 9/ 6 2-7 / 5-7 / 6-8 / 4-51 can / 4/ 5/ 3Abbott14.1-ozNutrition powdered9 cans/ 10/ 71 can / 4/ 5/ 42-8 / 5-8 / 6-9 / 5-6Abbott14.1-ozNutrition Nutrition powdered9 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 47 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 3Abbott14.1-ozNutrition powderedMeadJohnsonNutritionals16-oz powderedMeadJohnsonNutritionals16-oz powderedNutricia17.6-ozNorth AmericapowderedMeadJohnsonNutritionals16-oz powdered7 cans/ 8/ 6 1-6 / 4-6 / 5-7 / 4-51 can / 3/ 4/ 39 cans/ 10/ 7 2-8 / 5-8 / 6-9 / 5-61 can / 4/ 5/ 4MeadJohnsonNutritionals16-oz powderedNutricia14.1-ozNorth Americapowdered(Fd. Pkg. III)12 cans10 cansNutricia17.6-ozNorth AmericapowderedAbbott14.1-ozNutrition edAmerica57 cans10 cans11 cans303 pkts.182 pkts.8 cans10 cans10 cans8 cans9 cans10 cans12 cans13 cans303 pkts.303 pkts.8 cans8 cans9 cans11 cans5 cans9 cans11 cans8 cans9 cans12 cans8 cans9 cans9 cans12 cansExemptorWIC EligibleNutritionalsProductYield/Unitin(fl. 373Revised April 2015