Approved Formulas in the New York State WIC Program

Formulary

Effective October 2021

Contract Formulas
Contract Infant Formulas Size and formulation Approved for:
Enfamil Infant 12.5 oz. powder, 13 oz. concentrate, 32 oz. ready-to-use I / C
Enfamil NeuroPro Infant 32 oz. ready-to-use I / C
Enfamil A.R. 12.9 oz. powder I / C
Enfamil Gentlease 12.4 oz. powder I / C
Enfamil Reguline 12.4 oz. powder I / C
Similac Soy Isomil 12.4 oz. powder, 13 oz. concentrate, 32 oz. ready-to-use I / C
Exempt Formulas
Hypoallergenic Formulas Size and formulation Approved for:
EleCare for Infants 14.1 oz. powder I / C
EleCare Jr. 14.1 oz. powder C only
Nutramigen 13 oz. concentrate, 32 oz. ready-to-use I / C
Nutramigen with Enflora LGG 12.6 oz. powder I / C
Neocate Infant with DHA and ARA 14.1 oz. powder I / C
Neocate Jr. 14.1 oz. powder C only
Similac Alimentum 12.1 oz. powder, 32 oz. ready-to-use I / C
Formulas for Premature Infants    
Enfamil NeuroPro EnfaCare 13.6 oz. powder I only
Similac Neosure 13.1 oz. powder, 32 oz. ready-to-use I only
Specialized Formulas    
Pregestimil 16 oz. powder I / C
Enfaport 6 pack (6 oz.) ready-to-use I only
Similac PM 60/40 14.1 oz. powder I / C
WIC-Eligible Nutritionals
Calorie and Nutrient Dense Products    
Boost 6 pack (8 oz.) ready-to-use W only
Boost High Protein 6 pack (8 oz.) ready-to-use W only
Boost Kid Essentials 8 oz. ready-to-use C only
Bright Beginnings Soy Drink 6 pack (8 oz.) ready-to-use C only
Ensure 6 pack (8 oz.) ready-to-use W only
Ensure Plus 6 pack (8 oz.) ready-to-use W only
PediaSure 6 pack (8 oz.) ready-to-use C only
PediaSure with Fiber 6 pack (8 oz.) ready-to-use C only
PediaSure Enteral 8 oz. ready-to-use C only
PediaSure Enteral with Fiber 8 oz. ready-to-use C only
Modular Products    
MCT oil (Nestle) 32 oz. ready-to-use I / C / W
Phenex-1 14.1 oz. powder I / C
Phenex-2 14.1 oz. powder C / W
  • Medical documentation is required for:
    • Infants 6 months or older with greater amounts of contract formula in lieu of infant foods
    • Infants and children with exempt formula
    • Children with contract formula
    • Children and women with infant foods
    • Children and women with WIC-eligible nutritionals
  • Medical documentation includes an appropriate qualifying medical condition for the formula, quantity (ounces/day), length of use, and food restrictions. The Medical Documentation Form is available at: https://www.health.ny.gov/forms/doh-4456.pdf
  • Premature formulas may be provided to premature infants up to their corrected age of 12 months.
  • All flavors are approved for NYS WIC eligible formula products.
  • The need for Ready-To-Use formula will be addressed by the WIC Program

  • I = infant less than 1 year;    C = child less than 5 years;    W = woman