Food & Formula Reference Guide [FFRG]
|Food & Formula Reference Guide [FFRG] |
|Formula Listing |
|Effective October 1, 2014 – March 31, 2015 |
ACRONYMS SYMBOLS, ABBREVIATIONS, DEFINITIONS, AND CHANGES
MISSOURI WIC APPROVED INFANT FORMULAS AND SPECIAL FORMULAS (EXEMPT INFANT FORMULAS AND MEDICAL FOODS)
Infants - Contract Formulas Updated!
Infants - Exempt Formulas (Special Formulas) Updated!
WIC Eligible Nutritionals (Special Formulas) for Children and Women Updated!
Guidelines for Issuing Metabolic Formulas
Missouri Department of Health & Senior Services - Metabolic Formula Program
Formula Manufacturers (Contact Information and Websites)
Maximum Monthly Allowance of Supplemental Foods for “Food Package III Updated!
Acronyms, Abbreviations, Symbols, and Changes Updated!
|Acronyms and Abbreviations |
|WIC Cert = WIC Certifier |MJN = Mead Johnson Nutrition |PWD = Powder | |
|Nutri = Local WIC Nutritionist |Nestlé = Nestlé Nutrition |Conc. = Concentrated Liquid | |
|CPA = Competent Professional Authority |Abbott/Ross = Abbott Nutrition (formerly Ross ) |RTF = Ready To Feed | |
|(Nutritionist, Registered Nurse, and Registered Dietitian) |in MOWINS, “Ross” is used instead of Abbott. | | |
|RD = Registered Dietitian at Local WIC Provider |Nutricia = Nutricia North America |RTU = Ready To Use | |
|State RD = Registered Dietitian at State WIC Office |PBM = PBM Product – Perrigo Nutritionals |W/O = Without | |
| WIC 27 = Medical Documentation Form - Health Care Provider Authorization Form | | |
|Symbols |
|≥ |Greater than OR Equal to |≤ |Less than OR Equal to |> Greater than |< Less than |
| Changes to Formula Description - Effective October 1, 2014 |
|1) |Old Descriptions |New Descriptions |
| |1 QT/32 OZ ENFAMIL GENTLEASE RTU |1 QT/32 OZ OR (8 oz 4-pack) ENFAMIL GENTLEASE RTU |
| |1 QT/32 OZ ENFAMIL AR RTU |1 QT/32 OZ OR (8 oz 4-pack) ENFAMIL AR RTU |
| |1 QT/32 OZ ENFAMIL PROSOBEE RTU |1 QT/32 OZ OR (8 oz 4-pack) ENFAMIL PROSOBEE RTU |
| |1 QT/32 OZ ENFAMIL INFANT OR ENFAMIL PREMIUM INFANT RTU |1 QT/32 OZ OR (8 oz 4-pack) ENFAMIL INFANT RTU |
| |14.1 OZ ELECARE DHA/ARA (UNFLAVORED) POWDER – INFANTS |14.1 OZ ELECARE FOR INFANTS DHA/ARA (UNFLAVORED) PWD |
| |14.1 OZ SUPER SOLUBLE DUOCAL POWDER |14 OZ OR 14.1 OZ (400 G) SUPER SOLUBLE DUOCAL POWDER |
|2) |Changes to Milk Issuance - Effective October 1, 2014 | |
| |* Medical Documentation (WIC 27) is required to issue whole milk to children (24 – 59 months old) and women; thus, whole milk can only be issued through Food Package III in addition to formula if the |
| |health care provider writes a medical prescription for whole milk. (ER# 2.07000). |
| |** Skim milk and lowfat milk are not allowed for issuance to children 12-23 months old. |
| |*** CPA’s Assessment, determination and documentation are required. |
| |[note] Issuing soy milk to children (12-59 months) does not require medical documentation from health care providers. |
|3) |Changes to Names - Effective October 1, 2014 | |
| |Old Name |New Name |
| |No longer allows cheese to be issued beyond established substitution rate, even with medical documentation. (Federal Register/Vol. 79, No.42/Tuesday, March 4, 2014 / Rules and Regulations (Page 12280) |
| |For women in the fully breastfeeding food package, no more than 2 pounds of cheese may be substituted for milk. |
| |For children and women in the pregnant, partially breastfeeding and postpartum food packages, no more than 1 pound of cheese may be substituted. |
| |See FFRG Guidelines for the details. |
A. Missouri WIC Approved Infant Formulas and Special Formulas (Exempt Infant Formulas and Medical Foods)
INFANTS – CONTRACT FORMULAS
|Type |# |
Formula Manufacturers (Contact Information and Websites)
WIC Works Formula Database:
|Formula Manufacturer |Websites |Customer Service Phone Numbers |
|Mead Johnson Nutritionals (MJN) | |1-800-457-3550 |
| | | |
|Nutricia North America (Nutricia) | |1-800-365-7354 OR 1-877-482-7845 |
|Nestlé Infant Nutrition (Gerber) | |1-800-284-9488 |
|Nestlé HealthCare Nutrition | |1-877-463-7853 |
| |Product Information: |1-800-422-ASK2 (2752) or 1-800-285-2889 |
| | | |
| | | |
| |Packaging Information: | |
| | | |
|Perrigo Nutritionals, PBM Products | |1-800-272-5095 or 540-832-3282 (x1113) |
| | | |
|VitaFlow | |1-888-VITAFLO (888-848-2356) |
|(metabolic formulas) | |Direct Line: 703-519-1282 |
| | |Monday through Friday 9:00am – 5:00pm EST |
| | |Email: vitaflo@ |
|Abbott Nutrition |Product Information: |1-800-551-5838 |
|(Formerly Ross Pharmaceuticals) | | |
| |Packaging Information: | |
| | | |
Maximum Monthly Allowance of Supplemental Foods for “Food Package III” Updated!
|Foods |Infants |Children |Women |
| |0-5 |6-11 |Children (1 – 4) |Pregnant |Non-Breastfeeding |
| |Months |Months | |Mostly Breastfeeding |Some Breastfeeding |
| | | | |(≤ Max Allowed) |(> Max Allowed) |
|Infant Cereal |Not allowed |24 oz |32 oz infant cereal may be |32 oz infant cereal may be |32 oz infant cereal may be |32 oz infant cereal may be substituted for 36 oz.|
| | | |substituted for 36 oz. adult |substituted for 36 oz. adult cereal**|substituted for 36 oz. adult |adult cereal** |
| | | |cereal** | |cereal** | |
|Infant Fruit and |Not allowed |32- 4 oz. |Not allowed |Not allowed |Not allowed |No allowed |
|Vegetables | |containers | | | | |
|Juice, single strength |Not allowed |Not allowed |128 fl. oz. |144 fl. oz. |96 fl. oz. |144 fl. oz. |
| | | |2 - 64 oz. container |3 x 11.5 - 12oz. frozen |2 x 11.5-12oz. frozen |3 x 11.5-12oz. frozen |
|Milk, fluid*** |Not allowed |Not allowed |16 qt. |22 qt. |16 qt. |24 qt. |
|Breakfast cereal |Not allowed |Not allowed |36 oz. |36 oz. |36 oz. |36 oz. |
|Cheese |Not allowed |Not allowed |0*** |0*** |0*** |1 lb. |
|Eggs |Not allowed |Not allowed |1 dozen |1 dozen |1 dozen |2 dozen |
|Fruits and vegetables |Not allowed |Not allowed |$8.00 |$10.00 |$10.00 |$10.00 |
|Whole wheat bread |Not allowed |Not allowed |2 lb. |1 lb. |Not allowed |1 lb. |
|or Other Whole Grains | | | | | | |
|Fish (canned) |Not allowed |Not allowed |Not allowed |Not allowed |Not allowed |30 oz. |
|Legumes, dry/canned |Not allowed |Not allowed |1 pound dry beans |pound dry beans or 4-16 oz. cans |1 pound dry beans |1 lb dry beans or 4-16 oz. cans |
|AND/OR | | |OR |AND |OR |AND 1 x 16 - 18 oz. Peanut butter |
|Peanut Butter | | |4 x16 oz. cans |1 x 16-18 oz. Peanut butter |4-16 oz. cans | |
| | | |OR | |OR | |
| | | |1 x 16-18 oz. Peanut butter | |1 x 16-18 oz Peanut Butter | |
|Food Package III is for Woman, Infant, and Child participants who have a documented qualifying condition that requires the use of a WIC formula (infant formula, exempt infant formula, or WIC-eligible medical food)|
|because the use of conventional foods is precluded, restricted, or inadequate to address their special nutritional needs. |
|* See the Missouri WIC Approved Infant Formulas and Special Formulas (Exempt Infant Formulas and Medical Foods) (FFRG Formula Listing Page 4-9) |
|** 32 ounces infant cereal may be substituted for 36 ounces adult cereal. (ER# 2.07000) |
|*** See the Milk Substitute and Medical Documentation (WIC 27) Requirement Section (FFRG – Guidelines) Important! |
-----------------------
|# |Milk |Allowed Size |Children |Children |Women |
| | | |12-23 months |24–59 months | |
|1 |Whole Milk |½ Gallon/Gallon/Quart |Allowed |* |* |
|2 |Store Brand Evaporated Whole Milk |12 oz can |Allowed |* |* |
|3 |Store Brand Lactose Free Whole Milk |½ gallon |Allowed |* |* |
|4 |Goat Milk (Evaporated Whole) |12 oz. can |Allowed |* |* |
|5 |Soy Milk (Approved brands & Varieties) |½ gallon |*** |*** |Allowed |
|6 |Milk (Skim thru 1%) |½ Gallon/Gallon/Quart |Not Allowed |Allowed |Allowed |
|7 |2% milk |½ Gallon/Gallon/Quart |*** |*** |*** |
|8 |Evaporated Low Fat/Fat Free Milk |12 oz can |Not Allowed |Allowed |Allowed |
|9 |Goat milk (nonfat powdered) |12 oz can |Not Allowed |Allowed |Allowed |
|10 |Cultured Buttermilk |Quart |Not Allowed |Allowed |Allowed |
|11 |Non-Fat Dry Milk (powdered) |8 Quart-Box |Not Allowed |Allowed |Allowed |
|12 |Store Brand Lactose Free Milk (Skim thru 1%) |½ gallon |Not Allowed |Allowed |Allowed |
6. Important!
Please see page 2 for the new descriptions.
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