IN.gov | The Official Website of the State of Indiana
Food Price List (FPL) Updated 10/01/2017 FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Store NamePhone NumberEmailCounty FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Store AddressCityStateZip Code FORMTEXT ????? FORMTEXT ?????WIC Vendor Number (if known)Name of Person Completing this FPLInstructions:Complete all sections of the Food Price List (FPL) for all relevant WIC authorized foods in the following pages.If you have questions, explanations, or comments, please provide these in the space on the last page.If you are an existing vendor, save this document to your computer using the file name “County#####FPL.” For example, a store in Marion County with WIC vendor number 01234 would save the file as Marion01234FPL.Email the completed FPL document and Vendor Application to WICVendorMail@isdh..Minimum Inventory of WIC Approved Foods (Refer to the Vendor Food Card for more information.):Milk: 12 gallons total: 3-whole, 2-2%, 1-1% or skimInfant Formula: Cheese: 2 kinds, 3 lbs. in 8 or 16 oz. sizes6-12.1 oz. Gerber Good Start Gentle concentrateEggs: 3 dozen large or extra large white eggs, one-dozen20-12.7 oz. Gerber Good Start Gentle powderDry Beans: 2 kinds of dry beans for a total of 3 lbs. in 1 lb. bags10-12.4 oz. Gerber Good Start Soothe powder 5-12.9 oz. Gerber Good Start Soy powderCanned Beans: 128 oz. of canned beans in 15-64 oz. sizeInfant Cereal: 2 kinds for a total of 64 oz. in 8 or 16 oz. containersCereal: 6 kinds of dry and 1 kind of cooked, 20 boxes total, at least 1 whole grain cerealFruits and Vegetables Infant Food: 192 oz. in 4 oz. jars or 8 oz. 2-packsJuice: 15 containers of 64 oz., 3 kinds with 100% juice and 120% Vitamin C or moreMeat Baby Food: 16 containers of 2.5 oz. glass jarsJuice Concentrate: 5 cans of 11.5 or 12 oz. concentrate or 46-48 oz. juice, 2 kindsBread: 5 loaves of WIC approved whole grain bread in 16 oz. packagesPeanut Butter: 5 jars, 16-18 oz.Fruits and Vegetables: $30 worth with 2 different fruits and 2 different vegetablesDoes your store have all of the required WIC food listed above in stock?? Yes? NoA. MILK: Least expensive brand only. No organic.PriceWhole FORMTEXT ?????gallon2% FORMTEXT ?????gallon1% FORMTEXT ?????gallonSkim FORMTEXT ?????gallonWhole FORMTEXT ?????? gallon2% FORMTEXT ?????? gallon1% FORMTEXT ?????? gallonSkim FORMTEXT ?????? gallonLactose-Free FORMTEXT ?????? gallonLactose-Free FORMTEXT ?????quartSilk Original Soy Milk FORMTEXT ?????? gallon8th Continent Soy Milk FORMTEXT ?????? gallonEvaporated FORMTEXT ?????12 oz.Powdered Dry FORMTEXT ?????9.6 oz. Powdered Dry FORMTEXT ?????25.6 oz.UHT FORMTEXT ?????quartB. CHEESE: Highest price. No organic.8 oz.16 oz.American FORMTEXT ????? FORMTEXT ?????Cheddar FORMTEXT ????? FORMTEXT ?????Colby FORMTEXT ????? FORMTEXT ?????Colby-Jack FORMTEXT ????? FORMTEXT ?????Monterey-Jack FORMTEXT ????? FORMTEXT ?????Mozzarella FORMTEXT ????? FORMTEXT ?????Provolone FORMTEXT ????? FORMTEXT ?????Swiss FORMTEXT ????? FORMTEXT ?????Blend FORMTEXT ????? FORMTEXT ?????C. YOGURT: Highest price. 32 oz. plain or flavored. Container can be quart or multipacks. No Greek or light yogurt. No organic.PriceBrandContainer TypeNonfat or Low Fat FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Whole Fat FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????D. EGGS: Least expensive brand only. Cage- free allowed. No organic.PriceExtra Large White FORMTEXT ?????Large White FORMTEXT ?????E. CANNED BEANS: Highest price. No organic.PriceBlack FORMTEXT ?????15-16 oz.Garbanzo FORMTEXT ?????15-16 oz.Great Northern FORMTEXT ?????15-16 oz.Kidney FORMTEXT ?????15-16 oz.Navy FORMTEXT ?????15-16 oz.Pinto FORMTEXT ?????15-16 oz.Lima FORMTEXT ?????15-16 oz.Fat Free Refried FORMTEXT ?????15-16 oz.Black-Eye Peas FORMTEXT ?????15-16 oz.F. DRY BEANS: Highest price. No organic.TypePrice FORMTEXT ????? FORMTEXT ?????1 lb. (16 oz.) FORMTEXT ????? FORMTEXT ?????1 lb. (16 oz.) FORMTEXT ????? FORMTEXT ?????1 lb. (16 oz.)G. FISH: Highest price. Packed in water, oil, or vegetable broth. No premium or organic.Chunk Light TunaPink Salmon FORMTEXT ?????5 oz. FORMTEXT ?????5 oz. FORMTEXT ?????12 oz. FORMTEXT ?????6 oz. FORMTEXT ?????7.5 oz. FORMTEXT ?????14.75 oz.H. PEANUT BUTTER: 16-18 oz. jars only. Creamy or crunchy. No spreads or organic.PriceStore Brand FORMTEXT ?????Other FORMTEXT ?????Highest Price FORMTEXT ?????I. GRAINS: Highest price. No organic.16 oz. Whole Wheat BreadPriceAunt Millie’s FORMTEXT ?????Best Choice FORMTEXT ?????Bimbo FORMTEXT ?????Bunny FORMTEXT ?????Butternut FORMTEXT ?????Family Choice FORMTEXT ?????Holsum FORMTEXT ?????IGA FORMTEXT ?????Kroger FORMTEXT ?????Meijer FORMTEXT ?????Nature’s Own FORMTEXT ?????Pepperidge Farms Stone Ground FORMTEXT ?????Pepperidge Farms Cinnamon and Raisin Swirl FORMTEXT ?????16 oz. Whole Wheat BreadPriceSara Lee FORMTEXT ?????Schnucks FORMTEXT ?????Schwebel FORMTEXT ?????Sunbeam FORMTEXT ?????Village Hearth FORMTEXT ?????Wonder FORMTEXT ?????16 oz. Whole Wheat or Corn TortillaPriceBest Choice FORMTEXT ?????Chi-Chi’s FORMTEXT ?????Don Pancho FORMTEXT ?????Essential Everyday FORMTEXT ?????Food Club FORMTEXT ?????Great Value FORMTEXT ?????IGA FORMTEXT ?????Kroger FORMTEXT ?????La Banderita FORMTEXT ?????Meijer FORMTEXT ?????Mi Casa FORMTEXT ?????Mission FORMTEXT ?????Ortega FORMTEXT ?????Schnucks FORMTEXT ?????Spartan FORMTEXT ?????Tio Santi FORMTEXT ?????PriceBrown Rice: 14-16 oz. FORMTEXT ?????Whole Wheat Pasta: 16 oz. FORMTEXT ?????J. CEREAL: 18 oz. minimum size. List the price of all the approved cereals that you stock. Vendors must stock at least one hot and one whole grain cereal. *Indicates a whole grain cereal. General MillsPriceSizePriceSizePriceSize*Cheerios Regular FORMTEXT ?????12 oz. FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.*Multi-Grain Cheerios FORMTEXT ?????12 oz. FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Cinnamon Chex FORMTEXT ?????12 oz.Corn Chex FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.Rice Chex FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.*Kix FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.Berry Berry Kix FORMTEXT ?????12 oz.Honey Kix FORMTEXT ?????12 oz.Dora the Explorer FORMTEXT ?????18 oz.KelloggPriceSizePriceSizePriceSizeCrispix FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.Corn Flakes FORMTEXT ?????12 oz. FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.*Frosted Mini Wheats Original FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.*All-Bran Wheat Flakes FORMTEXT ?????18 oz.Rice Krispies FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.*Special K Original FORMTEXT ?????12 oz. FORMTEXT ?????18 oz.PostPriceSizePriceSizePriceSizeAlpha-Bits* FORMTEXT ?????12 oz.*Grape Nut Flakes FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Honey Bunches of OatsHoney Roasted FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Almonds FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Cinnamon Bunches FORMTEXT ?????18 oz.*Vanilla Bunches FORMTEXT ?????18 oz.*Honey Crunch FORMTEXT ?????18 oz.*Almond Crunch FORMTEXT ?????18 oz.Malt-O-MealPriceSizePriceSizePriceSize*Frosted Mini Spooners FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.*Strawberry Cream Mini Spooners FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.*Blueberry Mini Spooners FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Crispy Rice FORMTEXT ?????12 oz. FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.QuakerPriceSize*Life Original FORMTEXT ?????18 oz.Hot CerealsPriceSizePriceSizePriceSizeMalt-O-Meal Original FORMTEXT ?????18 oz. FORMTEXT ?????36 oz.Malt-O-Meal Chocolate FORMTEXT ?????36 oz.Cream of Rice FORMTEXT ?????12 oz.*Cream of Wheat Whole Grain FORMTEXT ?????18 oz.*Quaker Instant Oatmeal Original FORMTEXT ?????11.8 oz. FORMTEXT ?????23.7 oz.K. 64 OZ JUICE: Highest price. Can be shelf stable or refrigerated. Must be 100% juice and a minimum of 120% Vitamin C. No organic.BrandPriceOrange FORMTEXT ????? FORMTEXT ?????64 oz.Apple FORMTEXT ????? FORMTEXT ?????64 oz.Grape FORMTEXT ????? FORMTEXT ?????64 oz.Grapefruit FORMTEXT ????? FORMTEXT ?????64 oz.Pineapple FORMTEXT ????? FORMTEXT ?????64 oz.Tomato FORMTEXT ????? FORMTEXT ?????64 oz.Vegetable FORMTEXT ????? FORMTEXT ?????64 oz.BlendsJuicy Juice FORMTEXT ?????64 oz.Old Orchard FORMTEXT ?????64 oz.L. 46-48 OZ JUICE: Highest price. Can be shelf stable or refrigerated. Must be 100% juice and a minimum of 120% Vitamin C. No organic.BrandPriceOrange FORMTEXT ????? FORMTEXT ?????46-48 oz.Apple FORMTEXT ????? FORMTEXT ?????46-48 oz.Grape FORMTEXT ????? FORMTEXT ?????46-48 oz.Grapefruit FORMTEXT ????? FORMTEXT ?????46-48 oz.Pineapple FORMTEXT ????? FORMTEXT ?????46-48 oz.Tomato FORMTEXT ????? FORMTEXT ?????46-48 oz.Vegetable FORMTEXT ????? FORMTEXT ?????46-48 oz.BlendsJuicy Juice FORMTEXT ?????46-48 oz.M. JUICE CONCENTRATE: Highest price. Frozen or shelf stable. 11.5 or 12 oz. containers only. No organic.BrandPriceOrange FORMTEXT ????? FORMTEXT ?????Apple FORMTEXT ????? FORMTEXT ?????Grape FORMTEXT ????? FORMTEXT ?????Grapefruit FORMTEXT ????? FORMTEXT ?????Pineapple FORMTEXT ????? FORMTEXT ?????OtherWelch’s with yellow tab FORMTEXT ?????Old Orchard with green tab FORMTEXT ?????Dole (any flavor) FORMTEXT ?????Welch’s shelf stable (any flavor) FORMTEXT ?????N. INFANT CEREAL: Highest price. 8 or 16 oz. containers. No added fruit or quinoa. No organic.BrandPriceOatmeal FORMTEXT ????? FORMTEXT ?????Rice FORMTEXT ????? FORMTEXT ?????Multigrain FORMTEXT ????? FORMTEXT ?????Barley FORMTEXT ????? FORMTEXT ?????Other FORMTEXT ????? FORMTEXT ?????O. INFANT FOOD: Highest price. No organic.BrandPrice4 oz. Jar of Fruit and/or Veggie FORMTEXT ????? FORMTEXT ?????8 oz. 2-Pack of Fruit and/or Veggie FORMTEXT ????? FORMTEXT ?????2.5 oz. Jar of Meat FORMTEXT ????? FORMTEXT ?????P. INFANT FORMULA: *Indicates required formulas for all stores, even those without pharmacies.Is your store also a pharmacy? ? Yes? NoIf yes, pharmacies must provide prices for all formulas listed on this page and the next page or this application will not be approved. If your store does not have a pharmacy, then please provide prices of the formulas that are regularly stocked.58102506985? Yes? No00? Yes? NoCan you obtain any of the items on the WIC formulary list page 1-3 located at within 2 working days?Who is the WIC contact for special order formula at your store? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????NameTitlePhone NumberEmailPowderPriceReady to Feed (RTF)PriceLiquid ConcentratePriceGerber Good Start Gentle*12.7 oz. FORMTEXT ?????8.45 oz. 4-Pack FORMTEXT ?????*12.1 oz. FORMTEXT ?????Gerber Good Start Soothe*12.4 oz. FORMTEXT ?????Gerber Good Start Soy*12.9 oz. FORMTEXT ?????8.45 oz. 4-Pack FORMTEXT ?????12.1 oz. FORMTEXT ?????Q. SPECIAL FORMULAReminder: Stores with pharmacies must list prices for ALL FORMULAS ON THIS PAGE.PowderReady to Feed (RTF)Liquid ConcentrateCaseSize (UPC)PriceSize (UPC)PriceSize (UPC)PriceSize (UPC)PriceBoost (any flavor)8 oz. 6-Pack (041679674000) FORMTEXT ?????Boost Kid Essentials 1.0 Cal (any flavor)8.25 oz. 4-Pack (041679950968) FORMTEXT ?????EleCare for Infants w/ DHA & ARA14.1 oz. (070074535111) FORMTEXT ?????Enfamil Nutramigen w/ Enflora12.6 oz. (300871239418) FORMTEXT ?????Enfamil NutramigenQuart (300870499011) FORMTEXT ?????13 oz. (300870498014) FORMTEXT ?????Enfamil EnfaCare12.8 oz. (300870019448) FORMTEXT ?????8 oz. 6-Pack (300875102985) FORMTEXT ?????2 oz./48/case (300871390010) FORMTEXT ?????Ensure (any flavor)8 oz. 6-Pack (070074407111) FORMTEXT ?????Neocate Infant w/DHA & ARA14.1 oz. (749735025956) FORMTEXT ?????Neocate Jr (any flavor)14.1 oz. (749735017906) FORMTEXT ?????Pediasure Grow & Gain (any flavor)8 oz. 6-Pack (070074620503) FORMTEXT ?????Pediasure Grow & Gain w/ Fiber (any flavor)8 oz. 6-Pack (070074582214) FORMTEXT ?????Pediasure 1.5 Cal (any flavor)8 oz./24/case (070074564098) FORMTEXT ?????Pediasure Peptide 1.0 Cal (any flavor)8 oz./24/case (070074564111) FORMTEXT ?????Similac Expert Care Alimentum12.1 oz. (070074647128) FORMTEXT ?????Quart (070074575131) FORMTEXT ?????Similac Expert Care NeoSure16 oz. (070074574318) FORMTEXT ?????Quart (070074574561) FORMTEXT ?????This is not a complete list of all special formulas. Please see the complete list at wic..In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: , and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: -1 mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;-2 fax: (202) 690-7442; or-3 email: program.intake@.USDA is an equal opportunity provider and employer.-8572522479000Explanations and comments: FORMTEXT ??????????????? ................
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