PDF Medical Formula Price List June 2018 .us

Company Nestle Nestle Nestle

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Abbott Nutrition Nestle Nestle Nutricia Abbott Nutrition Abbott Nutrition Nutricia Abbott Nutrition

MN WIC Medical Formula Price List - October, 2018

Formula Alfamino Infant Alfamino Junior Beneprotein

Boost Original

Boost Breeze

Boost Glucose Control

Boost Kid Essentials 1.0 CAL

Boost Kid Essentials 1.5 CAL

Boost Kid Essentials 1.5 CAL with Fiber

Boost Plus (any flavor)

Calcilo XD Compleat Pediatric Compleat Pediatric Reduced Calorie Complete Amino Acid Mix Cyclinex 1 Cyclinex 2 Duocal Elecare for Infants

Container Size Listed on Voucher 14.1 oz. Powder 14.1 oz. Powder 8 oz. powder

6-packs 8 oz. RTF

8 oz. RTF

6-packs 8 oz. RTF

8 oz. RTF

8 oz. RTF

8 oz. RTF

6-packs 8 oz. RTF

13.2 oz. (375 g) Powder 8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF 7 oz. (200 g.) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder

Container UPC

7613034788214

7613034787958

043900284101 041679675663, 041679674666, 041679676660 043900186290, 043900186498, 043900186665 041679157916, 041679158128, 041679157817 043900335308, 043900335209, 043900335117 043900335902, 043900335889, 043900335407 043900335001 041679933664, 041679932667, 041679931660 070074533292

043900142401

043900380742

749735001240

070074511450

070074511474

749735002803

070074535111

Containers per Case

6 6 6

Maximum Price per Container $ 54.84 $ 54.84 $ 14.60

4

$ 10.82

27

$ 1.61

4

$ 11.75

27

$ 1.95

27

$ 2.61

27

$ 2.72

4

$ 12.84

6

$ 20.85

24

$ 3.37

24

$ 3.37

6

$ 124.53

6

$ 22.04

6

$ 48.27

6

$ 29.12

6

$ 47.88

Abbott Nutrition Elecare Jr (Age 1 & Up)

Mead Johnson Mead Johnson

Mead Johnson Mead Johnson Mead Johnson Mead Johnson Mead Johnson Mead Johnson Mead Johnson

Abbott Nutrition

EnfaCare EnfaCare

Enfamil Human Milk Fortifier Enfamil Premature 20 Cal Enfamil Premature 24 Cal Enfamil Premature 30 Cal Enfamil Premature High Protein 24 Cal Enfamil (w/Iron) 24 Calorie Enfaport

Ensure Clear (any flavor)

Abbott Nutrition

Ensure Clear (Therapeutic)

Abbott Nutrition

Ensure High Protein

Abbott Nutrition

Ensure Original

Abbott Nutrition

Ensure Plus (any flavor)

Abbott Nutrition

Nutricia Nestle

Ensure Pudding (any flavor)

GA1 Anamix Early Years Gerber Extensive HA

070074552545,

14.1 oz. (400 g) Powder

070074565866, 070074662763,

6-packs 8 oz. RTU

070074662718 300875102985

12.8 oz. Powder

*300870019448, 300875122082

box (100 packets, .71 g each) powder

300872014489

6-packs 2 oz. RTU

300875115701

6-packs 2 oz. RTU

300875115688

6-packs 2 oz. RTU

300875115725

6-packs 2 oz. RTU

300875115749

6-packs 2 oz. RTU

300875120583

6-packs 6 oz. RTU

300875105252

070074566054,

4-packs 10 oz. RTU

070074565019,

6.8 oz.

070074624815 070074566412,

070074566436, 070074641164,

6-packs 8 oz. RTU

070074665474,

070074641188 070074517858,

070074560168,

6-packs 8 oz. RTU

070074407012, 070074538075,

070074407050,

070074407111 070074517872,

6-packs 8 oz. RTU

070074407029, 070074407180,

070074407074 070074548494,

4-packs 4 oz. Pudding

070074548470,

14.1 oz (400 g) Powder

070074548456 749735002179

14.1 oz. Powder

050000598526

6

$ 47.88

4

$ 20.44

6

$ 26.42

2

$ 139.10

8

$ 12.17

8

$ 12.17

8

$ 12.17

8

$ 12.17

8

$ 10.61

4

$ 18.56

3

$ 11.19

32

$ 1.59

4

$ 14.38

4

$ 14.89

4

$ 16.15

12

$ 7.76

6

$ 65.57

6

$ 31.92

Abbott Nutrition Glucerna (Shake)

Abbott Nutrition Abbott Nutrition Nutricia

Nutricia

Abbott Nutrition Abbott Nutrition Nutricia Nutricia Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition Nutricia Nutricia

Nutricia

Abbott Nutrition Abbott Nutrition Nutricia Nestle Nestle Nutricia Nutricia Nutricia

Nutricia

Nutricia

Nutricia

Glutarex 1 Glutarex 2 HCU Anamix Early Years

HCU Lophlex LQ

Hominex 1 Hominex 2 IVA Anamix Early Years IVA Anamix Next I-Valex 1 I-Valex 2 Jevity 1 Cal Jevity 1.2 Cal Ketocal 3:1 Ketocal 4:1

Ketocal 4:1 LQ

Ketonex 1 Ketonex 2 Liquigen (MCT) MCT Oil Microlipid MMA/PA Anamix Early years MMA/PA Anamix Next Monogen (DHA & ARA)

MSUD Lophlex LQ

Neocate Infant with DHA & ARA

Neocate Junior

Nutricia

Neocate Junior w/ Prebiotics

6-pack 8 oz. RTU

14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. Powder packs (30 pouches 4.2 oz. (125ml)/pack) 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 8 oz. RTF 8 oz. RTF 11 oz. (300 g) Powder 11 oz. (300 g) Powder

8 oz. (237 ml) RTF

14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 8.5 oz. (250 ml) RTF 32 oz. (1 quart) RTU 3 oz. RTU 14.1 oz. Powder 14.1 oz. Powder 14.1 oz. (400 g) Powder packs (30 pouches 4.2 oz. (125ml)/pack) 14.1 oz. (400 g) Powder

14.1 oz. (400 g) Powder

14.1 oz. (400 g) Powder

070074578118, 070074578057, 070074578026, 070074578088 070074511412 070074511436 749735001691

749735067482

070074511177 070074511191 749735002117 749735094716 070074511375 070074511399 070074647586 070074646244 749735066720 749735018422 749735087961, 749735030547 070074511139 070074511153 749735019573 041679365038 041679087435 749735002155 749735094723 749735060339

749735067499

749735025956 749735017906, 749735021248, 749735026908 749735029121, 749735006276, 749735064566

4

$ 14.12

6

$ 43.84

6

$ 87.88

6

$ 65.57

1

$ 432.90

6

$ 43.84

6

$ 87.88

6

$ 65.57

6

$ 92.22

6

$ 43.84

6

$ 87.88

24

$ 2.05

24

$ 2.30

6

$ 35.19

6

$ 35.19

27

$ 5.96

6

$ 45.70

6

$ 87.88

4

$ 13.49

6

$ 73.34

48

$ 3.51

6

$ 65.57

6

$ 92.22

6

$ 41.96

1

$ 432.90

4

$ 48.09

4

$ 48.09

4

$ 48.09

Nutricia

Nutricia

Nutricia

Abbott Nutrition

Mead Johnson Mead Johnson Mead Johnson Mead Johnson Mead Johnson Nestle Nestle Nestle Nestle Mead Johnson Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition

Neocate Nutra

Neocate Splash

Neocate Syneo Infant

Nepro

Nutramigen Nutramigen Nutramigen 20 Calorie Nutramigen w/ Enflora LGG Nutramigen w/ Enflora LGG Toddler Nutren 1.0 Nutren 1.0 with Fiber Nutren Jr. Nutren Jr. with Fiber OA 1 PediaSure 1.5 Cal PediaSure 1.5 Cal w/ Fiber PediaSure Enteral 1.0 Cal PediaSure Enteral w/ Fiber 1.0

Abbott Nutrition

PediaSure Grow & Gain (any flavor)

Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition

PediaSure Grow & Gain w/ Fiber PediaSure Grow & Gain Shake Mix - Vanilla PediaSure Peptide 1.0 Cal PediaSure Peptide 1.5 Cal PediaSure Sidekicks

14.1 oz. (400 g) Powder

8 oz. (237 ml) RTF

14.1 oz. (400 g) Powder

8 oz. RTU

13 oz. Concentrate 32 oz. RTU 6-packs 2 oz. RTU 12.6 oz. Powder 12.6 oz. Powder 8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF 16 oz. Powder 8 oz. RTF 8 oz. RTF 8 oz. RTF 8 oz. RTF

6-packs 8 oz. RTF

6-packs 8 oz. RTF

14.1 oz. Powder

8 oz. RTF

8 oz. RTF

6-packs 8 oz. RTF

749735067390 749735024355, 749735024362, 749735024379 749735014363 070074620916, 070074620930, 070074620954 300870498014 300875115640 300871437418 300871239418 300875107348 798716162107 798716160561 798716160622 798716160639 300875101995 070074564104 070074564128 070074518053 070074518077 070074580531, 070074538198, 070074580593, 070074580562, 070074580500, 070074669205 070074563695, 070074580623

070074669540

070074621203, 070074621227, 070074621241 070074566566 070074669137, 070074666402, 070074669175

4

$ 47.03

27

$ 6.39

4

$ 50.43

24

$ 4.37

12

$ 10.60

6

$ 15.21

8

$ 11.00

6

$ 43.88

6

$ 43.88

24

$ 1.26

24

$ 1.33

24

$ 1.96

24

$ 2.10

6

$ 52.05

24

$ 3.85

24

$ 4.02

24

$ 2.56

24

$ 2.68

4

$ 17.55

4

$ 17.98

6

$ 21.18

24

$ 8.23

24

$ 11.30

24

$ 17.55

Nestle Nestle

Peptamen Peptamen 1.5

Nestle

Nestle Nestle Nestle Nestle

Nutricia Mead Johnson Abbott Nutrition Abbott Nutrition Mead Johnson Mead Johnson

Nutricia

Nutricia

Peptamen Jr.

Peptamen Jr. Fiber Peptamen Jr. 1.5 Peptamen Junior HP Peptamen Junior w/ Prebio

Periflex Advance PFD Toddler Phenex 1 Phenex 2 Phenyl-Free 1 Phenyl-Free 2

PKU Lophlex LQ 20

PKU Periflex Early Years

Nutricia

(PKU) Periflex Junior Plus

Nutricia Mead Johnson Mead Johnson Mead Johnson Mead Johnson Mead Johnson Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition Abbott Nutrition

Polycal Portagen Pregestimil Pregestimil 20 Calories Pregestimil 24 Calories Product 3232A Promote Promote with Fiber Pro-Phree Propimex 1 Propimex 2

8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF

8.45 oz. (250 ml) RTF

8.45 oz. (250 ml) RTF 8.45 oz. (250 ml) RTF 8.5 oz. RTF 8.45 oz. (250 ml) RTF

16 oz. (454 g) Powder 16 oz. Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 16 oz. Powder 16 oz. Powder packs (30 pouches 4.2 oz. (125ml)/pack) 14.1 oz. (400 g) Powder

14.1 oz. (400 g) Powder

14.1 oz. (400 g) Powder 14.46 oz. Powder 16 oz. Powder 6-packs 2 oz. RTU 6-packs 2 oz. RTU 16 oz. Powder 8 oz. RTF 8 oz. RTF 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder 14.1 oz. (400 g) Powder

798716162695 798716181924, 798716081900 798716601405, 798716062534, 798716062527 798716602006

798716073639

043900467689 798716364157, 798716162616 749735026502, 749735026256 300875101780

070074511214 070074511238, 070074557564 300875101728

300875100035 749735095355, 749735061305, 749735061299 749735001646 749735094778, 749735094761, 749735094747, 749735094785 749735011522

300875117286

300870367013

300871433410

300871434417

300870425416

070074507750

070074518732

070074511498

070074511337

070074511351

24

$ 7.61

24

$ 9.88

24

$ 7.90

24

$ 8.29

24

$ 10.42

24

$ 9.29

24

$ 8.29

6

$ 75.17

6

$ 26.03

6

$ 25.06

6

$ 49.22

6

$ 38.16

6

$ 44.06

1

$ 262.56

6

$ 26.29

6

$ 53.84

12

$ 10.04

6

$ 25.03

6

$ 44.46

8

$ 11.00

8

$ 11.00

6

$ 79.89

24

$ 2.07

24

$ 2.07

6

$ 10.79

6

$ 43.84

6

$ 87.88

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