PDF Medical Formula Price List June 2018 .us
Company Nestle Nestle Nestle
Nestle
Nestle
Nestle
Nestle
Nestle
Nestle
Nestle
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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