PDF Georgia WIC Formulary
Georgia WIC Formulary
A complete listing of approved formulas and nutritionals for the Georgia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Enfamil Infant Enfamil ProSobee Enfamil Gentlease
Contract Infant Formula
Mead Johnson Nutrition Mead Johnson Nutrition Mead Johnson Nutrition
Contract Infant Formula Requiring Medical Documentation
Enfamil 24
Mead Johnson Nutrition
Enfamil A.R.
Mead Johnson Nutrition
EnfaGrow Toddler Transitions
Mead Johnson Nutrition
EnfaGrow Toddler Transitions Gentlease
Mead Johnson Nutrition
EnfaGrow Toddler Transitions Soy
Mead Johnson Nutrition
Non-Contract Formulas/Nutritionals Requiring Medical Documentation:
Formula Acerflex Add-Ins Alfamino Infant Alfamino Junior
A-Soy
Benecalorie
Beneprotein
Boost
Boost Breeze Boost Glucose Control Boost Kid Essentials 1.0 Boost Kid Essentials 1.5 Boost Kid Essentials 1.5 w/fiber
Manufacturer Nutricia Nutricia Nestl? Nutrition Nestl? Nutrition PBM Products Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition
Nestl? Nutrition
Nestl? Nutrition
Nestl? Nutrition
Nestl? Nutrition
Formula Boost Nutritional Pudding
Boost Plus
Bright Beginning Soy
Calcilo XD
Carnation Breakfast Essentials
Compleat
Compleat Pediatric Compleat Pediatric Reduced Calorie Complete Amino Acid Mix Complex MSUD Amino Acid Bars
Manufacturer
Nestl? Nutrition
Nestl? Nutrition
PBM Products
Abbott Nutrition
Nestl? Nutrition
Nestl? Nutrition Nestl? Nutrition
Nestl? Nutrition
Nutricia North America
Applied Nutrition Corporation
Formula
Cyclinex 1
Cyclinex 2
Duocal EleCare (for Infants)
EleCare Jr
Enfamil NeuroPro EnfaCare Enfamil Human Milk Fortifier Acidified Liquid Enfamil Premature 20 with iron Enfamil Premature 24 with iron Enfamil Premature 30 with iron
Enfaport
Manufacturer Abbott Nutrition Abbott Nutrition Nutricia Abbott Nutrition Abbott Nutrition
Mead Johnson
Mead Johnson
Mead Johnson
Mead Johnson
Mead Johnson
Mead Johnson
Revised October 2018
Page 1 of 4
Georgia WIC Formulary
A complete listing of approved formulas and nutritionals for the Georgia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Formula Manufacturer
Ensure Clear
Abbott Nutrition
Ensure High Abbott
Protein
Nutrition
Ensure
Abbott
Original
Nutrition
Ensure Plus
Abbott Nutrition
Ensure
Abbott
Pudding
Nutrition
Fiber Source Nestl?
HN
Nutrition
Gerber
Nestl?
Extensive Nutrition/
HA
Gerber
Glucerna
Abbott Nutrition
Glutarex-1
Abbott Nutrition
Glutarex-2
Abbott Nutrition
Hominex-1
Abbott Nutrition
Hominex-2
Abbott Nutrition
Introlite
Abbott Nutrition
IsoSource Nestl?
1.5
Nutrition
IsoSource Nestl?
HN
Nutrition
I-Valex-1
Abbott Nutrition
I-Valex-2
Abbott Nutrition
Jevity
Abbott Nutrition
KetoCal 3:1 Nutricia
KetoCal 4:1 Nutricia
Ketonex-1
Abbott Nutrition
Ketonex-2
Abbott Nutrition
KetoVie
Cambrooke Therapeutics
Formula Manufacturer
KetoVolve
Solace Nutrition
L-Emental
Hormel Health Labs
L-Emental Hormel
Hepatic
Health Labs
L-Emental Hormel
Pediatric
Health Labs
Lipistart
Vitaflow
Lo*Pro
Med-Diet Labs
Lophlex LQ Nutricia
MCT Oil
Nestl? Nutrition
MCT Procal Vitaflow
Methionaid Nutricia
Microlipid
Nestl? Nutrition
Monogen Nutricia
MSUD Analog
Nutricia
MSUD Maxamaid
Nutricia
MSUD Maxamum
Nutricia
MSUD-1
Nutricia
MSUD-2
Nutricia
Neocate
Infant DHA & Nutricia ARA
Neocate Junior
Nutricia
Neocate
Junior with Nutricia
Prebiotics
Neocate Nutra
Nutricia
Neocate Splash
Nutricia
Neocate Syneo Infant
Nutricia
Nepro with Abbott
Carb Steady Nutrition
Nitro-Pro
Hormel Health Labs
Formula Manufacturer
NovaSource Nestle
Renal
Nutrition
Nutramigen
Mead Johnson
Nutramigen with Enflora LGG Toddler
Mead Johnson
Nutramigen with Enflora LGG
Mead Johnson
Nutren 1.0
Nestle Nutrition
Nutren 1.0 Nestl?
with Fiber Nutrition
Nutren 1.5
Nestl? Nutrition
Nutren 2.0
Nestl? Nutrition
Glytrol
Nestl? Nutrition
Nutren
Nestl?
Junior
Nutrition
Nutren
Nestl?
Junior Fiber Nutrition
Nutren
Nestl?
Pulmonary Nutrition
Replete with Nestl?
Fiber
Nutrition
NutriHep
Nestl? Nutrition
Osmolite 1.0
Abbott Nutrition
Osmolite 1.2
Abbott Nutrition
PediaSure Grow and Gain
Abbott Nutrition
PediaSure Abbott
1.5 Cal
Nutrition
PediaSure 1.5 Cal with fiber
Abbott Nutrition
PediaSure Abbott
Enteral
Nutrition
Revised October 2018
Page 2 of 4
Georgia WIC Formulary
A complete listing of approved formulas and nutritionals for the Georgia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Formula PediaSure Enteral w/Fiber and scFOS PediaSure Peptide 1.0 Cal PediaSure Peptide 1.5 Cal PediaSure Grow and Gain w/Fiber
Pepdite Junior
Peptamen
Peptamen 1.5 Peptamen AF Peptamen Jr. HP Peptamen Junior Peptamen Junior 1.5 Peptamen Junior Fiber Peptamen Junior with Prebio
Perative
Periflex Advance Periflex Early Years Periflex Infant Periflex LQ
(previously Xphe Maxamum)
Manufacturer
Abbott Nutrition
Abbott Nutrition
Abbott Nutrition
Abbott Nutrition
Nutricia North America Nestle Nutrition Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition Nestl? Nutrition
Nestl? Nutrition
Abbott Nutrition
Nutricia
Nutricia North America Nutricia North America
Nutricia North America
Revised October 2018
Formula
Phenex-1
Phenex-2
PhenylAde 40Drink Mix
PhenylAde 60Drink Mix
PhenylAde Amino Acid Bars PhenylAde Amino Acid Blend
PhenylAde Drink Mixes
PhenylAde Essential Drink PhenylAde MTE Amino Acid Blend Phenyl-Free 2 Phenyl-Free 2HP Phlexy - 10 Bar Phlexy - 10 Capsules Phlexy - 10 Drink Mix PKU Periflex Junior Plus PKUExpress
PKU-Gel
Polycal
Portagen
Pregestimil
Manufacturer Abbott Nutrition Abbott Nutrition Applied Nutrition Corporation Applied Nutrition Corporation Applied Nutrition Corporation Applied Nutrition Corporation Applied Nutrition Corporation Applied Nutrition Corporation Applied Nutrition Corporation Mead Johnson Mead Johnson
Nutricia
Nutricia
Nutricia
Nutricia North America Vitaflo Limited Vitaflo Limited Nutricia Mead Johnson Mead Johnson
Formula Manufacturer
Pregestimil Mead
24
Johnson
Product
Mead
3232 A
Johnson
ProMod Liquid Protein
Abbott Nutrition
Promote
Abbott Nutrition
Promote with Abbott
Fiber
Nutrition
Pro-Peptide
Hormel Health Labs
Pro-Peptide Hormel
for Kids
Health Labs
Pro-Peptide Hormel
VHN
Health Labs
Pro-Phree
Abbott Nutrition
Propimex-1
Abbott Nutrition
Propimex-2
Abbott Nutrition
Nutricia
Protifar
North
America
ProViMin
Abbott Nutrition
Pulmocare
Abbott Nutrition
PurAmino
Mead Johnson
PurAmino Mead
Toddler
Johnson
PurAmino Mead
Junior
Johnson
RCF
Abbott Nutrition
RE/GEN
Nutra/ Balance
Renalcal
Nestl? Nutrition
RenaStart Vitaflo
Resource Nestl?
2.0
Nutrition
Page 3 of 4
Georgia WIC Formulary
A complete listing of approved formulas and nutritionals for the Georgia Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Formula Manufacturer
Scandical
Calorie
Aptalis
Booster
Scandishake Aptalis
Scandishake Lactose Free
Aptalis
Scandishake Sugar Free
Aptalis
Similac
Abbott
Alimentum Nutrition
Similac
Abbott
NeoSure
Nutrition
Similac Human Milk Fortifier
Abbott Nutrition
Similac PM Abbott
60/40
Nutrition
Similac Special Care with Iron 20
Abbott Nutrition
Similac Special Care with Iron 24
Abbott Nutrition
Similac Special Care with Iron 30
Abbott Nutrition
SolCarb Suplena with Carb Steady
Tolerex
Solace Abbott Nutrition Nestl? Nutrition
TwoCal HN
Abbott Nutrition
Tyrex-1
Tyrex-2
UCD Anamix Junior UCD-2 Vivonex Pediatric
Vivonex Plus
Abbott Nutrition Abbott Nutrition
Nutricia
Nutricia Nestl? Nutrition Nestl? Nutrition
Formula
Vivonex RTF
Vivonex T.E.N. XLeu Maxamaid XLeu Maxamum XLys, XTrp Maxamaid XLys, XTrp Maxamum XMet Maxamaid XMet Maxamum XMTVI Maxamaid XMTVI Maxamum XPhe , XTyr Maxamaid XPhe Maxamaid XPTM Analog
Manufacturer Nestl? Nutrition Nestl? Nutrition Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Nutricia
Revised October 2018
Page 4 of 4
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