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

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download