WIC Medical Formula Price List - February 2018
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1 WIC Medical Formula Price List - February 2018 Company Formula Container Size Listed on Voucher Container UPC Containers per Case Maximum Price per Container Nestle Alfamino Infant 14.1 oz. Powder (case) 6 $ Nestle Alfamino Junior 14.1 oz. Powder (case) 6 $ Nestle Beneprotein 8 oz. powder $ Nestle Boost (Original, any flavor) 6-packs 8 oz. RTF , , 4 $ Nestle Boost Breeze 8 oz. RTF , , 27 $ Nestle Boost Glucose Control 6-packs 8 oz. RTF , , 4 $ Nestle Boost Kid Essentials 1.0 CAL 8 oz. RTF , , 27 $ Nestle Boost Kid Essentials 1.5 CAL 8 oz. RTF , , 27 $ Nestle Boost Kid Essentials 1.5 CAL with Fiber 8 oz. RTF $ 2.72 Nestle Boost Plus (any flavor) 6-packs 8 oz. RTF , $ Abbott Nutrition Calcilo XD 13.2 oz. (375 g) Powder $ Nestle Compleat Pediatric 8.45 oz. (250 ml) RTF $ 3.37 Nestle Compleat Pediatric Reduced Calorie 8.45 oz. (250 ml) RTF $ 3.37 Nutricia Complete Amino Acid Mix 7 oz. (200 g.) Powder $ Abbott Nutrition Cyclinex oz. (400 g) Powder $ Abbott Nutrition Cyclinex oz. (400 g) Powder $ Nutricia Duocal 14.1 oz. (400 g) Powder $ Page 1 of 7
2 Abbott Nutrition Elecare for Infants 14.1 oz. (400 g) Powder $ Abbott Nutrition Elecare Jr 14.1 oz. (400 g) Powder , , , $ Mead Johnson EnfaCare 6-packs 8 oz. RTU $ Mead Johnson EnfaCare 12.8 oz. Powder $ Mead Johnson Enfamil EnfaCare 2 oz. RTU $ 1.77 Mead Johnson Enfamil Human Milk Fortifier box (100 packets,.71 g each) powder $ Mead Johnson Enfamil Premature 20 Cal 2 oz. RTU $ 2.03 Mead Johnson Enfamil Premature 24 Cal 2 oz. RTU $ 2.03 Mead Johnson Enfamil Premature 30 Cal 2 oz. RTU $ 2.03 Mead Johnson Enfamil Premature High Protein 24 Cal 2 oz. RTU $ 2.03 Mead Johnson Enfamil (w/iron) 24 Calorie 2 oz. RTU $ 1.77 Mead Johnson Enfaport 6-packs 6 oz. RTU $ Abbott Nutrition Ensure Clear (any flavor) 4-packs 10 oz. RTU Abbott Nutrition Ensure Clear (Therapeutic) 6.75 oz. Abbott Nutrition Ensure High Protein 6-packs 8 oz. RTU Abbott Nutrition Ensure Original (any flavor) 6-packs 8 oz. RTU Abbott Nutrition Ensure Plus (any flavor) 6-packs 8 oz. RTU Abbott Nutrition Ensure Pudding (any flavor) 4-packs 4 oz. Pudding , , , , , , , , , , , , $ $ $ $ $ $ 7.76 Nestle Gerber Extensive HA 14.1 oz. Powder $ Page 2 of 7
3 Abbott Nutrition Glucerna Shake 6-pack 8 oz. RTU , , , $ Abbott Nutrition Glutarex oz. (400 g) Powder $ Abbott Nutrition Glutarex oz. (400 g) Powder $ Nutricia HCU Anamix Early Years 14.1 oz. Powder $ Nutricia HCU Lophlex LQ packs 4.2 oz. (125ml) $ Abbott Nutrition Hominex oz. (400 g) Powder $ Abbott Nutrition Hominex oz. (400 g) Powder $ Nutricia IVA Anamix Early Years 14.1 oz. (400 g) Powder $ Nutricia IVA Anamix Next 14.1 oz. (400 g) Powder $ Abbott Nutrition I-Valex oz. (400 g) Powder $ Abbott Nutrition I-Valex oz. (400 g) Powder $ Abbott Nutrition Jevity 1 Cal 8 oz. RTF $ 2.05 Abbott Nutrition Jevity 1.2 Cal 8 oz. RTF $ 2.30 Nutricia Ketocal 3:1 11 oz. (300 g) Powder $ Nutricia Ketocal 4:1 11 oz. (300 g) Powder $ Nutricia Ketocal 4:1 LQ 8 oz. (237 ml) RTF , $ 5.88 Abbott Nutrition Ketonex oz. (400 g) Powder $ Abbott Nutrition Ketonex oz. (400 g) Powder $ Nutricia Liquigen 8.5 oz. (250 ml) RTF $ Nestle MCT Oil 32 oz. (1 quart) RTU $ Nestle Microlipid 3 oz. RTU $ 3.51 Nutricia MMA/PA Anamix Early years 14.1 oz. Powder $ Nutricia Monogen 14.1 oz. (400 g) Powder $ Nutricia MSUD Lophlex LQ packs 4.2 oz. (125ml) $ Nutricia Neocate Infant with DHA & ARA 14.1 oz. (400 g) Powder $ Nutricia Neocate Junior 14.1 oz. (400 g) Powder , , $ Page 3 of 7
4 Nutricia Neocate Junior w/ Prebiotics 14.1 oz. (400 g) Powder , , $ Nutricia Neocate Nutra 14.1 oz. (400 g) Powder $ Nutricia Neocate Splash 8 oz. (237 ml) RTF , , $ 7.08 Nutricia Neocate Splash Unflavored 8 oz. RTU $ 7.08 Nutricia Neocate Syneo Infant 14.1 oz. (400 g) Powder $ Abbott Nutrition Nepro 8 oz. RTU , , $ 4.37 Mead Johnson Nutramigen 13 oz. Concentrate $ Mead Johnson Nutramigen 32 oz. RTU $ Mead Johnson Nutramigen 6-packs 8 oz. RTU $ Mead Johnson Nutramigen 20 Calorie 2 oz. RTU $ 1.83 Mead Johnson Nutramigen w/ Enflora LGG 12.6 oz. Powder $ Mead Johnson Nutramigen w/ Enflora LGG Toddler 12.6 oz. Powder $ Nestle Nutren oz. (250 ml) RTF $ 1.26 Nestle Nutren 1.0 with Fiber 8.45 oz. (250 ml) RTF $ 1.33 Nestle Nutren Jr oz. (250 ml) RTF $ 1.96 Nestle Nutren Jr. with Fiber 8.45 oz. (250 ml) RTF $ 2.10 Mead Johnson OA 1 16 oz. Powder $ Abbott Nutrition PediaSure 1.5 Cal 8 oz. RTF $ 3.85 Abbott Nutrition PediaSure 1.5 Cal w/ Fiber 8 oz. RTF $ 4.02 Abbott Nutrition PediaSure Enteral 1.0 Cal 8 oz. RTF $ 2.56 Abbott Nutrition PediaSure Enteral w/ Fiber oz. RTF $ 2.68 Abbott Nutrition PediaSure Grow & Gain (any flavor) 6-packs 8 oz. RTF Abbott Nutrition PediaSure Grow & Gain w/ Fiber 6-packs 8 oz. RTF , , , , , $ $ Abbott Nutrition PediaSure Grow & Gain Shake Mix - Vanilla 14 oz. Powder $ Page 4 of 7
5 Abbott Nutrition PediaSure Peptide 1.0 Cal 8 oz. RTF , , $ 8.23 Abbott Nutrition PediaSure Peptide 1.5 Cal 8 oz. RTF $ Abbott Nutrition PediaSure Sidekicks (any flavor) 6-packs 8 oz. RTF , , $ Abbott Nutrition PediaSure Sidekicks.63 Cal 8 oz. RTF $ 2.68 Nestle Peptamen 8.45 oz. (250 ml) RTF $ 7.61 Nestle Peptamen oz. (250 ml) RTF Nestle Peptamen Jr oz. (250 ml) RTF , , , $ $ 7.90 Nestle Peptamen Jr. Fiber 8.45 oz. (250 ml) RTF $ 8.29 Nestle Peptamen Jr oz. (250 ml) RTF $ Nestle Peptamen Junior HP 8.5 oz. RTF $ 9.29 Nestle Peptamen Junior w/ Prebio 8.45 oz. (250 ml) RTF Nutricia Periflex Advance 16 oz. (454 g) Powder , , $ $ Mead Johnson PFD Toddler 16 oz. Powder $ Abbott Nutrition Phenex oz. (400 g) Powder $ Abbott Nutrition Phenex oz. (400 g) Powder , $ Mead Johnson Phenyl-Free 1 16 oz. Powder $ Mead Johnson Phenyl-Free 2 16 oz. Powder $ Nutricia PKU Lophlex LQ 20 packs 4.2 oz (125ml) , , $ Nutricia PKU Periflex Early Years 14.1 oz. (400 g) Powder $ Nutricia (PKU) Periflex Junior Plus 14.1 oz. (400 g) Powder , , , $ Page 5 of 7
6 Nutricia Polycal 14.1 oz. (400 g) Powder $ 9.75 Mead Johnson Portagen oz. Powder $ Mead Johnson Pregestimil 16 oz. Powder $ Mead Johnson Pregestimil 20 Calories 2 oz. RTU $ 1.83 Mead Johnson Pregestimil 24 Calories 2 oz. RTU $ 1.83 Mead Johnson Product 3232A 16 oz. Powder $ Abbott Nutrition Promote 8 oz. RTF $ 2.07 Abbott Nutrition Promote with Fiber 8 oz. RTF $ 2.07 Abbott Nutrition Pro-Phree 14.1 oz. (400 g) Powder $ Abbott Nutrition Propimex oz. (400 g) Powder $ Abbott Nutrition Propimex oz. (400 g) Powder $ Abbott Nutrition Pro-ViMin 5.3 oz. Powder $ Abbott Nutrition Pulmocare 8 oz. RTF $ 2.54 Mead Johnson PurAmino 14.1 oz. Powder $ Mead Johnson PurAmino Toddler 14.1 oz. Powder $ Abbott Nutrition RCF (Ross Carbohydrate Free) 13 oz. liquid concentrate $ 5.51 Abbott Nutrition Similac 24 Cal w/ Iron 2 oz. RTF $ 2.80 Abbott Nutrition Similac Alimentum 2 oz. RTF $ 2.68 Abbott Nutrition Similac Alimentum 6-packs 8 oz. RTF $ Abbott Nutrition Similac Alimentum Quart (946 ml) RTF $ Abbott Nutrition Similac Alimentum 12.1 oz. Powder $ Abbott Nutrition Similac for Diarrhea Quart (32 oz.) RTF $ 8.22 Abbott Nutrition Similac Go & Grow 1.5 lb (24 oz.) Powder $ Abbott Nutrition Similac Human Milk Fortifier box (50 packets,.9g each) powder $ Abbott Nutrition Similac Neosure 2 oz. RTF $ 1.34 Abbott Nutrition Similac Neosure Quart (946 ml) RTF $ Abbott Nutrition Similac Neosure 13.1 oz. (371 g) Powder $ Abbott Nutrition Similac PM 60/ oz. (400 g) Powder $ Abbott Nutrition Similac Special Care 24 w/ Iron 2 oz. RTF $ 2.80 Abbott Nutrition Similac Special Care 30 w/ Iron 2 oz. RTF $ 2.80 Abbott Nutrition Similac Special Care 24 High Protein 2 oz. RTF $ 2.80 Page 6 of 7
7 Abbott Nutrition Suplena 8 oz. RTF $ 3.52 Nestle Tolerex 2.82 oz. Powder Packets $ 9.80 Nutricia TYR Anamix Early Years 14.1 oz. cans Powder $ Nutricia TYR Lophlex LQ packs 4.2 oz. (125ml) $ Mead Johnson Tyros 2 16 oz. Powder $ Nestle Vivonex Pediatric 1.7 oz. Powder Packets $ 6.51 Nestle Vivonex T.E.N oz. Powder Packets $ 9.42 Page 7 of 7
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