Approved Formulas in the New York State WIC Program
Formulary
Effective October 2024
| Contract Infant Formulas | Size and Formulation | Temporary Formulas and Sizes Available | Approved for |
|---|---|---|---|
| Enfamil Infant | 12.5 oz. powder, 13 oz. concentrate | I / C | |
| Enfamil Infant and Enfamil NeuroPro Infant | 32 oz. ready-to-use | I / C | |
| Enfamil A.R. | 12.9 oz. powder | Enfamil AR 19.5 oz powder Enfamil AR 27.4 oz powder Enfamil AR 30.4 oz powder |
I / C |
| Enfamil Gentlease | 12.4 oz. powder | Enfamil Gentlease 19.9 oz powder Enfamil NeuroPro Gentlease 19.5 oz powder Enfamil NeuroPro Gentlease 27.4 oz powder Enfamil NeuroPro Gentlease 30.4 oz powder Enfamil NeuroPro Gentlease 35.2 oz powder Enfamil Sensitive 19.5 oz powder Enfamil Sensitive 29.4 oz powder |
I / C |
| Enfamil NeuroPro Gentlease | 32 oz. ready-to-use | I / C | |
| Enfamil Reguline | 12.4 oz. powder | Enfamil Reguline 19.5 oz powder | I / C |
| Similac Soy Isomil | 12.4 oz. powder, 13 oz. concentrate, 32 oz. ready-to-use |
I / C |
| Hypoallergenic Formulas | Size and Formulation | Approved for |
|---|---|---|
| Alfamino Infant | 14.1 oz. powder | I / C |
| Alfamino Jr. | 14.1 oz. powder | C only |
| EleCare for Infants | 14.1 oz. powder | I / C |
| EleCare Jr. | 14.1 oz. powder | C only |
| Extensive HA | 14.1 oz. powder | I / C |
| Nutramigen | 13 oz. concentrate, 32 oz. ready-to-use | I / C |
| Nutramigen with Probiotic LGG | 12.6 oz. powder | I / C |
| Neocate Infant with DHA and ARA and Neocate Syneo Infant | 14.1 oz. powder | I / C |
| Neocate Jr. | 14.1 oz. powder | C only |
| Neocate Splash | 27 pack (8 oz.) ready-to-use | C only |
| PurAmino Infant | 14.1 oz. powder | I / C |
| PurAmino Jr | 14.1 oz. powder | C only |
| Similac Alimentum | 12.1 oz. powder, 32 oz. ready-to-use | I / C |
| Formulas for Premature Infants | Size and Formulation | Approved for |
| Enfamil NeuroPro EnfaCare | 13.6 oz. powder | I only |
| Similac Neosure | 13.1 oz. powder, 32 oz. ready-to-use | I only |
| Specialized Formulas | Size and Formulation | Approved for |
| Enfaport | 6 pack (6 oz.) ready-to-use | I only |
| KetoCal 3:1 | 11 oz. powder | C only |
| KetoCal 4:1 | 11 oz. powder | C only |
| Pregestimil | 16 oz. powder, 6 pack (2 oz.) ready-to-use |
I / C |
| Pregestimil 24 cal | 6 pack (2 oz.) ready-to-use | I/C |
| Similac PM 60/40 | 14.1 oz. powder | I / C |
| Pareve Infant Formula | Size and Formulation | Approved for |
|---|---|---|
| Gerber Good Start Soy (PAREVE for religious exemptions only) |
20 oz. powder | I / C |
| Calorie and Nutrient Dense Products | Size and Formulation | Approved for |
|---|---|---|
| Boost | 6 pack (8 oz.) ready-to-use | W only |
| Boost High Protein | 6 pack (8 oz.) ready-to-use | W only |
| Boost Kid Essentials | 8 oz. ready-to-use | C only |
| Ensure | 6 pack (8 oz.) ready-to-use | W only |
| Ensure Plus | 6 pack (8 oz.) ready-to-use | W only |
| PediaSure | 6 pack (8 oz.) ready-to-use | C only |
| PediaSure with Fiber | 4 pack (7.4 oz.) ready-to-use | C only |
| PediaSure Enteral | 8 oz. ready-to-use | C only |
| PediaSure Enteral with Fiber | 8 oz. ready-to-use | C only |
| Kate Farms Pediatric Standard 1.2 | 8.45 oz. ready-to-use | C only |
| Peptide Based Products | Size and Formulation | Approved for |
| Kate Farms Pediatric Peptide 1.0 | 8.45 oz. ready-to-use | C only |
| Kate Farms Pediatric Peptide 1.5 | 8.45 oz. ready-to-use | C only |
| PediaSure Peptide 1.0 | 8 oz. ready-to-use | C only |
| PediaSure Peptide 1.5 | 8 oz. ready-to-use | C only |
| Peptamen Jr. | 8.45 oz. ready-to-use | C only |
| Peptamen Jr. 1.5 | 8.45 oz. ready-to-use | C only |
| Modular Products | Size and Formulation | Approved for |
| MCT oil (Nestle) | 32 oz. ready-to-use | I / C / W |
| Phenex-1 | 14.1 oz. powder | I / C |
| Phenex-2 | 14.1 oz. powder | C / W |
- Medical documentation is required for:
- Infants 6 months or older with greater amounts of contract formula in lieu of infant foods
- Infants and children with exempt formula
- Children with contract formula
- Children and women with infant foods
- Children and women with WIC-eligible nutritionals
- Medical documentation includes an appropriate qualifying medical condition for the formula, quantity (ounces/day), length of use, and food restrictions. The Medical Documentation Form is available at: https://www.health.ny.gov/forms/doh-4456.pdf
- Premature formulas may be provided to premature infants up to their corrected age of 12 months.
- All flavors are approved for NYS WIC eligible formula products.
- The need for Ready-To-Use formula will be addressed by the WIC Program
- I = infant less than 1 year; C = child less than 5 years; W = woman
