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  • Utah Wic Formula Form

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Utah WIC Program Formula and Food Authorization Infants up to 12 Months of Age Please complete each appropriate section below or formula/foods cannot be issued. A. Marked Medical Reason/ Qualifying Condition Utah WIC Formula and Food Authorization Form Step A Complete patient information. Step B Indicate all medical diagnoses that apply to patient. Step F authority. Utah WIC Contract Formulas Issuing the following contract formula doesn t require.

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WIC Contract formulas are Similac Advance, Similac Isomil Soy, Similac Sensitive, Similac for Spit-Up, and Similac Total Comfort. These formulas can be given without a doctor's approval. Most other infant formulas can be supplied by WIC with a Food and Formula Authorization Form.

North Carolina contracts with Gerber to provide WIC recipients standard types of infant formulas.

WIC Formula Information If mom is not providing breastmilk, milk-based formula is the recommended food for infants under one year of age. Tennessee WIC has a contract with Abbott Nutrition to provide Similac formulas including Advance, Isomil (soy-based), Sensitive, Total Comfort.

(WSAZ) - WV WIC will only offer Similac products, effective March 1, 2023. WV WIC will continue to allow larger sized cans of Similac products to be purchased through April 30, 2023. In March 2022, WV WIC expanded allowable sizes, brands, and types of formula available for purchase with eWIC benefits.

WIC provides breastfeeding support, nutritious foods, information on healthy eating, and referrals to health care to pregnant, postpartum and breastfeeding women and children up to age five.

The Utah Women, Infants and Children (WIC) Program would like to welcome you to our website! Our program provides nutrition and breastfeeding services and supplemental foods to pregnant women, mothers, infants and children up to their 5th birthday.

ounces prepared 360 ounces per month / 90 fl ounces prepared = 4 cans Round 3.829 up to 4 cans per month. Formula Fed Infants: Formula issuance cannot exceed maximum amounts even with a physician's prescription.

The Utah WIC Program presently has a rebate agreement to provide the milk-based contract formulas Similac Advance, Similac Sensitive, Similac Sensitive for Spit-Up, Similac Total Comfort, and. The soy-based contract formulas is Similac Soy Isomil.

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© Copyright 1997-2025
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3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232