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21-046 May 21 Formula Resource Update (PDF) Memorandum #21-046 TO: WIC Regional Directors WIC Local Agency Directors FROM: Amanda Hovis, Director Nutrition Education/Clinic Services Unit Nutrition Services Section DATE: May 21, 2021 SUBJECT: Formula Resource Update Formula Approval Resources: The following Formula Approval resources have been updated and will be posted by their effective date, 6/1/2021. • Formula Code List • Formulary • Nutrition Assessment Requirement Guide • Texas WIC Maximum Quantity Table for Women and Children The June updated resources will be available here soon. Changes include: 1. Addition of eleven new products: • Code 627 Equacare Jr • Code 628 Essential Care Jr • Code 629 KetoVie 4:1 Peptide • Code 630 KetoVie 4:1 • Code 631 KetoVie 3:1 • Code 632 KetoVie 4:1 Unflavored • Code 633 ENU Shake • Code 634 ENU Pro3+ • Code 635 COMPLEAT Pediatric Organic Blends • Code 636 COMPLEAT Pediatric Peptide 1.5 • Code 637 Peptamen Jr HP 1.2 This institution is an equal opportunity provider. 2. Code 556 Pediasmart Soy has been discontinued and will no longer be available to issue effective 6/1/2021. If you have questions, please contact the Formula Team via email at: [email protected] This institution is an equal opportunity provider. FORMULA CODE LIST JUNE 2021 Formula Level: LA = Local Agency approval. SA = State Agency approval Note: Shaded items have packaging challenges. E=Exempt Approval Formula Formula Description Packaging/Flavors Smallest Available Unit/Comments S=Std Level- LA- Code (If left blank, smallest available unit is 1.) MF=WIC Local SA- Elig Nutr State E LA 593 ALFAMINO INFANT PWD 14.1OZ 6 cans/case MF LA 594 ALFAMINO JR PWD 14.1OZ 6 cans/case E LA 598 ALIMENTUM PWD 12.1OZ 6 cans/case E LA 395 ALIMENTUM RTU 32OZ 6 ctnrs/case E SA 463 BCAD 1 PWD 16OZ 6 cans/case MF SA 278 BCAD 2 PWD 16OZ 6 cans/case MF SA 528 BENECALORIE RTU 1.5OZ 24 ctnrs/case 24 containers MF SA 571 BETAQUIK MCT RTU 8.45OZ 18 ctnrs/case Must order in multiples of 18 MF LA 496 BOOST BREEZE RTU 8OZ 27 ctnrs/case; orange, peach, berry, variety (mixed flavors) MF LA 274 BOOST HP RTU 8OZ 24 ctnrs/case; vanilla MF LA 492 BOOST KID ESSENTIALS RTU 8OZ 4 ctnrs/case vanilla, chocolate MF LA 476 BOOST KID ESSENTIALS 1.5 FBR RTU 8OZ 27 ctnrs/case MF LA 475 BOOST KID ESSENTIALS 1.5 RTU 8OZ 27 ctnrs/case vanilla, chocolate, strawberry MF LA 429 BOOST PLS RTU 8OZ 24 ctnrs/case; vanilla, chocolate, strawberry MF SA 275 BOOST PUDD RTU 5OZ 4 cups/carton; vanilla, chocolate, 4 pack butterscotch MF LA 428 BOOST RTU 8OZ 24 ctnrs/case; vanilla, chocolate, strawberry MF LA 538 BOOST VHC RTU 8OZ 27 ctnrs/case; vanilla MF LA 434 BRIGHT BEGIN SOY RTU 8OZ 24 cans/case; vanilla 6 pack E SA 470 CALCILO XD PWD 13.2OZ 6 cans/case MF SA 572 CARB ZERO LCT RTU 8.45OZ 18 ctnrs/case Must order in multiples of 18 MF LA 636 24 pouches/case; chicken-garden blend, COMPLEAT PED ORGANIC RTU 10.1OZ plant-based MF LA 635 COMPLEAT PED PEPT 1.5 RTU 8.45OZ 24 ctnrs/case; unflavored MF LA 539 COMPLEAT PED RED CAL RTU 250ML 24 ctnrs/case MF LA 101 COMPLEAT PEDIATRIC RTU 250ML 24 ctnrs/case MF LA 102 COMPLEAT RTU 250ML 24 ctnrs/case MF SA 544 COMPLEX ESSENTIAL MSD PWD 1LB 4 cans/case; vanilla MF SA 542 COMPLEX JR MSD PWD 400G 4 cans/case MF SA 543 COMPLEX MSD AA BLEND PWD 1LB 4 cans/case E/MF SA 342 CYCLINEX 1 PWD 14.1OZ 6 cans/case MF SA 343 CYCLINEX 2 PWD 14.1OZ 6 cans/case MF LA 109 DIABETISOURCE AC RTU 250ML 24 ctnrs/case MF SA 238 DUOCAL PWD 400G 6 cans/case E LA 479 ELECARE DHA/ARA PWD 14.1OZ 6 cans/case MF LA 515 ELECARE JR PWD 14.1OZ 6 cans/case; unflavored, vanilla, banana, chocolate E SA 443 ENF PREMATURE 24 /IRON RTU 2OZ 6 bottles/carton; 48 bottles/case 6 bottles E SA 557 ENF PREMATURE 30 RTU 2OZ 6 bottles/carton; 48 bottles/case 6 bottles E SA 509 ENF PREMATURE HI PRO24 RTU 2OZ 6 bottles/carton; 48 bottles/case 6 bottles MF LA 608 ENFAGROW PREMIUM TODDLER PWD 24OZ 4 cans/case; natural milk, vanilla; E SA 305 ENFAMIL HMF PWD 0.71G 100 packets/carton; 2 cartons/case 100 packets E SA 510 ENFAMIL LIQUID HMF RTU 5ML 100 vials/carton; 2 cartons/case 100 vials E LA 371 ENFAMIL NEUROPRO ENFACARE PWD 12.8OZ 6 cans/case E LA 623 ENFAMIL NEUROPRO ENFACARE RTU 2OZ 6 bottles/carton; 24 bottles/case; 48 6 bottles bottles/case E LA 564 ENFAPORT RTU 6OZ-6PACK(36OZ) 4-6 packs/case (24-6oz ctnrs) MF LA 606 ENSURE CLEAR RTU 8OZ 24 ctnrs/case; apple, mixed berry MF LA 279 ENSURE HC RTU 8OZ 24 ctnrs/case; vanilla, chocolate MF LA 573 ENSURE HP TN RTU 8OZ 24 ctnrs/case; vanilla, chocolate TN=Therapeutic nutrition; institutional version only MF LA 121 ENSURE PLS RTU 32OZ 6 ctnrs/case; vanilla, chocolate MF LA 120 ENSURE PLS RTU 8OZ 24 ctnrs/case; vanilla, chocolate, butter pecan, strawberries & cream, coffee latte MF SA 122 ENSURE PUDD RTU 4OZ 4 cups/carton; vanilla, milk chocolate, 4 pack butterscotch Page 1 Revised 6/1/21 FORMULA CODE LIST JUNE 2021 Formula Level: LA = Local Agency approval. SA = State Agency approval Note: Shaded items have packaging challenges. E=Exempt Approval Formula Formula Description Packaging/Flavors Smallest Available Unit/Comments S=Std Level- LA- Code (If left blank, smallest available unit is 1.) MF=WIC Local SA- Elig Nutr State MF LA 075 ENSURE RTU 8OZ 24 ctnrs/case; vanilla, chocolate, coffee latte, strawberry, butter pecan MF SA 634 ENU PRO3+ PWD 12OZ unflavored MF LA 633 ENU SHAKE RTU (6-8.5OZ) 18 ctnrs/case (3-6 packs); vanilla, chocolate MF LA 627 EQUACARE JR PWD 14.1OZ 6 cans/case; unflavored, vanilla, chocolate MF LA 628 ESSENTIAL CARE JR PWD 14.1OZ 6 pouches/case; unflavored, vanilla, white chocolate, citrus E LA 592 EXTENSIVE HA PWD 14.1OZ 6 cans/case MF LA 126 FIBERSOURCE HN RTU 250ML 24 ctnrs/case MF SA 580 GA 1 ANAMIX EARLY PWD 400G 6 cans/case E SA 464 GA PWD 16 OZ 6 cans/case MF SA 541 GLUTARADE AA GA 1 PWD 1LB 4 cans/case MF SA 540 GLUTARADE JR GA 1 PWD 400G 4 cans/case E SA 344 GLUTAREX 1 PWD 14.1OZ 6 cans/case MF SA 345 GLUTAREX 2 PWD 14.1OZ 6 cans/case MF SA 614 GLYCOSADE PWD 60G 30 packs/case Must order in multiples of 30 MF SA 132 GLYTROL RTU 250ML 24 ctnrs/case; vanilla MF LA 603 GOOD START GROW 3 PWD 24OZ 4 cans/case MF SA 576 HCU ANAMIX EARLY PWD 400G 6 cans/case MF SA 583 HCU ANAMIX NEXT PWD 400G 6 cans/case E SA 465 HCY 1 PWD 16OZ 6 cans/case MF SA 328 HCY 2 PWD 16OZ 6 cans/case E/MF SA 346 HOMINEX 1 PWD 14.1OZ 6 cans/case MF SA 347 HOMINEX 2 PWD 14.1OZ 6 cans/case E/MF SA 348 I VALEX 1 PWD 14.1OZ 6 cans/case MF SA 349 I VALEX 2 PWD 14.1OZ 6 cans/case E LA 140 IMPACT RTU 250ML 24 ctnrs/case MF LA 152 ISOSOURCE 1.5 RTU 250ML 24 ctnrs/case MF LA 153 ISOSOURCE HN RTU 250ML 24 ctnrs/case MF SA 577 IVA ANAMIX EARLY PWD 400G 6 cans/case MF SA 584 IVA ANAMIX NEXT PWD 400G 6 cans/case MF LA 155 JEVITY RTU 8OZ 24 ctnrs/case MF SA 456 KETOCAL 3:1 PWD 300G 6 cans/case MF SA 364 KETOCAL 4:1 PWD 300G 6 cans/case MF SA 505 KETOCAL 4:1 RTU 8OZ 27 ctnrs/case; vanilla E/MF SA 350 KETONEX 1 PWD 14.1OZ 6 cans/case MF SA 351 KETONEX 2 PWD 14.1OZ 6 cans/case MF SA 631 KETOVIE 3:1 RTU 8.5OZ 30 ctnrs/case; unflavored Must order in multiples of 30 MF SA 629 KETOVIE 4:1 PEPTIDE RTU 8.5OZ 30 ctnrs/case; unflavored Must order in multiples of 30 MF SA 630 KETOVIE 4:1 RTU 8.5OZ 30 ctnrs/case; vanilla, chocolate Must order in multiples of 30 MF SA 632 KETOVIE 4:1 UNFLV RTU 8.5OZ 30 ctnrs/case; unflavored Must order in multiples of 30 MF LA 625 KFARMS PEDIATRIC PEPTIDE 1.0 RTU 8.45OZ 12 ctnrs/case; vanilla MF LA 610 KFARMS PEDIATRIC PEPTIDE 1.5 RTU 8.45OZ 12 ctnrs/case; vanilla MF LA 611 KFARMS PEDIATRIC STANDARD 1.2 RTU 8.45OZ 12 ctnrs/case; vanilla MF LA 612 KFARMS PEPTIDE 1.5 RTU 11OZ 12 ctnrs/case; plain MF LA 613 KFARMS STANDARD 1.0 RTU 11OZ 12 ctnrs/case; chocolate, vanilla MF SA 498 LIPISTART PWD 400G MF SA 567 LIQUIGEN RTU 8.5OZ 12 ctnrs/case E SA 574 LMD PWD 16OZ 6 cans/case MF SA 499 LOPHLEX LQ PKU RTU 4.2OZ 30 pouches/case; berry, tropical Must order in multiples of 30 MF LA 425 MCT OIL RTU 32OZ 6 bottles/case MF SA 618 MCT PROCAL PWD 16G 30 packs/case Must order in multiples of 30 MF SA 424 MICROLIPID RTU 3OZ 48 bottles/case 8 bottles MF SA 579 MMA-PA ANAMIX EARLY PWD 400G 6 cans/case Page 2 Revised 6/1/21 FORMULA CODE LIST JUNE 2021 Formula Level: LA = Local Agency approval.
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