Hypoallergenic Formulas for Infants Product Company Description Indications for Use Name Package size EleCare Abbott Amino-Acid Based Intact or hydrolyzed protein intolerance, protein Powder Hypoallergenic maldigestion, malabsorption, severe food 14.1 oz. can Gluten-free, Soy-free allergies, short bowel syndrome, eosinophilic GI Fructose-free, Galactose- disorders, GI-tract impairment. free, lactose-free, milk Galactosemia protein-free. For Infants 0-12 months MCT 33% of fat Halal 20 Calories per fluid ounce

Neocate Nutricia Amino-Acid based Sensitivity to intact proteins such as Cow’s milk Infant with Powder Hypoallergenic protein allergy DHA/ARA 14.1 oz. can Lactose-free, sucrose-free, Soy’s protein allergy. galactose-free Multiple food allergies. Halal & Kosher Pareve Food allergies associated conditions: Short 20 Calories per fluid ounce bowel syndrome, food protein-induced enterocolitis syndrome, Eosinophilic esophagitis, Malabsorption, Gastroesophageal reflux. Galactosemia For Infants 0-12 months

Nutramigen Mead Johnson Extensively hydrolyzed Cow’s milk protein allergy RTF^ protein (peptide based) Soy’s protein allergy 6 - 8 fl oz. Package Hypoallergenic Lactose intolerance Gluten-free, Galactose-free Malabsorption problems Lactose-free, Sucrose-free Galactosemia Iron-fortified For Infants 0-12 months^^ 20 Calories per fluid ounce

Nutramigen Mead Johnson Extensively hydrolyzed Cow’s milk protein allergy with Enflora Powder protein (peptide based) Soy’s protein allergy LGG 12.6 oz. can Hypoallergenic Lactose intolerance Gluten-free, Lactose-free, Malabsorption problems Sucrose-free, galactose- Galactosemia free For Infants 0-12 months^^ Probiotic Lactobacillus rhamnosus GG (LGG) Iron-fortified 20 Calories per fluid ounce

Pregestimil Mead Johnson Semi elemental with Fat malabsorption, steatorrhea, associated with Powder extensively hydrolyzed cystic fibrosis, short bowel syndrome, 16 oz. can proteins intractable diarrhea, severe protein calorie Hypoallergenic malnutrition.

Gluten-free, Lactose-free, Sensitivity to intact proteins such as cow’s milk Sucrose-free protein allergy and soy protein allergy. Pregestimil RTF^ MCT 55% of fat Galactosemia 20 Cal 6 – 2 fl oz. Package For Infants 0-12 months^^ Pregestimil 6 – 2 fl oz. Package 20 Calories per fluid ounce 24 Cal 24 Calories per fluid ounce

Puramino Mead Johnson Amino-Acid based Severe cow’s milk protein allergy not Powder Hypoallergenic effectively managed by an extensively 14.1 oz. can Gluten-free, Lactose-free, hydrolyzed formula. Multiple food protein Galactose-free. allergies. 20 Calories per fluid ounce Galactosemia For Infants 0-12 months^^ Similac Abbott Semi elemental with Protein sensitivity, sensitivity to intact protein, Alimentum Powder extensively hydrolyzed severe food allergies. 12.1 oz. can proteins (casein Protein maldigestion RTF^ hydrolysate supplemented Fat malabsorption 32 fl oz. bottle with free amino acids) Lactose sensitivity Hypoallergenic For Infants 0-12 months MCT 33% of fat Lactose-free, Gluten-free, Ready to feed formula is corn-free. Contains sugar and modified tapioca starch 20 Calorie per fluid ounce ^ Ready to Feed Formulas (RTF) may be authorized when the CPA determines and documents that one of the following conditions are met: 1) The participant’s household has an unsanitary or restricted water supply or poor refrigeration, 2) The person caring for the participant may have difficulty in correctly diluting concentrated liquid or powder forms; or 3) The WIC infant formula is only available in ready-to-feed. In addition to those conditions, RTF may be issue in Food Package III if 1) a RTF form better accommodates the participant’s condition; or 2) if it improve the participant’s compliance in consuming the prescribed WIC formula. ^^ Could be used for supplemental nutrition beyond 12 months of age, for which when used as a milk substitute, the total calcium content of the diet should be assessed.