MN WIC Medical Formula Price List - September 2017

Size: px

Start display at page:

Download "MN WIC Medical Formula Price List - September 2017"

Poppy Todd
6 years ago
Views:

1 Size Listed UPC (except as noted) s Nestle Alfamino Infant 14.1 oz $ Nestle Alfamino Junior 14.1 oz $ Nestle Beneprotein 8 oz. powder $ Nestle Boost (Original) 6-packs 8 oz. RTF Nestle Boost Breeze 8 oz. RTF Nestle Boost Glucose Control 6-packs 8 oz. RTF Nestle Boost Kid Essentials oz. RTF Nestle Boost Kid Essentials oz. RTF (-5366 & -6363) (-6402, & ) (-7800 & -8104) (-5220 & -5336) (-5886 & -5992) 4 $ $ $ $ $ 2.35 Nestle Boost Kid Essentials 1.5 with Fiber 8 oz. RTF $ 2.52 Nestle Boost Plus 6-packs 8 oz. RTF (-2360 & -3367) 4 $ PBM Bright Beginnings Soy 8 oz. RTF $ 2.06 Calcilo XD MN WIC Medical Price List - September oz. (375 g) $ Nestle Compleat Pediatric 8.45 oz. (250 ml) RTF $ 2.61 Nestle Compleat Pediatric Reduced Calorie 8.45 oz. (250 ml) RTF $ 2.61 Complete Amino Acid Mix 7 oz. (200 g.) $ Cyclinex 1 Cyclinex $ $ of 8

2 Duocal Elecare for Infants Elecare Jr Unflavored (1 & Up) Elecare Jr Vanilla (1 & Up) Size Listed UPC (except as noted) s $ $ $ $ Mead Johnson EnfaCare 2 oz. RTU $ 1.77 Mead Johnson EnfaCare 6-packs 8 oz. RTU $ Mead Johnson EnfaCare 12.8 oz $ Mead Johnson Enfamil 24 Cal Nursette 2 oz. RTU (carton) 48 $ 1.77 Mead Johnson Enfamil Human Milk Fortifier box (100 packets,.71 g each) powder (carton/box) 2 $ Mead Johnson Enfamil Premature 20 Cal 2 oz. RTU (carton) 48 $ 2.03 Mead Johnson Enfamil Premature 24 Cal 2 oz. RTU (carton) 48 $ 2.03 Mead Johnson Enfamil Premature 30 Cal 2 oz. RTU (carton) 48 $ 2.03 Mead Johnson Enfamil Premature High Protein 24 Cal 2 oz. RTU (carton) 48 $ 2.03 Mead Johnson Enfaport 6-packs 6 oz. RTU $ Ensure Clear 4-packs 10 oz. RTU ( ) 3 $ Ensure Clear Therapeutic 6.8 oz ( ) 32 $ 1.59 Ensure High Protein 6-packs 8 oz. RTU ( , ?) 4 $ Ensure Original 6-packs 8 oz. RTU Ensure Plus 6-packs 8 oz. RTU ( , , , , ) ( , , , ) 4 $ $ Ensure Pudding 4-packs 4 oz. Pudding ( , ) 12 $ 7.76 Nestle Gerber Extensive HA 14.1 oz $ Nestle Gerber Good Start Soy Stage 3 24 oz $ of 8

3 Size Listed Glucerna Shake 6-pack 8 oz. RTU Glutarex 1 Glutarex 2 HCU Lophlex LQ Hominex 1 Hominex 2 IVA Anamix Early Years IVA Anamix Next I-Valex 1 I-Valex 2 packs ( oz pouches) RTU UPC (except as noted) ( , , & ) s 4 $ $ $ $ $ $ $ $ $ $ Jevity 1 Cal 8 oz. RTF $ 2.05 Jevity 1.2 Cal 8 oz. RTF $ 2.30 Ketocal 3:1 11 oz. (300 g) $ Ketocal 4:1 11 oz. (300 g) $ Ketocal 4:1 LQ 8 oz. (237 ml) RTF (-30547) 27 $ 5.88 Ketonex 1 Ketonex $ $ Liquigen 8.5 oz. (250 ml) RTF $ of 8

4 Size Listed UPC (except as noted) s Nestle MCT Oil 32 oz. (1 quart) RTU $ Nestle Microlipid 3 oz. RTU $ 2.93 Monogen MSUD Lophlex LQ Neocate Infant with DHA/ARA Neocate Junior Neocate Junior w/ Prebiotics Neocate Nutra packs ( oz pouches) RTU Neocate Splash 8 oz. (237 ml) RTF Neocate Syneo Infant Nepro 8 oz. RTU $ $ $ ( & ) 4 $ ( & ) 4 $ $ (-24355, , and ) 27 $ $ ( & ) 24 $ 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 Nursette 2 oz. RTU (carton) 48 $ 2.33 Mead Johnson Nutramigen with Enflora LGG 12.6 oz $ Mead Johnson Nutramigen w/ Enflora LGG Toddler 12.6 oz $ Nestle Nutren oz. (250 ml) RTF $ 1.31 Nestle Nutren 1.0 with Fiber 8.45 oz. (250 ml) RTF $ 1.40 Nestle Nutren Jr oz. (250 ml) RTF $ of 8

5 Size Listed UPC (except as noted) s Nestle Nutren Jr. w/ Fiber 8.45 oz. (250 ml) RTF $ 1.81 Mead Johnson OA 1 16 oz $ PediaSure Grow & Gain 6-packs 8 oz. RTF ( , , , ) 4 $ PediaSure Grow & Gain w/fiber 6-packs 8 oz. RTF ( ) 4 $ PediaSure Grow & Gain Shake Mix Vanilla 14 oz $ PediaSure 1.5 Cal 8 oz. RTF $ 3.85 PediaSure 1.5 Cal w/ Fiber 8 oz. RTF $ 4.02 PediaSure Enteral oz. RTF $ 2.56 PediaSure Enteral 1.0 w/fiber 8 oz. RTF $ 2.68 PediaSure Peptide oz. RTF ( & ) 24 $ 8.23 PediaSure Peptide oz. RTF $ PediaSure Sidekicks 6-packs 8 oz. RTF ( & ) 24 $ PediaSure Sidekicks.63 Cal 8 oz. RTF $ 2.68 Nestle Peptamen 8.45 oz. (250 ml) RTF (-2609) 24 $ 6.64 Nestle Peptamen oz. (250 ml) RTF (-1907) 24 $ 9.88 Nestle Peptamen Jr oz. (250 ml) RTF (-1306 & -2531) 24 $ 6.62 Nestle Peptamen Jr. w/ Fiber 8.45 oz. (250 ml) RTF $ 6.81 Nestle Peptamen Jr. with Prebio 8.45 oz. (250 ml) RTF (-4164) 24 $ 6.81 Nestle Peptamen Junior oz. (250 ml) RTF $ 9.27 Nestle Peptamen Junior HP 8.5 oz. RTF $ 7.80 Periflex Advance 16 oz. (454 g) (-26526) 6 $ of 8

6 PKU Periflex Early Years Periflex Junior Plus Size Listed UPC (except as noted) s $ (-94761, & ) 6 $ Mead Johnson PFD Toddler 16 oz $ Phenex 1 Phenex $ ( ) 6 $ Mead Johnson Phenyl-Free 1 16 oz $ Mead Johnson Phenyl-Free 2 16 oz $ PKU Lophlex LQ Polycal packs ( oz pouches) RTU ( & ) 1 $ $ 9.75 Mead Johnson Portagen oz $ Mead Johnson Pregestimil 16 oz $ Mead Johnson Pregestimil 20 Calorie 2 oz. RTU $ 2.33 Mead Johnson Pregestimil 24 Calorie 2 oz. RTU $ 2.33 Mead Johnson Product 3232A 16 oz $ Promote 8 oz. RTF $ 2.07 Promote w/ Fiber 8 oz. RTF $ 2.07 Pro-Phree Propimex 1 Propimex $ $ $ Pro-ViMin 5.3 oz $ Pulmocare 8 oz. RTF $ 2.54 Mead Johnson PurAmino 14.1 oz $ Mead Johnson PurAmino Toddler 14.1 oz $ of 8

7 Size Listed UPC (except as noted) s RCF (Ross Carbohydrate Free) 13 oz. liquid concentrate $ 5.51 Axcan Scandishake 4-packets 3 oz (-80144, , , , , & ) 1 $ Similac 24 Cal w/ Iron 2 oz. RTF $ 2.80 Similac Alimentum 2 oz. RTF $ 2.68 Similac Alimentum 6-packs 8 oz. RTF $ Similac Alimentum Quart (946 ml) RTF $ Similac Alimentum 12.1 oz $ Similac for Diarrhea Quart (32 oz.) RTF $ Similac Go & Grow Milk 1.38 lb (22 oz.) $ Similac Human Milk Fortifier box (50 packets,.9g each) powder $ Similac Neosure 2 oz. RTF $ 1.27 Similac Neosure Quart (946 ml) RTF $ Similac Neosure Similac PM 60/ oz. (371 g) $ $ Similac Special Care 20 w/ Iron 2 oz. RTF $ 2.80 Similac Special Care 24 w/ Iron 2 oz. RTF $ 2.80 Similac Special Care 30 Cal 2 oz. RTF $ 2.80 Similac Special Care 24 Cal High Protein 2 oz. RTF $ 2.80 Suplena 8 oz. RTF $ 3.52 Nestle Tolerex TYR Lophlex LQ 2.82 oz. Packets packs ( oz pouches) RTU $ $ Mead Johnson Tyros 2 16 oz $ of 8

8 Size Listed UPC (except as noted) s Nestle Vivonex Pediatric 1.7 oz. Packets $ 6.27 Nestle Vivonex T.E.N oz. Packets $ of 8

EBT FORMULA CODE LIST October 2009

EBT FORMULA CODE LIST October 2009 Note: Shaded items have packaging challenges. Contact the formula pager for assistance with issuing. (512) 499-6814 088 ACERFLEX PWD 454G 409 ALIMENTUM PWD 16OZ 395 ALIMENTUM RTU 32OZ 463 BCAD 1 PWD 16