WIC Formula List

Nevada WIC Formula List

Please note that while all formulas provided on Medical Foods list are authorized, Nevada WIC follows federally mandated cost containment contract and medical documentation procedures.  Although listed, many of the formulas require medical authorization of an MD to complete the WIC medical documentation form for issuance and may not be provided solely based on preference.

Medical documentation form must be signed by authorizing physician.

Medical Food Breakdown Form (Rvsd 2-9-17)