WIC Vendors - Grocery
Forms for applicants
Forms for authorized vendors
Any owner of a grocery store or pharmacy located in Wisconsin may apply
for authorization as a WIC grocery vendor. WIC authorization does not
transfer to a new owner when a change of ownership occurs. Vendors shall
not accept drafts until all application requirements are met, including
completing forms and submitting supporting documents, passing a site
visit, completing a training program and receiving an authorization letter
from the WIC Program. Completion of the application does not guarantee WIC
vendor authorization. Submission of false information will result in
denial of the application.
Conditions of Eligibility Vendors Must Meet
An acceptable history with WIC and other food and nutrition service
programs of the USDA.
Charge a price for a standardized combination of foods which is
comparable to the average price charged for those foods by other
vendor applicants in the project service area in which the grocery
store is located, as determined by the state WIC office.
Have a satisfactory site visit by the state or local WIC project
wherein it is determined that:
packages; 9-16 oz each. Any combination of:
100% whole wheat bread, buns or rolls;
soft corn tortillas; OR
whole wheat tortillas; OR
total retail value ($10 of the total retail value must be
from fresh fruit and vegetables); AND
5 types fresh, frozen or canned fruits; two types must be
fresh (not including lemons and limes); AND
5 types fresh, frozen or canned vegetables; two types must
be fresh (not including onions, garlic and ginger root).
canned green beans
different types (hot or cold); 9 oz boxes or larger; minimum
4 boxes of each; 2 types must be whole grain (marked
"WG" on the WIC
Approved Foods List).
containers 64 oz; 3 different flavors; AND
12 containers 46 - 48 oz; 3 different flavors; AND
4 containers 11.5 - 12 oz frozen concentrate; one flavor.
gallons unflavored whole (Vitamin D or homogenized);
8 gallons unflavored 1% or skim (low-fat or fat-free): AND
3 half-gallons unflavored 1% or skim (low-fat or fat-free).
one-dozen cartons; white only; any size; any grade.
containers; 16 - 18 oz; any brand; creamy, crunchy,
extra-crunchy or natural, low sodium/salt, reduced/no sugar.
BEANS, PEAS, LENTILS
cans; 14 -16 oz; three different types.
|DRIED PEAS, BEANS, LENTILS
pounds total; two 1-pound bags of 2 different types.
20 cans 12.7 oz powder, OR
62 containers 12.1 oz concentrated
10 cans 12.7 oz powder, AND
31 containers 12.1 oz concentrated
brand only; six 8 oz boxes; 2 different types.
Stores with 4 or less cash registers (count all
brand only; Stage 2 or 2½; 4 oz jars only;
3 different varieties of fruits:
12 jars each, AND
3 different varieties of
vegetables: 12 jars each.
Stores with 5 or more cash registers (count all
brand; Stage 2 or 2½; 4 oz jars only;
6 different varieties of fruits:
12 jars each, AND
6 different varieties of
vegetables: 12 jars each.
|Stores with 11 or more cash
registers must stock infant meats (count all registers):**
brand; Stage 1; 2.5 oz jars only;
Minimum 2 varieties, total of 48 jars.
prices are marked on the food containers or posted in the
immediate area where foods are kept in the customer area of the
prices are not substantially higher than those listed on the
the store is not in violation of applicable federal, state or
local health protection laws and ordinances;
authorized foods are not older than the expiration date indicated
on the package or are otherwise fresh.
Following an acceptable site visit, participate in a training
program at a location designated by local WIC Project staff. A signed
contract, authorization letter, vendor stamp, and educational
materials will be distributed at the training session.
Duration of Authorization
The Wisconsin WIC Program has a three-year authorization
contract period. Refer to the Agreement Between the State of Wisconsin and
the Vendor (see below) for details on the current contract period. If the
vendor wishes to continue to be authorized beyond its current agreement,
the vendor must reapply for authorization.
Other Documents Required
Proof of ownership of business and/or building.
Examples of proofs include, but are not limited to:
Copy of the Food Dealers License.
Required registration with the Wisconsin Department of
Financial Institutions (DFI). Any corporation or partnership must be
registered with DFI and be in good standing. Go to www.wdfi.gov
for more information.
If your store has been open and operating for more
than six months, provide copies of the four most recent months of
Wisconsin Sales and Use Tax Forms (Form ST-12) filed.
Regulations, Statutes and Administrative Rules
Applications are reviewed within 90 days of receipt of complete
applications. If the application is not complete, a notice of incomplete
items will be sent and the application will not be processed further. An
application returned due to incompleteness may, following completion, be
resubmitted within 15 days to the State WIC Office, or a new application
may be submitted at any time.
Forms for Authorized Vendors
WIC Vendor Integrity
PO Box 2659
Madison, WI 53701-2659
"How to Become a WIC Vendor"
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May 16, 2013