WIC Vendors - Pharmacy
Forms for applicants
Forms for authorized vendors
Any owner of a pharmacy located in Wisconsin may apply for
authorization as a WIC pharmacy 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 Vendor Must Meet
- An acceptable history with WIC and other food and nutrition service
programs of the USDA.
- Charge a price for infant formula which is comparable to the average
price charged by other vendor applicants in the project service area
in which the pharmacy is located, as determined by the state WIC
- Have a satisfactory site visit by the state or local WIC project
wherein it is determined that:
- 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 Pharmacy 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 17, 2013