WIC Standard Contract Formula and Prescription-Required
Product Information for Health Care Providers

• Nutrition Fact Sheets

  • Wisconsin WIC Formulas and Medical Foods for Infants and Children 
    P-40023 (PDF, 130 KB) 

  • Wisconsin WIC Services for Infants and Children with Special Health Care Needs  
    P-40139 (PDF, 82 KB) 

• Forms

  • WIC Prescriptions/Clinical Data Forms

    • Women  
      F-44024A (PDF, 24 KB) 

    • Children  
      F-44024B (PDF, 25 KB)  

    • Infants  
      F-44024D (PDF, 27 KB) 
         

• Publications

  • Infant Formulas, Contract Standard 
    P-40077A (PDF, 25 KB) 

  • Infant Formulas, Exempt, Prescription Required 
    P-40077B (PDF, 41 KB) 

  • Child Formulas, Medical Foods and Other Foods, Prescription Required 
    P-40077C (PDF, 43 KB) 

  • Women's Medical Foods and Other Foods, Prescription Required  
    P-40077D (PDF, 31 KB)

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Last Revised:  June 14, 2011