Health Care Providers

Instructions for Prescription Formula Form - WIC 53

 Instructions for health care providers on filling out the prescription formula form. 

Prescription Formula Form - WIC 53

Prescription Formula Form for medical formulas/medical foods which must be completed by a health care provider.

Updates

The West Virginia WIC Program continues to promote breastfeeding as the preferred method of infant feeding for at least the infant's first year.  For healthy infants prescribed a standard soy-based infant formula, the West Virginia WIC Program will transition from providing Gerber Good Start Soy to Similac Soy Isomil effective January 29, 2019.  Standard milk-based formulas provided by WIC will continue to be Similac Advance OptiGRO, Similac Sensitive, Similac for Spit-Up and Similac Total Comfort.