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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 218 (CI) IVA Anamix Early Years (14.1 oz. Powder) 80.00 Special Medical Conditions - Metabolic: leucine-free with DHA/ARA; nutritionally incomplete; 13.5g of protein equivalent per 100g powder; for oral or tube feeding.

Mixing Instructions: To make a standard dilution (21 kcal/fl oz), add 1 unpacked level scoop (5 g) of powder to each fluid ounce of water.

Allergens by Nature: Milk, Coconut and Soy 1. Isovaleric acidemia 2. Other proven disorders of leucine metabolism Limitations: Can only issue to infants and children.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Nutricia 6 cans/case 229 (CI) IVA Anamix Next (14.1 oz. Powder) 78.00 Special Medical Conditions - Metabolic: leucine-free with DHA/ARA, nutritionally incomplete; 13.5g of protein equivalent per 100g powder.

Dilution: 18 g (approx. 2 scoops) with 3.5 fl oz for final 3.9 fl oz. (0.6 kcal/mL)

Allergens by Nature: Coconut and Soy 1. Isovaleric acidemia 2. Other proven disorders of leucine metabolism Limitations: Can only issue to children 12 months to 5 years old and women.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Nutricia 6 cans/case 230 (CI) IVA Maxamum (16 oz. Powder) 84.00 Special Medical Conditions - Metabolic: leucine and fat-free, nutritionally incomplete; 40 g of protein equivalents/100 g powder.

Dilution: Add 38 g (approx. ¼ cup) of powder to 6 - 8 fl oz. water

Allergens by Nature: Coconut and Soy 1. Isovaleric acidemia 2. Other proven disorders of leucine metabolism Limitations: Can only issue to women.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Nutricia 6 cans/case 154 (CI) Ketocal 3:1 (11 oz. Powder) 108.00 Special Medical Conditions - Ketogenic: high-fat, low-carbohydrate; nutritionally complete; 3 to 1 fat to carbohydrate and protein ratio.

Dilution: 9.3 g powder with 90 ml water, final 100 ml for 20 kcal per oz.

Allergens by Nature: Milk 1. Refractory/intractable epilepsy 2. Other epilepsy-related conditions where the ketogenic diet is indicated, including: - Glucose transporter type-1 deficiency syndrome (Glut1DS) - Pyruvate dehydrogenase deficiency (PDH) - Dravet syndrome - Super Refractory Status Epilepticus (SRSE) Limitations: Can only issue to children 12 months to 5 years old. Nutricia 6 cans/case 81 (PWD)

199 (RTF) (CI) Ketocal 4:1 (11 oz. Powder)

(CI) Ketocal 4:1 (8 oz. Liquid) 8.00

51.00 Special Medical Conditions - Ketogenic: high-fat, low-carbohydrate; nutritionally complete; 4 to 1 fat to carbohydrate and protein ratio.

Allergens by Nature: Milk and Soy 1. For the dietary management of drug- resistant epilepsy 2. Other epilepsy-related conditions where a ketogenic diet is indicated, including: - Glucose Transporter Type 1 Deficiency Syndrome (Glut1 DS) - Pyruvate Dehydrogenase Deficiency (PDHD) - Dravet Syndrome - Super Refractory Status Epilepticus (SRSE) Limitations: Can only issue to children 12 months to 5 years. Nutricia Powder: 6 cans/case

Liquid: 27 containers/case unflavored vanilla chocolate