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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 221 (CI) Periflex Early Years (14.1 oz Powder) 80.00 Special Medical Conditions - Metabolic: Phenylalanine-free, nutritionally incomplete

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 Phenylketonuria (PKU) or hyperphenylalaninemia 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 236 (CI) Periflex Junior Plus (14.1 oz. Powder) 51.00 Special Medical Conditions - Metabolic: phenylalanine-free; nutritionally incomplete; 28 protein equivalents per 100 g powder.

Preparation and dilution only as directed by a physician

Allergens by Nature: Coconut and Soy Phenylketonuria (PKU) or hyperphenylalaninemia Limitations: Can only issue to children 12 months to 5 years old.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Nutricia 6 cans/case plain orange berry vanilla 18 (CI) Phenex- 1 (14.1 oz. Powder) 96.00 Special Medical Conditions - Metabolic: Phenylalanine and lactose- free; nutritionally incomplete.

1 Tbsp powder = 8 g; Preparation and dilution only as directed by a physician

RFO is calculated based on mixing to 20cal/oz

Allergens by Nature: Coconut and Soy Phenylketonuria (PKU) or hyperphenylalaninemia Limitations: Can only issue to infants and children.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Abbott 6 cans/case unflavored

101 (CI) Phenex- 2 (14.1 oz. Powder) 55.00 Special Medical Conditions - Metabolic: Phenylalanine and lactose-free; nutritionally incomplete.

1 Tbsp powder = 8 g; Preparation and dilution only as directed by a physician

RFO is calculated based on mixing to 30cal/oz

Allergens by Nature: Coconut and Soy Phenylketonuria (PKU) or hyperphenylalaninemia 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 Abbott 6 cans/case unflavored vanilla 106 (CI) Phenyl- Free 2HP (16 oz. Powder) 59.00 Special Medical Conditions - Metabolic: phenylalanine, lactose, galactose-free; nutritionally incomplete; 40 g protein equivalents/100 g powder.

1 scoop = 15.1 g powder

Allergens by Nature: Soy Phenylketonuria (PKU) or hyperphenylalaninemia 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 Mead Johnson 6 cans/case 104 (CI) PhenylAde Essential Drink Mix (16 oz. Powder) 80.00 Special Medical Conditions - Metabolic: phenylalanine-free, nutritionally incomplete; with flax and soluble fiber; 40 g/scoop = 10 g protein equivalents.

Dilution: Add 40 g powder (approx. 1/4 cup, level and unpacked) to approx. 7 fl oz of cold water

Allergens by Nature: Soy Phenylketonuria (PKU) or hyperphenylalaninemia 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 vanilla strawberry orange crème chocolate unflavored