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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 113 (CI) Propimex-2 (14.1 oz. Powder) 55.00 Special Medical Conditions - Metabolic: Methionine, valine, and lactose-free; low in isoleucine and threonine; 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 Propionic or methylmalonic acidemia 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 242 (CI) ProViMin (5.3 oz. Powder) 23.00 Modular: Protein-vitamin-mineral with iron, reduced fat and carbs, increased protein; nutritionally incomplete.

1 Tbsp = 8 g

RFO is calculated based on mixing to 20cal/oz

Allergens by Nature: Coconut and Milk For use in the management of patients who require a formula modified in carbohydrate, fat, and/or increased protein Limitations: Can only issue to infants and children.

Requirements: Modular formulas must be approved by District Nutrition Director or State WIC Office Abbott 6 cans/case unflavored 151 (CI) PurAmino (14.1 oz. Powder) 98.00 Elemental/Amino Acid: 20 cal/oz, hypoallergenic; lactose, sucrose, soy, and galactose-free; 100% free amino acids; 14.3 g protein equivalents/100 g powder

Mixing Instructions: Mix 1 fl oz of water with 1 unpacked level scoop of powder (4.5 g)

Similar to Alfamino, Elecare, Neocate DHA/ARA, Neocate Syneo

Allergens by Nature: Soy 1. Cow’s milk protein allergy (CMPA) 2. Multiple food allergies 3. Eosinophilic GI disorders 4. Malabsorptive conditions 5. Short bowel syndrome (SBS) 6. Food protein-induced enterocolitis syndrome (FPIES) Limitations: Can only issue to infants and children through 23 months old.

Recommendations: A protein hydrolysate (Alimentum, generic hypoallergenic, Extensive HA, Nutramigen, Pepticate, or Pregestimil) is recommended before issuing unless medically contraindicated. Mead Johnson 4 cans/case 205 (CI) PurAmino Junior (14.1 oz. Powder) 66.00 Elemental/Amino Acid: 30 cal/oz, hypoallergenic, 100% free amino acids; contains DHA.

Mixing Instructions: Mix 1 fl oz of water with 1 unpacked level scoop of powder (6.8 g)

Similar to Alfamino Jr., Elecare Jr, Neocate Jr.

Allergens by Nature: Soy 1. Cow’s milk protein allergy (CMPA) 2. Multiple food allergies 3. Eosinophilic GI disorders 4. Malabsorptive conditions 5. Short bowel syndrome (SBS) 6. Food protein-induced enterocolitis syndrome (FPIES) Limitations: Can only issue to children 12 months to 5 years old. Mead Johnson 4 cans/case unflavored vanilla 114 (CI) RCF Soy Infant Formula Base with Iron (13 oz. Conc) 26.00 Special Medical Conditions - Metabolic: 20 cal/oz, carbohydrate and lactose free, soy protein. Nutritionally incomplete; carbohydrate source must be added separately.

Dilution: For 20 Cal/fl oz Formula, dissolve carbohydrate in 12 fl oz of water, cover and bring to a boil, Add RCF to cooled carbohydrate solution.

Allergens by Nature: Coconut and Soy Non-metabolic reason: Seizure disorders requiring a ketogenic diet Metabolic reason: Carbohydrate intolerance Limitations: Can only issue to infants and children through 23 months old.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Abbott 12 cans/case unflavored