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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 202 (CI) Renastart (14.1 oz Powder) 66.00 Special Medical Conditions - Renal: 30 cal/oz, low levels of milk protein, calcium, potassium, phosphorus and vitamin A.

Mixing Instructions: Add 1 level scoop (7 g) to 1 fl oz water. Use the scoop provided in the can.

Allergens by Nature: Soy and Milk Pediatric kidney disease Limitations: Can only issue to infants and children from 6 months to 5 years old. Vitaflo 6 cans/case unflavored 243 (CI) Renastep (6.7 oz RTF) 6.70 Special Medical Conditions - Renal: 60 cal/oz; contains protein, carbohydrate, and fat (including DHA), vitamins and minerals for a diet restricted in potassium, chloride, phosphorus, calcium, and vitamin D; not suitable as a sole source of nutrition. Dosage to be determined by the prescribing physician. Pediatric kidney disease Limitations: Can only issue to children from 1 to 5 years old. Vitaflo 15 bottles/case vanilla 053 (PWD)

54 (RTF) Similac Alimentum (12.1 oz Powder)

Similac Alimentum (32 oz. RTF) 87.00

32.00 Hydrolyzed/Peptide: 20 cal/oz, hypoallergenic infant formula with iron; contains hydrolyzed casein with free amino acids; 33% of fat as MCT oil; contains DHA/ARA; suitable for lactose sensitivity.

Add 1 unpacked level scoop (8.7 g) to 2 fl oz of water

Similar to generic hypoallergenic, Nutramigen, Pepticate, Pregestimil.

Allergens by Nature: Soy Contains casein hydrolysate (derived from milk) but does not contain milk protein. 1. Cow’s milk protein allergy and multiple food protein intolerance 2. Cow’s milk-induced FPIES 3. Soy protein sensitivity Limitations: Can only issue to infants and children through 23 months old.

Staff may only issue Similac Alimentum RTU when it meets criteria outlined in Chapter 5 of the WIC Procedure Manual (5.3). Abbott Powder: 6 cans/case RTF: 6 bottles/case 122 (PWD)

123 (2oz RTF)

121 (32oz RTF) Similac Neosure (13.1 oz. Powder)

(CI) Similac Neosure (2 oz. RTF)

Similac Neosure (32 oz. RTF) 87.00

2.00

32.00 Special Medical Conditions - Premature: 22 cal/fl oz, high in protein, vitamins, and minerals for preterm and/or low birth weight infants; contains 25% fat from MCT oil.

Powder Mixing Instructions: Add 1 unpacked level scoop (9.6 g) to 2 fl oz of water.

Allergens by Nature: Soy and Milk 1. Prematurity (<37 weeks), regardless of birthweight 2. Low or very low birth weight (LBW/VLBW) <5lb 8oz Limitations: Can only issue powder to infants and children through 2 years old. RTF 2oz. may only be issued through 12 months of age.

Recommendations: At 6 months chronological age staff should assess infant's readiness to eat solids.

Staff may only issue Similac Neosure RTF when it meets criteria outlined in Chapter 5 of the WIC Procedure Manual (5.3). Abbott Powder: 6 cans/case

2oz RTF: 48 bottles/case

32oz RTF: 6 bottles/case