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State Plan Checklist - FOOD FUNDS MANAGEMENT 8/14/2026 Page 3

ii. Exempt infant formula (check all that apply): [ ] Home food delivery system [ ] Direct distribution [X] Retail food delivery system [X] Other Specify: Ordered directly from the manufacturer or distributor and shipped to clinic.

iii. WIC-eligible nutritionals (check all that apply): [ ] Home food delivery system [ ] Direct distribution system [X] Retail food delivery system [X] Other Specify: Ordered directly from the manufacturer or distributor and shipped to clinic.

b. The State agency has a rebate contract/agreement for infant formula. If no, check which applies. [X] Yes [ ] No

c. My rebate price sheet is available and attached as Appendix (Proceed to A. 3. Infant Formula Issuance. )

Primary Contract Infant Formula: '