Revised 1-2026 Connecticut WIC Program Manual

WIC 400-12 SECTION: Food Delivery

SUBJECT: Retail Purchase of Special (Exempt) Formula Federal Regulations: POLICY Special formulas must be purchased at WIC authorized retail and grocery store pharmacies. WIC Nutritionists should use these guidelines to assist WIC participants in obtaining WIC Special (Exempt) Infant Formula and/or WIC- Eligible Nutritionals at retail and grocery store pharmacies. 1. Ensure that a participant has a valid Medical Documentation Form on file.

2. Determine the size and packaging of the Special formula requested. Reference the WIC Approved Contract and Specialized Formulas-Medical Food Listing for the manufacturer’s product information. If you are unsure of formula size of packaging contact the Nutrition Services Unit at the State agency by phone or by e-mail at ctwicnsu@ct.gov.

3. Proceed to the CT-WIC Food Prescription screen and assign the food package to the participant.

4. Proceed to the CT-WIC Issue Benefits screen and issue WIC Special Formula benefits directly to participants.

5. For a first-time order, assist the authorized person/caretaker in identifying and contacting at least one WIC authorized retail and/or grocery store pharmacy. The nutritionist or other CPA should call the authorized pharmacy to inquire if the prescribed formula is in stock. If it is not, assist the participant in placing the initial order.

6. The nutritionist or other CPA has the option to provide the Authorized Person/Caretaker with the Special Formula and Medical Food Issuance report located on the CT-WIC Print Documents screen. CT-WIC will auto-populate the following information: • Authorized Person name • Participant Name • WIC Issued Special formula name • Quantity/Amount issued • Benefit Valid Dates • Receipt Description • Food Description and formula packaging information (can/bottle/tetrapak size, can/bottle/tetrapak per case) • Authorized UPC numbers • Local Agency WIC Office • Local Agency WIC Office address

Revised 1-2026 • Local Agency WIC Office phone number The following fields on the report should be manually completed by local agency staff: • WIC Authorized Vendor • WIC Authorized Vendor phone number • Contact at WIC Authorized Vendor • Printed name of Local agency Nutritionist/CPA • Signature of Local agency Nutritionist/CPA

Once the form is completed, local agency staff should provide this report to the Authorized Person/Caretaker and advise them to bring this to the store/pharmacy to assist with the WIC formula purchase.

7. Educate the authorized person/caretaker in securing future WIC Special formula orders at their local WIC authorized retail or grocery store pharmacies.

8. In the case where a WIC participant is prescribed a different product (Special Formula or Standard, Contract Formula) within the issuance period (the current date is within the first day to use and the last day to use), the WIC Nutritionist or other CPA should request that the participant return the unused and unopened WIC Special formula to the local agency. Please refer to WIC 400-15 WIC Formula Return Policy for more details on safe handling of returned formula. Common Scenarios: Scenario #1 What do I do if I can’t reach the specific pharmacy that the participant typically shops at to place an order? Guidance: Access the Authorized Vendor List and identify other pharmacies in your local agency area. Ask the participant which pharmacy would be preferred and attempt contact. If you are unable to contact any local area pharmacy, provide the Authorized Vendor List and the completed Special Formula and Medical Food Issuance report to the participant. Follow up with the participant on the status of the formula order within 1 business day. Scenario #2 Do I need to assist the participant in placing a first time order if they already have experience in placing special formula orders at a pharmacy? Guidance: No, but verify that the pharmacy is a WIC Authorized Vendor. If the pharmacy is not a WIC Authorized Vendor, provide the Authorized Vendor List to the participant and assist with the order as needed for that participant.