WIC Information for Healthcare Providers

Links referenced on this page
Request for Medical Formula for Infants		http://msdh.ms.gov/msdhsite/index.cfm/41,7489,128,pdf/972.pdf
Request for Medical Formula for Women and Children		http://msdh.ms.gov/msdhsite/index.cfm/41,7488,128,pdf/263.pdf
List of WIC-Approved Medical Formulas		http://msdh.ms.gov/msdhsite/index.cfm/41,13627,416,pdf/Names%5Fof%5FMedical%5FFormulas%5Fv15.pdf
Formulary: Medical Formula Amounts Guide		http://msdh.ms.gov/msdhsite/index.cfm/41,13626,416,pdf/WIC%5FMedical%5FFormula%5FAmounts.pdf
Refer to the formula manufacturer for details regarding specific formulas.		https://icongr.am/material/arrow-right-circle.svg?size=22&color=aaddbb
Medicaid Prior Authorization Form		https://medicaid.ms.gov/wp-content/uploads/2014/12/PriorAuthorizationForm.pdf

Resources referenced
Request for Medical Formula for Infants		https://msdh.ms.gov/msdhsite/index.cfm/41,7489,128,pdf/972.pdf ok
Request for Medical Formula for Women and Children		https://msdh.ms.gov/msdhsite/index.cfm/41,7488,128,pdf/263.pdf ok
List of WIC-Approved Medical Formulas		https://msdh.ms.gov/msdhsite/index.cfm/41,13627,416,pdf/Names%5Fof%5FMedical%5FFormulas%5Fv15.pdf ok
Formulary: Medical Formula Amounts Guide		https://msdh.ms.gov/msdhsite/index.cfm/41,13626,416,pdf/WIC%5FMedical%5FFormula%5FAmounts.pdf ok

Find this page at https://msdh.ms.gov/page/41,30482,128.html

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