For Health Care Providers
WIC provides breastfeeding counseling, support and education to all pregnant and breastfeeding women. WIC also provides loaner breast pumps to breastfeeding mothers.
Infants who are not exclusively breastfed can be provided formula, up to the WIC Maximum Monthly Amount. If a non-standard formula is medically indicated, please complete the Prior Authorization form below.
Medical Documentation and Prior Authorization Form
This form is required before non-standard/medical formula can be provided to WIC participants. Health care providers, please follow these steps:
- Download the form in Word or PDF format
- Fill out form
- Fax it to your local WIC office or to the State WIC Agency at 207-287-3993.
Standing Order for 19kcal/oz Standard Formula
WIC federal regulations require standard cow’s milk and soy- based infant formulas provided to WIC participants to contain 67 kcals/L (~20kcal/oz) unless medical documentation is received from the health care provider. Three standard Similac formulas (Sensitive, Total Comfort and Similac for Spit-Up) have a standard dilution of 19kcal/oz. Please complete this standing order form (PDF or Word) to allow WIC staff to issue ANY of the 19 kcal/oz formulas to your patient after WIC staff nutrition assessment has determined which formula best meets individual needs.
Health Care Provider Food Insecurity Toolkit
With winter approaching, food security issues increase for Maine families. Health care providers can help to identify those families who need assistance with this most basic of needs. The Health Care Provider toolkit can help you in your work with the patients you see every day.
The kit includes:
- Introductory letter (PDF) describing your vital role in identifiying food insecurity
- Food insecurity Infographic (PDF) providing two screening questions to use in order to identify food insecure families (PDF)
- WIC Food Referral Chart (PDF) with referral websites and phone numbers for Maine’s nutrition assistance programs
- WIC outreach brochure (PDF) - contact WIC at 207-287-3991 to request copies for distirbution to your patients
- WIC Infographic (PDF) describing positive health outcomes provided by the WIC program in Maine
If you would like hard copies of any of these materials, do not hesitate to contact the Maine CDC WIC Nutrition Program office at 207-287-3991 or send your request to us at http://www.maine.gov/dhhs/mecdc/health-equity/wic/contact.shtml.
Thank you for all you do to assist in identifying families in your practice who may benefit from Maine’s nutrition programs.
Maine CDC WIC Nutrition Program Formulary - Updated January 2018
The Maine CDC WIC Formulary includes standard and medical formulas. All prescription formula request for items not included on our Formulary are evaluated on a case-by-case basis. Only contract brand standard formulas can be provided.
- Standard Contract Formulas (Cow's Milk, Soy and Added Rice Starch)
- Preterm, Low Birth Weight and Failure to Thrive Formulas for Infants
- Hypoallergenic and Malabsorption Formulas
- Failure to Thrive Formulas for Children
- Miscellaneous Medical Formulas
Provision of Ready To Feed (RTF) formulas:
WIC staff may provide ready to feed (RTF) infant formulas for a WIC participant only when assessment determines that at least one of the following conditions exists:
- The participant's household has an unsanitary or restricted water supply or poor refrigeration
- The person caring for the participant may have difficulty in correctly diluting concentrated or powdered formulas
- The formula is only available in ready-to-feed form.
Participants with a prescription for a medically necessary formula (non-standard formula, exempt formula, WIC-eligible nutritional) may be provided RTF formula for the following additional reasons:
- The ready to feed form better accommodates the participant’s condition
- The ready to feed form improves the participant’s compliance in consuming the prescribed WIC formula
For information on RTF forms of specific formulas, consult the appropriate section of the WIC formulary.
- Monday - Friday 8am-5pm
- Phone: (207) 287-3991
In-state Toll Free:
TTY: Maine relay 711
Fax: (207) 287-3993
- Mailing address:
11 State House Station
Augusta, ME 04333
Phone Number to your
Local WIC Clinic
East Wilton 207-645-3764
Presque Isle 207-768-3026
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