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Information for Medical Providers Medical providers: What you need to know about medical documentation required to request WIC Special Formulas/Foods List of Authorized WIC Formulas (Effective 11/1/12) WIC Qualifying Medical Conditions New Medical Documentation Form for medical providers authorized to write prescriptions: Instructions for Special Formula/Food Requests Form DCH-1326 Michigan WIC Special Formula/Food Request Form [Revised 8/1/12] The Michigan WIC infant formula manufacturer contract with Mead Johnson Nutrition is effective November 1, 2011 through October 31, 2016.

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