Oregon WIC Pharmacy Shelf Price Survey by suchenfz


									                                      Oregon WIC Program
                               Pharmacy Shelf Price Survey
  Store/Corp. Name:
           WIC ID #:
     Contact Name:
       Contact Title:
     Do you prefer to receive urgent WIC news bulletins by E-mail, FAX, or US Mail?
    E-mail Address:

                        Please provide prices for all formulas listed below.

     Unit UPC                              Formula Description                          Price

  0-70074-55968-1       Quart Isomil Advance or Isomil Soy ready-to-feed

  0-70074-55962-1       Quart Similac Sensitive RS or Sensitive Spit up ready-to-feed

  0-70074-56731-0       Quart Similac Advance ready-to-feed

  0-70074-57534-6       Quart Similac Sensitive ready-to-feed

  0-70074-55964-0       12.9 oz Isomil Advance or 12.4 oz Isomil Soy powder

  0-70074-55958-2       12.9 oz or 12.4 oz Similac Advance Powder

  0-70074-57541-4       12.9 oz or 12.6 oz Similac Sensitive powder, orange can

  0-70074-50960-0       12.9 oz Similac Sensitive RS or 12.3 oz Spit-up powder

  0-70074-56976-0       13 oz. Isomil Advance or Isomil Soy concentrate

  0-70074-56974-1       13 oz. Similac Advance concentrate

  0-70074-57536-0       13 oz. Similac Sensitive concentrate


Call 1-877-807-0889 or e-mail wic.vendorservices@state.or.us if you have questions. Surveys
in pdf and Excel formats are available at http://www.oregon.gov/DHS/ph/wic/vendor.shtml
Send completed shelf price surveys to:
Oregon WIC Program, Attn: Vendor Team, PO Box 14450, Portland OR 97293
by fax to 971-673-0071
or by email to wic.vendorservices@state.or.us                                           rev. 5/14/2010

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