WIC Vendor Documents and Forms

Related resources

• WIC Participant Complaint Forms
  Form 1114
• WIC Program Grocery Price Survey
  Form 1166
• WIC Program Pharmacy Price Survey
  Form 1199
• WIC Program Store Brand Declaration Form
  Form 1112
• PDF [249KB] 
  WIC Vendor Complaint Form PDF [249KB] 
  Form 1235
• XLSX [71KB] 
  Additional Store Attachment Form XLSX [71KB] 
  Form 1167
• PDF [281KB] 
  Verification of Cashier Training PDF [281KB] 
  Form 1224
• PDF [171KB] 
  Vendor Technology Survey PDF [171KB] 
  Updated May 2024 (Form 1185)
• PDF [457KB] 
  Mississippi WIC Program UPC Submission Form 1178 PDF [457KB] 

• XLSX [11KB] 
  Mississippi WIC Approved Products List Updates XLSX [11KB] 
  Updated October 2024
• XLS [2MB] 
  Mississippi WIC Approved Products List XLS [2MB] 
  Updated November 2024
• PDF [122KB] 
  Medical Formulas Available PDF [122KB] 
• PDF [98KB] 
  Medical Formula Amounts Guide PDF [98KB] 

• PDF [258KB] 
  WIC Pharmacy Guide PDF [258KB] 
• PDF [247KB] 
  Produce Mapping for Integrated Mississippi WIC Retailers PDF [247KB] 
  February 2021
• PDF [179KB] 
  Authorized WIC Vendors PDF [179KB] 
• PDF [502KB] 
  Mississippi WIC Vendor Handbook PDF [502KB] 
  December 2022
• PDF [4MB] 
  Mississippi WIC Vendor Food Guide PDF [4MB] 
• PDF [132KB] 
  Notice of Deferral of Application Processing PDF [132KB] 
• PDF [17KB] 
  WIC-Approved Infant Formula Suppliers PDF [17KB] 
• PDF [1MB] 
  WIC Program Minimum Stock Requirements PDF [1MB] 
  Form 6044

• PDF [3MB] 
  WIC Vendor Training for Pharmacy Associates PDF [3MB] 
• PDF [8MB] 
  WIC Vendor Training for Grocery Store Associates PDF [8MB] 

• PDF [86KB] 
  Additional Store Attachment Instructions PDF [86KB] 
  Form 1167 Instructions
• PDF [33KB] 
  WIC Pharmacy Price Survey Instructions PDF [33KB] 
  Form 1199 Instructions
• PDF [105KB] 
  WIC Program Grocery Price Survey Instructions PDF [105KB] 
  Form 1166 Instructions
• PDF [85KB] 
  WIC Program Vendor Application Instructions PDF [85KB] 
  Form 1113 Instructions
• PDF [128KB] 
  Instructions for Joining Microsoft Teams Meetings PDF [128KB] 

Mississippi State Department of Health • 570 East Woodrow Wilson Dr • Jackson, MS 39216 • 866‑HLTHY4U • Contact and information