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 December 2024
• XLS [2MB]
  Mississippi WIC Approved Products List XLS [2MB]
  Updated December 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 [544KB]
  Mississippi WIC Vendor Handbook PDF [544KB]
  November 2024
• 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]