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 [69KB]
  Additional Store Attachment Form XLSX [69KB]
  Form 1167
• PDF [274KB]
  WIC Program Verification of Training PDF [274KB]
• PDF [158KB]
  Vendor Technology Survey Form 1185 PDF [158KB]
  January 21, 2020
• PDF [388KB]
  Mississippi WIC Program UPC Submission Form 1178 PDF [388KB]
  June 3, 2020

• PDF [2MB]
  WIC Pharmacy Guide PDF [2MB]
• PDF [204KB]
  Names of Medical Formulas PDF [204KB]
• PDF [242KB]
  WIC Program Medical Formula Amounts Guide PDF [242KB]
• PDF [247KB]
  Produce Mapping for Integrated Mississippi WIC Retailers PDF [247KB]
  February 2021
• PDF [180KB]
  List of Authorized WIC Vendors PDF [180KB]
  December 2023
• 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 [3MB]
  Mississippi WIC Approved Product List PDF [3MB]
  Updated November 2023
• 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]
• WIC Program Vendor Application