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WIC Vendor Documents and Forms
This page has been automatically translated from English. MSDH has not reviewed this translation and is not responsible for any inaccuracies.
Related resources
FORMS
WIC Vendor Application/Reauthorization Form
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
[274KB]
WIC Program Verification of Training
PDF
[274KB]
PDF
[171KB]
Vendor Technology Survey
PDF
[171KB]
Updated May 2024 (Form 1185)
PDF
[388KB]
Mississippi WIC Program UPC Submission Form 1178
PDF
[388KB]
June 3, 2020
DOCUMENTS
PDF
[2MB]
WIC Pharmacy Guide
PDF
[2MB]
PDF
[39KB]
Available Infant Medical Formulas
PDF
[39KB]
PDF
[147KB]
WIC Program Medical Formula Amounts Guide
PDF
[147KB]
PDF
[247KB]
Produce Mapping for Integrated Mississippi WIC Retailers
PDF
[247KB]
February 2021
PDF
[179KB]
List of Authorized WIC Vendors
PDF
[179KB]
April 2024
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]
XLS
[2MB]
Mississippi WIC Approved Product List
XLS
[2MB]
Updated April 2024
XLSX
[12KB]
Mississippi WIC Approved Product List Updates
XLSX
[12KB]
Updated April 2024
PDF
[1MB]
WIC Program Minimum Stock Requirements
PDF
[1MB]
Form 6044
TRAINING
PDF
[204KB]
WIC Vendors: Required Annual Training Schedule and Registration
PDF
[204KB]
February 2024
PDF
[3MB]
WIC Vendor Training for Pharmacy Associates
PDF
[3MB]
PDF
[8MB]
WIC Vendor Training for Grocery Store Associates
PDF
[8MB]
INSTRUCTIONS
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]
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Mississippi State Department of Health
•
570 East Woodrow Wilson Dr
•
Jackson, MS 39216
•
866‑HLTHY4U
•
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