WIC Vendors - Pharmacy

Forms for applicants
Forms for approved vendors

Any owner of a pharmacy located in Wisconsin may apply for authorization as a WIC pharmacy vendor. WIC authorization does not transfer to a new owner when a change of ownership occurs. Vendors shall not accept drafts until all application requirements are met, including completing forms and submitting supporting documents, passing a site visit, completing a training program and receiving an authorization letter from the WIC Program. Completion of the application does not guarantee WIC vendor authorization. Submission of false information will result in denial of the application.

Conditions of Eligibility Vendor Must Meet

1. An acceptable history with WIC and other food and nutrition service programs of the USDA.
2. Charge a price for infant formula which is comparable to the average price charged by other vendor applicants in the project service area in which the pharmacy is located, as determined by the state WIC office.
3. Have a satisfactory site visit by the state or local WIC project wherein it is determined that:

1. prices are marked on the food containers or posted in the immediate area where foods are kept in the customer area of the store;
2. prices are not substantially higher than those listed on the application;
3. the store is not in violation of applicable federal, state or local health protection laws and ordinances;
4. authorized foods are not older than the expiration date indicated on the package or are otherwise fresh.

4. Following an acceptable site visit, participate in a training program at a location designated by local WIC Project staff. A signed contract, authorization letter, vendor stamp, and educational materials will be distributed at the training session.

Duration of Authorization

Initial authorization expires one year after the date on which the authorization was granted. Application for reauthorization is mailed the first of the month prior to the anniversary month.

Application Materials

• Agreement Between the State of Wisconsin and the Vendor. 
  (PDF, 27 KB)
  Two copies are needed, and both copies must be signed and returned. A copy signed by the Department will be returned when the store is authorized.
• Wisconsin WIC Program Retail Vendor Application and Instructions. (PDF, 42 KB)
  Photocopy each page of the completed application for your records. 
• Wisconsin WIC Retail Vendor Application Amendment. (PDF, 17 KB)
  Use this form to update your application information after it has been approved. 
• Pharmacy Stock Price Survey. (PDF, 13 KB) Photocopy each page of the completed stock price survey for your records.
• WIC Retail Vendor Annual Food Sales Survey. (PDF, 29 KB) 
• WIC Authorized Infant Formula Suppliers. (PDF, 9 KB) 

Other Documents Required

1. Copy of pharmacy license.

Regulations, Statutes and Administrative Rules

• WIC Vendor Manual (PDF, 1.4 MB) (Large file; may download slowly) 

• Title 7 CFR Part 246 as of January 1, 2005. (PDF, 297 KB)
  Or search for "7CFR246" in the online Code of Federal Regulations. (exit DHFS)

• Section 49.17, Wisconsin Statutes. Note: Scroll down to page 23 for the WIC section. (exit DHFS)

• Chapter HFS 149, Wisconsin Administrative Code. 

Determination Period

Applications are reviewed within 90 days of receipt of complete applications. If the application is not complete, a notice of incomplete items will be sent and the application will not be processed further. An application returned due to incompleteness may, following completion, be resubmitted within 15 days to the State WIC Office, or a new application may be submitted at any time.

Vendor Forms 

• Complaint form

• Vendor supplies request

Department Contact

WIC Vendor Integrity
PO Box 2659
Madison, WI 53701-2659
(608) 266-6912

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Last Revised:  July 29, 2008