1. Carefully read through the ITCA WIC Program Minimum Stock Requirements on pages 2 through 4.

Transcription

1 ITCA WIC SEMI-ANNUAL VENDOR PRICE/STOCK REPORT FY INSTRUCTIONS Complete all sections of pages 5 through 11, documenting the price and quantity of each WIC food item currently on the shelf or in inventory housed at your store location. If a space is left blank, the WIC program will assume that your store does not have that particular food item. Do not estimate or project prices or stock. The Semi-Annual WIC Vendor /Stock Report must reflect actual shelf prices and actual stock on hand at the time of completion. [Exception: Pharmacies shall be exempt from this requirement if they are contracted to provide only special infant formula.] 1. Carefully read through the ITCA WIC Program Minimum Stock Requirements on pages 2 through On pages 5 through 11, answer all yes and no questions and list the highest actual shelf price for each WIC food item in stock (except for milk, please list lowest price). Fill in the price for the exact size listed. NOTE: you must carry both milk and soy based iron fortified infant formula. Low iron formula may not be counted in the quantity listed. 3. After completing pages 5 through 11, sign below to certify the accuracy of this report. 4. If you would like a copy of this report, please copy before you submit the report to the State Agency. I certify that: CERTIFICATION i. I am authorized to act on behalf of the Vendor. ii. iii. I have verified that the required amounts of WIC inventory described on pages 5-11, are either on the shelves or in inventory housed at the Vendor s store location. I have verified that the prices listed on pages 5-11, are true and correct. Signature Date Print Name Title ( ) Telephone Number ~ 1 ~

2 ITCA WIC Program MINIMUM STOCK REQUIREMENTS Refer to the Arizona WIC Programs Food List for authorized food items. Milk - 12 gallons, 2 half gallons and 4 quarts of lowest cost brand of refrigerated milk. Must carry whole milk and 1% milk or Skim milk No organic, raw, pints, goats milk,, evaporated filled milk, sweetened condensed milk, buttermilk, acidophilus, half & half, non-dairy milk, rice milk or soy. (Soy milk is only allowed if specified on food instrument.) No chocolate or any flavored milk. Must be pasteurized and fortified. Juice - Shelf stable/refrigerated: WIC Authorized 100% juice without added sugar Must carry 4-64 oz. containers and have 3 varieties and one must be orange juice. * AND * Frozen Concentrate: WIC Authorized 100% juice without added sugar Must carry oz containers and have 2 varieties. No 6-ounce frozen containers, glass bottles or non-frozen concentrates. No organic, non-frozen concentrate, juice in glass bottles or juice in 6 ounce frozen containers. Cheese - 2 varieties of any brand, WIC authorized cheese. Must be domestic, prepackaged (16 ounces only) in blocks (or mozzarella string cheese). Must be plain cheese with no added ingredients (i.e., peppers, pimentos, flavoring, etc.). * AND * A combined total of at least 4 pounds of cheese. No shredded, cubed, sliced, added ingredients, cheese from deli counter, random weighted, organic or imported, cheese food, cheese product, cheese spread or cheese imitation. No cheese in packages less than 16 ounces. No cheese sticks or cheese swirls. Eggs - 4 dozen, any brand, fresh, raw, white chicken eggs. One dozen cartons of small, medium, or large only. No brown, extra large, jumbo or six pack cartons of eggs. No egg substitutes, or specialty eggs that include low cholesterol, DHA, organic, free range, cage free, nest and fertile eggs. ~ 2 ~

3 ITCA WIC Program MINIMUM STOCK REQUIREMENTS Refer to the Arizona WIC Programs Food List. Dry Beans & Peas/Lentils - 1 variety of any type and brand of dry beans, peas or lentils in a 1-pound package or bulk (up to 1 pound). *AND * 4 pounds of any combination of dry beans, peas or lentils. No organic, snap beans, fresh, frozen, flavored, seasoned, or gourmet, bean soup mixes, green beans, yellow beans or wax beans Peanut Butter - 2 jars of any brand, plain (smooth, chunky or natural) peanut butter in 16 to 18 ounce jars. No organic, spreads, added jelly, honey, candy chips, marshmallows, chocolate or peanut butter in tubes. Canned Beans - Must carry 8 cans (up to 16 ounces) - 2 varieties of canned beans and 1 must be pinto beans. *list of approved canned beans are listed on page 6. No frozen beans, peas or lentils, canned green peas, yellow beans, snap beans, green beans, wax beans, refried beans, Cajun style, chili beans, seasoned beans, BBQ, Ranch-style beans, baked beans, dry beans or organic beans Cereal - Cold cereal: 3 varieties and 2 must be whole grain. All cereal listed with a * on page 9 indicates the cereal is whole grain. Must carry 12 boxes- 12 ounces or larger in bags or boxes. * AND * Hot cereal: 1 variety of hot cereal. Must carry 2 boxes-11.8 ounces or larger in boxes. No organic or variety packs, cold cereal in packages less than 12 ounces or packages of hot cereal less than 11.8 ounces. Whole Grains Fresh Fruit and Vegetables - Must carry 6 (16 oz package) loaves of bread. *List of approved whole grains is on page 7. No organic, gluten-free, diet, light or mini-loaves. - Any variety of fresh fruit and vegetables. Must carry 15 pounds of fresh vegetables and 15 pounds of fresh fruit. Fresh fruit: Must carry fresh bananas and 3 other fresh fruits *AND* Fresh vegetables: Must carry 5 varieties of fresh vegetables No white potatoes; herbs and spices; edible blossoms such as squash blossoms; creamed or sauced vegetables; vegetable-grain mixtures; fruit-nut mixtures; breaded vegetables; fruits and vegetables for purchase on salad bars; salad kits; nuts; ornamental fruits and vegetables, such as chilies on a string; painted pumpkins; fruit baskets and party trays; and items such as blueberry muffins. ~ 3 ~

4 ITCA WIC Program MINIMUM STOCK REQUIREMENTS Refer to the Arizona WIC Programs Food List. Canned Fish - Tuna: any brand of water packed chunk light tuna Must carry 6 cans (5 ounce cans) No tuna packed in oil or pouches or with any added ingredients. *AND* Salmon: any brand of water packed pink salmon Must carry 4 cans- (7.5 oz. cans) No red sockeye salmon, salmon in pouches or with added ingredients. *AND* Sardines: any brand and any type of sardines Must carry 8 cans-(3.75) ounce cans No Brisling sardines or Norwegian Brisling sardines Infant Cereal - Beechnut or Gerber only, plain single grain without added fruit in 8 ounce or 16 ounce containers. 2 varieties and 1 must be rice cereal 12-8 ounce containers or 6-16 ounce containers No organic, cereal with added fruits, formula, DHA & ARA Infant Formula ounce cans of powdered Similac Advance EarlyShield infant formula *AND * At least ounce cans of powdered Enfamil Prosobee infant formula. No low iron infant formula. Infant Fruit and Vegetables - Any brand, Stage 2, any single variety or combination of plain fruits or vegetables in 3.5 oz or 4 oz. containers 4 varieties of fruits and 4 varieties of vegetables ounce containers and 8-4 ounce containers No organic, added cereal, formula, DHA & ARA, salt, sugar or starches, desserts, dinners or food combinations Infant Meats - Any brand, single ingredient infant meats with added broth or gravy in 2.5 ounce containers Must carry 31 containers and 2 varieties. No organic, added salt and/or sugars, dinners or food combinations ~ 4 ~

5 Complete this document and mail to either: Date: ITCA WIC Program 2214 North Central Avenue, Suite 100 Phoenix, AZ Store Name/Number: Store Address: WIC Instructions: List the highest regular, NOT sale, price for each WIC food item in stock (except Milk). MILK Lowest Cost Brand Quantity: Are there at least (I) 12-gallons, 2 half gallons and 4 quarts of refrigerated milk? Yes No, If NO, # in stock = gallons (I) Quarts. EGGS Any eligible brand, small, medium and large, fresh, raw, white, chicken only Are there at least (I) 4 dozen? Yes No, If NO, # of dozen in stock = Variety: Does the Vendor carry (I) Whole and 1% or Skim? Yes No, If NO, Variety missing:. Size 1 dozen Large Type Gallon ½ Gallon Quart Whole Reduced Fat (2%) Low Fat (1%) Fat Free (Skim/Nonfat) Lactose Reduced Evaporated Whole 12 oz. can Medium Small Refrigerator Temperature: F (Acceptable: < 45 ) CHEESE Any eligible brand, plain, domestic - 16 oz. prepackaged in blocks Are there at least (I) 2 varieties? Evaporated Skim 12 oz. can Long Shelf life (UHT) Non Fat Dry oz. Yes No, If NO, # of varieties in stock? Variety missing: Are there at least (I) 4 pounds? NA Refrigerator Temperature: F (Acceptable: < 45 ) Yes No, If NO, # of pounds in stock? Type 1 pound MILK ALTERNATIVES Tofu Item Type/Size Meyenberg Goat s Milk 8 th Continent Soy Milk Pacific Ultra Soy any eligible brand (up to 16 oz.) refrigerated, quart only (32 oz) refrigerated, plain or vanilla, ½ gallon only shelf stable, plain or vanilla, quart only (32 oz) Cheddar (includes longhorn) Colby (includes longhorn) Colby Jack Monterey Jack Mozzarella (whole or part skim), includes string Refrigerator Temperature: F (Acceptable: < 45 ) ~ 5 ~

6 JUICE - Vitamin C Fortified - 100% juice, no added sugar Are there at least (I) 3 varieties of shelf stable or refrigerated (must include orange juice) and 2 varieties of frozen concentrate? Yes No, If NO, # of varieties in stock? Variety missing: Are there at least (I) 4 shelf stable/refrigerated and 6 frozen containers? TUNA Any eligible brand, chunk light, water packed Are there at least (I) 6 5 oz. cans of tuna? Yes No, If No, # of cans in stock? 5 oz Size 5 oz. Yes No, If NO, # of containers in stock? Any Brand Orange Any Brand Grapefruit Campbell s Tomato Dole Pineapple Item Dole Pineapple Orange Langer s Langer s Grape Langer s White Grape Langer s Pineapple Old Orchard Old Orchard Grape Old Orchard Pineapple Seneca Shurfine Shurfine Grape Tree Top Welch s Grape Welch s White Grape Western Family Western Family Grape 64 oz. Refrigerated 64 oz. Shelf Stable 11.5 /12 oz. frozen PINK SALMON Any eligible brand, plain water packed, pink salmon Are there at least (I) 4 (7.5 oz.) cans of salmon? Yes No, If No, # of cans in stock? 7.5 oz. Size 7.5 oz. SARDINES Any eligible brand, flavored, seasoned or plain Are there at least (I) 8 (3.75 oz.) cans Yes No, If No, # of cans in stock? Size 3.75 oz. PEANUT BUTTER Any eligible brand, plain (creamy, chunky, super chunk or natural) Are there at least (I) 2 jars of peanut butter? Yes No, If No, # of jars in stock? Size (16 oz. to 18 oz.) oz. oz. Freezer Temperature: F (Acceptable: < 0 ) ~ 6 ~

7 LEGUMES Dry Beans / Peas / Lentils Any eligible brand and type Are there at least (I) 4 pounds of beans and peas or lentils? Yes No, If NO, # of pounds in stock? Item 1 lb. package Bulk Beans Peas/Lentils Canned Beans - Only These Brands and Types (up to 16 oz. cans) Quantity: Are there at least ( I ) 8 cans (up to 16 oz. size) Yes No, If NO, # of cans in stock? Variety: Are there at least ( I ) 2 Varieties (1 must be Pinto beans)? Yes No NA If NO, variety missing: Brand Type Size Albertson s Cannellini oz. Garbanzo oz. Great Northern oz. Red oz. Canned Beans - Only These Brands and Types (up to 16 oz cans) Brand Type Size Fry s / Kroger Black oz. Blackeye Peas oz. Cannellini Dark Red oz. oz. Garbanzo oz. Great Northern oz. Light Red oz. Pinto oz. Red oz. Great Value Black oz. Great Northern oz. Pinto oz. Red oz. Safeway Black oz. Whole Pinto oz. Bush s Black oz. Cannellini White Dark Red oz. oz. Garbanzo oz. Great Northern oz. Pinto oz. El Mexicano Garbanzo oz. Shurfine (Premium) Garbanzo oz. Light Red oz. Lima oz. Pinto oz. Red oz. Black oz. Dark Red oz. Garbanzo oz. Food Club Pinto oz. Dark Red oz. Garbanzo oz. Great Northern oz. Western Family (Premium) Great Northern oz. Light Red oz. Pinto oz. Black oz. Pinto oz. Garbanzo oz. Springfield (Fancy) Black oz. Blackeye Peas oz. Pinto oz. Great Northern oz. Light Red oz. Pinto oz. Value Time Pinto oz. ~ 7 ~

8 WHOLE GRAINS 100% WHOLE WHEATBREAD Loaves only, 16 ounce packages (includes any store brand labeled 100% whole wheat) Are there at least (I) 6 packages (16 oz. each)? Yes No, If NO, # of packages in stock? Only these brands Brand Brand Bimbo 100% Whole Wheat Wonder Soft 100% Whole Wheat Roman Meal Sun Grain 100% Whole Wheat Store brand: Sara Lee Classic 100% Whole Wheat Store brand: Note: Store brand, if any, must be labeled 100% whole wheat TORTILLAS AND RICE 16 ounce packages only Are there at least (I) No Requirement Soft Corn Tortillas Only these brands of yellow or white Brand Brand Casa Rica Mama Lola s Don Pancho Mission Yellow Guerrero Santa Fe Tortilla Company La Banderita Store Brand: La Burrita Store Brand: Soft Whole Wheat Flour Tortillas Only these brands Brand Brand Guerrero Tortillas de Harina Integral Mission Whole Wheat La Banderita Fajita Whole Wheat Store Brand: Brown Rice Only these brands of long or short grain Brand Brand Blue Ribbon Springfield Mahatma Store Brand: Shurfine Store Brand: ~ 8 ~

9 CEREAL Boxes or Bags Quantity: Are there at least (I) 14 packages (12 cold and 2 hot)? Yes No, If No, # of packages in stock? Cold Hot Variety: Are there at least (I) 3 varieties of cold cereal and 1 hot cereal? Variety: Are there (I) 2 whole grain varieties of cold cereal? Yes No, If No, # of varieties in stock? Yes No, If No, variety missing COLD CEREALS (12 oz. or larger) SIZE PRICE SIZE PRICE SIZE PRICE Any Store Brand Crispy Rice oz. oz. oz. Any Store Brand Toasted Oats* oz. oz. oz. General Mills Cheerios Plain* oz. oz. oz. General Mills Cheerios MultiGrain* oz. oz. oz. General Mills Corn Chex oz. oz. oz. General Mills Rice Chex oz. oz. oz. General Mills Wheat Chex* oz. oz. oz. General Mills Kix Plain oz. oz. oz. General Mills Total Whole Grain* oz. oz. oz. Kellogg s All Bran Complete Wheat Flakes* oz. oz. oz. Kellogg s Corn Flakes oz. oz. oz. Kellogg s Frosted Mini Wheats (Bite Size)* oz. oz. oz. Kellogg s Rice Krispies oz. oz. oz. Kellogg s Special K Plain oz. oz. oz. Malt O Meal Frosted Mini Spooners* oz. oz. oz. Malt O Meal Crispy Rice oz. oz. oz. Post Banana Nut Crunch* oz oz. oz. Post Honey Bunches of Oats Almonds oz. oz. oz. Post Honey Bunches of Oats Honey Roasted Post Honey Bunches of Oats with Vanilla Bunches* oz. oz. oz. oz. oz. oz. Post Grape Nuts* oz oz. oz. Post Grape Nuts Flakes oz. oz. oz. Quaker Life Plain* oz oz. oz. Quaker Oatmeal Squares Brown Sugar* oz oz. oz. Quaker Oatmeal Squares Cinnamon* oz oz. oz. HOT CEREALS (11.8 oz. or larger) SIZE PRICE SIZE PRICE SIZE PRICE Cream of Wheat Instant Original Flavor (single serving packets) oz. oz. oz. Malt O Meal Original Hot Cereal oz. oz. oz. Quaker Instant Oatmeal Regular Flavor (single serving packets)* *Indicates cereal is Whole Grain oz. oz. oz. ~ 9 ~

10 FRESH FRUITS and VEGETABLES Any variety of fresh Quantity: Are there at least ( I ) 15 pounds of fresh fruits and 15 pounds of fresh vegetables? Yes No, If No, # of varieties of fruits and # of varieties of vegetables in stock in stock? Variety: Are there at least ( I ) 4 varieties of fruits AND 5 varieties of vegetables? Yes No, If No, # of pounds of fruits and # of pounds of vegetables in stock in stock? INFANT FRUITS/VEGETABLES Any eligible brand, Stage 2 Only Are there at least (I) 4 varieties of fruits? Yes No, If NO, # of varieties in stock? Are there at least (I) 4 varieties of vegetables? Yes No, If NO, # of varieties in stock? Are there at least (I) 64 (3.5 oz.) and 8 (4 oz.) containers? Yes No, If NO, # of containers in stock? Brand 3.5 oz. 4 oz. (Document Brand Name) INFANT CEREAL Gerber and/or Beechnut, single grain, without fruit Are there at least (I) 2 varieties? (must include rice) Yes No N/A If NO, # of varieties in stock? Does not carry rice Are there at least (I) 12 (8 oz.) boxes or 6 (16 oz.) boxes? Yes No, If NO, # of boxes in stock? _ 8oz 16 oz. Brand 8 oz. 16 oz. Gerber Beechnut INFANT JARRED MEAT Any eligible brand, any stage, single ingredient with added broth or gravy Are there at least (I) 31containers? Yes No, If NO, # of containers in stock? Brand (Document Brand Name) 2.5 oz. ~ 10 ~

11 INFANT FORMULA Iron Fortified, NO LOW IRON MILK BASED FORMULA (Similac Advance with Iron Only, with EarlyShield) Are there at least (I) 27 cans powder? Yes No, If No, # of cans in stock? SOY BASED FORMULA (Enfamil ProSobee) Are there at least (I) 9 cans powder? Yes No, If No, # of cans in stock? CONTRACT FORMULA Powder Size (up to 16 oz.) Powder Concentrate (13 oz.) RTF (Quart / 32 oz.) RTF - 8 oz. (4 or 6 pack) Similac Advance with Iron (with EarlyShield) oz. Enfamil ProSobee oz. Other formula Similac Sensitive and/or Sensitive for Fussiness and Gas Similac Alimentum and/or Similac Expert Care Alimentum Similac NeoSure and/or Similac Expert Care Neosure oz. oz. oz. Similac Pediasure Similac Go & Grow oz. Similac Isomil DF and/or Similac Expert Care for Diarrhea oz. Similac Sensitive RS and/or Sensitive for Spit-up oz. Enfagrow Soy Toddler oz. Enfamil EnfaCare oz. Enfamil Nutramigen oz. Enfamil Pregestimil oz. ~ 11 ~