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Attachment A: Types of Formulas
This list is not all inclusive. If the formula ordered is not on the list, please check with the ordering
provider.
TYPE OF FORMULA/SUPPLEMENT
Caloric Supplements
Supplemental Formula
Amino Acid Formula
Protein Hydrolysate Formula
Premature Infants Formula
EXAMPLE(S) OF FORMULA/SUPPLEMENT
Polycose®
Duocal®
MCT Oil
Enfamil® Human milk fortifier
Pediasure®
Neocate®
EleCare®
Similac® Alimentum®
Nutramigen®
Enfamil® Pregestamil®
Premie Enfamil®
Similac® Neosure®
Similac® Special Care
Enfamil EnfaCare®
Provider Services
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Attachment A: Types of Formulas
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