Retailer Application and Forms
Thank you for your interest in becoming or continuing to be a Missouri WIC authorized retailer. Here you will find everything you need to know to determine if your store meets the minimum criteria and stocking requirements necessary to be considered for the Missouri WIC program.
The full criteria to be considered a Missouri WIC authorized retailer can be found in the WIC Retailer Manual. To be an authorized Missouri WIC retailer you must:
- Maintain the stocking requirements.
- Have a passed sanitation inspection within the past year.
- Have been in business in the current location for at least a year.
- Be registered with the Missouri Secretary of State’s Office.
- Pass a pre-agreement site visit.
Authorized retailers are required to purchase all infant formula from approved licensed or authorized retailers, distributors or wholesalers. Any distributor or wholesaler not on this list may contact the WIC state agency to request consideration for inclusion.
If you are interested in reviewing the Code of Federal Regulations (CFR) guiding the Missouri WIC program, click here.
Application
If you are interested in becoming a Missouri WIC authorized retailer, complete the WIC Retailer and Authorization Application and send the completed form to MOWICVendorGroup@health.mo.gov.
Retailer Forms
- Retailer Resource Order Form
- Price List
- Communication Form This form provides the Missouri WIC program with retailer contact information to use in the distribution of important updates.
- WIC Retailer Request for Additional Payment Form This form shall be submitted as an appeal on a payment received or not received by the retailer.
- Deposit Form
- Retailer Concern Form Retailers should use this for to submit a concern or complaint about the WIC program or a WIC customer.
WIC and Nutrition Services
Missouri Department of Health and Senior Services
PO Box 570
Jefferson City, MO 65102-0570
Telephone: 573-751-6204 or
(toll-free) 800-392-8209
Fax: 573-526-1470
Email: WICinfo@health.mo.gov