WIC-26, Commodity Price List Survey

New Jersey Department of Health WIC SERVICES P.O. Box 364

Trenton, NJ 08625-0364

Store Name*

Street Address*

City, State, Zip Code*

Label

COMMODITY PRICE LIST SURVEY

Date* Vendor Code(s) Telephone Number* Vendor Stamp Email Address*

* Required fields.

Identify price zone if designated: Check one: 1. I hereby certify that the prices on this survey reflect the regular shelf prices available today, and the minimum stock

requirements are available. 2. I hereby certify the minimum stock requirements were reviewed and not available.

Name (Print)*

Title*

Signature*

Date*

INSTRUCTIONS: Do NOT complete shaded areas. Do NOT change pre-printed wording. Enter prices and brands (if requested) using regular prices (not sale prices) for WIC items that you sell. Mail completed form to the above address.

Minimum Stock for New Jersey WIC Services:

To meet the needs of all types of WIC participants, WIC retail stores are required to maintain minimum stock standards of all available WIC foods and have them available at all times.

For consideration as a new WIC retail store the minimum stock inventory must be at the prospective store at the time of submission of the application packet and hereafter.

All WIC retail stores must submit lowest [L] and highest [H] prices, brands and sizes for mandatory minimum stock.

USDA Nondiscrimination Statement

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form , (AD-3027) found online at: , and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

(1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@.

This institution is an equal opportunity provider.

WIC-26 OCT 17

Page 1 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

Store Name

Vendor Code (s)

Date

FOOD ITEM

MILK Dry/Powdered Milk, 8 Quart (Any Brand)

STATE USE ONLY

FIDC

Items In Stock

Minimum Stock

Requirement

228

Dry/Powdered Milk, 10 Quart (Any Brand)

226

BRAND

176

Evaporated Milk (Any Brand)

176

Fluid: Whole

(Store Brand Only)

190

Fluid: Whole

(Store Brand Only)

184

Fluid: Low Fat/Skim

(Store Brand Only)

185

Fluid: Low Fat/Skim (Store Brand Only)

182

UHT (Shelf Milk),

2%, 1% or Skim/Fat Free

191

(Any Brand)

UHT (Shelf Milk) Whole Milk (Any Brand)

192

Lactose Reduced/

100% Lactose Free 1% or Skim/Fat Free

188

(Any Brand)

Lactose Reduced/

100% Lactose Free 2%

275

(Any Brand)

Lactose Reduced/

100% Lactose Free Whole Milk

189

(Any Brand)

Kosher Milk, Whole (Any Brand)

187

Kosher Milk, Fat Free (Any Brand)

186

16 12-Ounce Cans

4 Half Gallons 5 Gallons

8 Half Gallons 10 Gallons

Store: Store: Store: Store:

SIZE

PRICE

[L]: 8 Quart

[H]:

[L]: 10 Quart

[H]:

[L]: 12 Ounces

[H]:

[L]: 12 Ounces

[H]:

Half Gallon

Gallon

Half Gallon

Gallon

[L]: Quart

[H]:

[L]: Quart

[H]:

[L]: Half Gallon

[H]:

[L]: Half Gallon

[H]:

[L]: Half Gallon

[H]:

[L]: Half Gallon

[H]:

[L]: Half Gallon

[H]:

WIC-26 OCT 17

Page 2 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

Store Name

Vendor Code (s)

Date

FOOD ITEM

SOY MILK (HALF GALLON) 8th Continent Soy Milk (Original) 8th Continent Soy Milk (Vanilla)

Silk Original Soy Milk

STATE USE ONLY

FIDC

Items In Stock

218 218 218

Minimum Stock

Requirement

BRAND

8th Continent 8th Continent

Silk

SIZE

Half Gallon Half Gallon Half Gallon

PRICE

TOFU (16 OUNCE PACKAGE ONLY)

Azumaya Tofu Silken

181

Azumaya

16 Ounces

House Foods America Firm Tofu

181

House Foods America

16 Ounces

House Foods America Medium Firm Tofu

181

House Foods America

16 Ounces

House Foods America Extra Firm Tofu

181

House Foods America

16 Ounces

EGGS [ANY BRAND, ONE DOZEN (12) CARTON] NOT ALLOWED ? 1/2 dozen cartons (6 eggs); cooked eggs; jumbo eggs; extra large eggs; medium eggs; brown eggs; specialty eggs; low cholesterol eggs; organic eggs; Eggland's Best; cage-free/free range eggs; eggs with Omega-3.

Grade A Large, White Only

198

16 1-Dozen Containers

[L]: 1 Dozen

[H]:

WIC-26 OCT 17

Page 3 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

[32 OUNCE (OZ) CONTAINER ONLY] ALLOWED: Plain, Vanilla, And Strawberry. NOT ALLOWED ? Yogurts sold with accompanying mix-in ingredients such as granola, candy pieces, honey, nuts, and similar ingredients as well as drinkable yogurts. (Minimum Stock Required: 1 Brand, 1 Variety, to total 10 containers.)

WHOLE FAT YOGURT

Plain Yogurt

10 Containers

Lucerne Dannon Shop Rite Foodtown

[L]: 32 ounces

[H]:

Vanilla Yogurt

10 Containers

Dannon

32 ounces

LOW FAT

Plain Yogurt Vanilla Yogurt

10 Containers 10 Containers

Best Yet Foodtown Dannon Shop Rite Stop & Shop

Weis White Rose

Lucerne Best Yet Dannon Foodtown Shop Rite

Weis White Rose

Yoplait

[L]: 32 ounces

[H]:

[L]: 32 ounces

[H]:

Great Value

Strawberry Yogurt

10 Containers

Lucerne Dannon Foodtown Yoplait Great Value

[L]: 32 ounces

[H]:

NON FAT

Plain Yogurt Vanilla Yogurt

10 Containers 10 Containers

Shop Rite Stop & Shop

Weis Lucerne Best Yet Dannon Foodtown Great Value Best Yet Great Value Shop Rite Stop & Shop

[L]: 32 ounces

[H]:

[L]: 32 ounces

[H]:

WIC-26 OCT 17

Page 4 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

FOOD ITEM

STATE USE ONLY

FIDC

Items In Stock

BRAND

SIZE

PRICE

CHEESE, 16 OUNCE PACKAGE ONLY, ANY DOMESTIC BRAND (MADE IN USA) ALLOWED ? Cheese made in the USA from 100% pasteurized cow's milk only. Cheese labeled low/reduced cholesterol, low/reduced fat, or low/light in sodium, individual slices (unwrapped), block, or shredded. NOT ALLOWED ? Individually wrapped slices, deli cheese; imported cheese, cheese food, cheese spread; cheese product; flavored cheese; string cheese; organic cheese. (Minimum Stock Required: 1 Brand, 2 Varieties, to Total 10 Packages)

American (Pasteurized Processed)

178

[L]: 16 Ounces

[H]:

Cheddar

178

[L]: 16 Ounces

[H]:

Colby

178

[L]: 16 Ounces

[H]:

Monterey Jack

178

[L]: 16 Ounces

[H]:

Mozzarella (Part Skim or Whole)

178

[L]: 16 Ounces

[H]:

Muenster

178

[L]: 16 Ounces

[H]:

Provolone

178

[L]: 16 Ounces

[H]:

Swiss

178

[L]: 16 Ounces

[H]:

WIC-26 OCT 17

Page 5 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

FOOD ITEM

STATE USE ONLY

FIDC

Items In Stock

BRAND

SIZE

PRICE

CHEESE, 16 OUNCE PACKAGE ONLY, ANY DOMESTIC BRAND (MADE IN USA), CONTINUED

KOSHER CHEESE (No Minimum Stock Required)

American (Pasteurized Processed)

[L]: 16 Ounces

[H]:

Cheddar

[L]: 16 Ounces

[H]:

Colby

[L]: 16 Ounces

[H]:

Monterey Jack

[L]: 16 Ounces

[H]:

Mozzarella (Part Skim or Whole)

[L]: 16 Ounces

[H]:

Muenster

[L]: 16 Ounces

[H]:

Provolone

[L]: 16 Ounces

[H]:

Swiss

[L]: 16 Ounces

[H]:

WIC-26 OCT 17

Page 6 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

FOOD ITEM

STATE USE ONLY

FIDC

Items In Stock

Minimum Stock

Requirement

BRAND

SIZE

PRICE

MATURE BEANS, PEAS AND LENTILS (ANY BRAND) NOT ALLOWED ? Green beans; green peas; snap beans; orange beans; wax beans; baked beans; pork and beans; beans with meat (such as franks and beans); canned beans with added sugars, fats, meat or oils; organic beans; soups.

DRY (VARIETIES OF MATURE BEANS, PEAS AND LENTILS) (16 OUNCE ONLY)

Dry, All Varieties

197

8 1-Lb. Bags

[L]: 1 Lb.

[H]:

CANNED (VARIETIES OF MATURE BEANS, PEAS AND LENTILS (15.5 ? 16 OUNCE ONLY)

Canned, All Varieties

197

8 15.5-16 Oz.

Cans

[L]: 15.5-16 Oz. Cans

[H]:

FOOD ITEM

STATE USE ONLY

FIDC

Items In Stock

Minimum Stock

Requirement

BRAND

SIZE

PRICE

PEANUT BUTTER, CREAMY OR CRUNCHY ALLOWED ? Any store brand and select National brands Skippy and Jif NOT ALLOWED ? Organic peanut butter; peanut spread; freshly ground or whipped peanut butter; peanut butter mixed with jelly, marshmallow, chocolate or honey; peanut butter with added vitamins and minerals.

193

Peanut Butter,

Creamy or Crunchy

193

193

8 16-18 Ounce

Jars

Jif Skippy

[L]: 16-18 Ounces

[H]:

16-18 Ounces

16-18 Ounces

WIC-26 OCT 17

Page 7 of 26 Pages.

WIC SERVICES COMMODITY PRICE LIST SURVEY, Continued

For all categories as allowed on the Authorized Food List, write BOTH your store brand and all national brand names, sizes and prices that you have in your store.

FOOD ITEM

STATE USE ONLY

FIDC

Items In Stock

BRAND

SIZE

PRICE

CANNED FISH (ANY COMBINATION) (Minimum Stock Required: Any Brand, 1 Variety, to Total 12 Cans) NOT ALLOWED ? Albacore tuna, blueback salmon, red salmon; flavored fish; fish with added ingredients; organic fish; fish in pouches; fish in individual serving size containers.

JACK MACKERAL

Jack Mackeral (15-Ounce Size) 207

Iberia

15 Ounces

PINK SALMON, PACKED IN WATER/OIL, ANY BRAND (PLAIN VARIETIES); MAY CONTAIN BONES AND SKIN

207 Pink Salmon

207

[L]: 7.5 Ounces

[H]:

[L]: 14.75 Ounces

[H]:

SARDINES, PACKED IN WATER/OIL, ANY BRAND (PLAIN VARIETIES)

Sardines

207

[L]: 3.75 Ounces

[H]:

TUNA, PACKED IN WATER, ANY BRAND (PLAIN VARIETIES)

Tuna, Light 5-Ounce Minimum Size

207

Ounces

[L]:

Ounces

[H]:

WIC-26 OCT 17

Page 8 of 26 Pages.

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