- Skip Navigation

Note: This message is displayed if (1) your browser is not standards-compliant or (2) you have you disabled CSS. Read our Policies for more information.

  • Business & Agriculture
  • Residents
  • Government
  • Education
  • Taxes & Finance
  • Visiting & Playing
  • Family & Health

Indiana State Department of Health

Indiana State Department of Health

WIC Home > Forms Forms

Farmers' Markets and Farm Stands Applications

Vendor Applications

  • Vendor Application (SF 48064)  and   Food Price List  (required with application)
  • Pharmacy Formula Price List  (required with application for pharmacy)
  • Vendor Manual

WIC Clinic Forms


WIC Data Request Form