Request for NYS WIC Vendor Application

To determine whether your store location is needed for participant access, you must complete and submit the REQUEST FOR NYS WIC VENDOR APPLICATION and all supporting documents to the Vendor Management Agency in your area for review. Request for Application Mail, email, or fax your completed questionnaire and all required documents to:

the appropriate Vendor Management Agency which has jurisdiction in your geographic area

PLEASE review ALL information located under the “Informational Material” section before submitting a REQUEST FOR APPLICATION for review.

Review ALL of the following downloads BEFORE submitting a REQUEST FOR APPLICATION: NYS WIC Foods Card Minimum Stock Requirements -Grocery Store Minimum Stock Requirements- Pharmacy Are you prepared for the Pre-Authorization Monitoring Inspection? Instructions on Counting the Number of Registers in Your Store Workers Compensation & Disability Form NYS WIC Infant Formula Supplier List