Pump Order Guide MN WIC 2016 Medela
Order Guide 2016: MN WIC Breast Pumps Eligible for Reimbursement Exhibit 6I
We will reimburse ONLY for breastpumps listed on this guide, unless you have made a request for another product to the State WIC Breastfeeding Coordinator
and received written approval to purchase that item. This is not a complete list of pumps and supplies available through the Cooperative Purchasing Venture
(CPV). If you identify a need for a product that is not on this list contact the State WIC Breastfeeding Coordinator.
This is not an order form and is not to be sent with your order. See Exhibit H for instructions on purchasing through the CPV.
Case
Quantity
Product # ¹
Medela manual breastpump (Includes 24 mm and 27 mm flanges.)
20
6107293W
$159.00
Medela harmony (Includes 24 mm and 27 mm flanges.)
20
67161W2
$300.00
Medela WIC Lactina double pump kit (Includes 24mm and the
27mm flanges; one bottle stand is included manual piston is
included )
20
6107170W
$300.00
Medela WIC Symphony / Lactina double pump kit
20
67116W
$440.00
Medela Spring⁵
Container Stand⁶ (holder for milk collection container)
1
4707004
8100552
$1.71
$5.82
Ask if
possible to
order single
bottle
Type of Pump / Supply
Pump Description
Manual Breastpump
Double Personal Pump Kit
Parts & Supplies
Parts & Supplies continued
Price per
pump ²,³,⁴
Price per
case ²,³,⁴
NA
Parts & Supplies continued
Cavicide, 8 oz spray (Medela)⁷
12
3007009
Parts & Supplies continued
Parts & Supplies continued
Parts & Supplies continued
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Vacuum Gauge (Medela)⁸
Small Specialty Flanges: Personal Fit Breast Shield (21 mm)
Medium Specialty Flanges: Personal Fit Breast Shield (24 mm)
Large Specialty Flanges: Personal Fit Breast Shield (27 mm)
1
12
12
12
1977005
87086
87087
87077
$28.49
$24.00
$24.00
$24.00
Parts & Supplies continued
X - Large Specialty Flanges: Personal Fit Breast Shield (30 mm)
12
87079
$24.00
XX - Large Specialty Flanges: Personal Fit Breast Shield (36 mm)
12
87094
$36.24
6
87088
3
57018W
$258.00
1
016SC01
$299.00
Parts & Supplies continued Membranes
Personal-Use Electric
Double Breastpump.
WIC Personal Double Pump Advanced (Two-Phase)
Requires prior written
approval.⁵
Multi-user Electric
Breastpump (for use in WIC
agency, not for loan.)
Medela Lactina Select
Requires prior written
approval.⁵
$3.44
$20.64
1. Use this item number to obtain
2. Most must be purchased in case quantities. If you do not need a full case contact the State WIC Breastfeeding Coordinator. We maintain a small stock of a few types of pumps to meet
the needs of smaller agencies.
3. Minnesota WIC Agencies: see guidelines in MOM 6.11 on pumps in Minnesota WIC.
4. Please make sure that the order includes the information that you are a MN WIC agency and purchasing through the State of Minnesota / WSCA Contract #01910. If you are charged a
higher price than listed on this form, please contact the manufacturer before paying for the order.
5. State WIC Breastfeeding Coordinator contact [email protected]
6. A new spring and a container stand must be issued with the Medela WIC Lactina double pump kit when issuing a PedalPump.
7. Cavicide or Envirocide are used to clean the PedalPump and the case for the electric pump. They are listed here for your convenience, but cannot be claimed on the pump claim form.
They can be treated as a regular WIC expense.
8. A pressure gauge is used to test the suction on electric breastpumps. Pressure gauges are also available from local hardware stores. They are listed here for your convenience but
cannot be claimed on the pump claim form. They can be treated as a regular WIC expense.
Rev. January 2016