Pump Order Guide MN WIC 2016 Hygeia
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.
Type of Pump /Supply
Manual Breastpump
Pump Description
Hygeia Manual Breastpump WSCA (Includes (1) Medium
Flange 27 mm, (1) Large Flange 30 mm, (1) 4 oz. Mother's
Milk Storage Container, (1) Ring, (2) Duckbill Valves, (1)
Piston, (1) Ring Cover
EnHande Manual Breastpump (One manual pump with one
27mm flange, 1-4oz bottle, and poly bag)
Case
Quantity
Product #¹
Price per pump ²,³,⁴
Price per case ¹,²,³
20
10-0121
20
10-0106
$14.50
$290.00
20
10-0108
$19.50
$390.00
20
10-0102
NA
$390.00
12
10-0088
$26.00
12
10-0089
$26.00
Professional Pressure Gauge Kit⁶ (Includes gauge, tube,
stopper on the tube, and extra stopper for second flange.)
1
10-0085
$71.50
NA
Hygeia Q Personal-Use Electric Double Breast Pump (Includes (1) Hygeia Q Breast Pump, (1) Black Deluxe Tote
Personal-Use Electric Double
Set, (1) Hard Cooling Element, (1) Hygeia Q Personal
Breastpump. Requires prior
accessory Set, (1) Set of 27 mm Flanges, (1) Set of 30 mm
written approval.⁵
Flanges, (4) 4oz BPA Free Bottles, (1) Manual Pump Piston
and Cylinder, (1) 110-VAC, 60-Hz Power Supply)
1
20-0083
$100.00
NA
Multi-User Electric
Breastpump (for use in WIC
agency, not for loan.)
Requires prior written
approval.⁵
1
10-0025
$269.00
NA
1
10-0021
$9.00
NA
12
10-0020
$105.50
NA
Manual Breastpump
Continued
Double Personal Pump Kit
Double Personal Pump Kit
Continued
Parts & Supplies
Parts & Supplies continued
Parts & Supplies continued
EnDeare Plus Personal Accessory Set Kit for Multi-User
Electric Double Breastpump. (Includes (2) Med Flanges, (2)
Large Flanges, (2) 40" Tubing, (4) 4 oz. Mother's Milk Storage
Containers, (1) Bacteriostatic filter, (2) Duckbill Valves, (4)
Rings, (2) Narrow-Mouth Container Adapters, (2) Ring
Covers, (1) Manual Pump Piston and Cylinder)
Hygeia Kit for Multi-User Electric Double Breastpumps.
(Includes (2) Med 27 mm Flanges, (2) Large 30 mm Flanges,
(2) 40" Tubing, (4) 4 oz. Mother's Milk Storage Containers, (4)
Duckbill Valves, (4) Rings, (2) Narrow-Mouth Container
Adapters, (2) Ring Covers, (1) Manual Pump Piston and
Cylinder)
Hygeia Large Flange. Compatible with all Hygeia pumps,
except the one hand manual pump. (Includes Extra Large
Flange (30 to 31 mm), Duckbill Valve)
Hygeia Extra Large Flange. Compatible with all Hygeia
pumps, except the one hand manual pump. (Includes Extra
Large Flange (31 to 36 mm), Duckbill Valve)
EnDeare Electric Breastpump (without Internal NiMH
Rechargeable Battery, sold separately), without Black Hard
Sided Carry Case)
Expression Cup for Collection Expression Cup (Includes Expression Cup, 4 oz. Mother's Milk
of Hand Expressed Breastmilk Storage Container, Ring and Ring Cover
$196.00
1. Use this item number to obtain correct pricing.
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. http://www.health.state.mn.us/divs/fh/wic/localagency/program/mom/chsctns/ch6/sctn6_11.pdf
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 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