Pump Order Guide MN WIC 2016 Ameda
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
Pump Description
Manual Breastpump
(Evenflo/Ameda) One-Hand Manual Breastpump, non-sterile,
with CustomFitbreast flanges (25 mm and 30.5 mm flanges,
Case Quantity
Product
#¹
Price per pump ²,³,⁴
Price per case ²,³,⁴
20
17194
NA
$245.00
Double Personal Pump
Kit
Ameda Dual HygieniKit Milk Collection System (Includes: (1)
Tubing Adapter,• (2) Silicone Tubings, (2) Adapter Caps, (2)
Silicone Diaphragms, (2) 30.5 mm Breast Flanges, (2) 28.5
mm Inserts, (2) 25.0 mm Breast Flanges, (4) White Valves, (2)
4 oz. Bottles with Lock‐Tight Sealing Lids, One‐Hand Breast
Pump Adapter )
20
17186
NA
$330.00
Parts & Supplies
Extra Large Specialty Flanges (XXL/XL) 36.00 mm flange with
32.5 mm insert. Adapts to all Ameda breastpumps and kits.
6
17358M
NA
$23.95
Parts & Supplies
continued
Large Specialty Flanges (Lg/Med) 30.5 mm flange with 28.5
insert. Adapts to all Ameda breastpumps and kits.
6
17148PM
NA
$23.95
Parts & Supplies
continued
Breastpump valves. Replacement parts for Ameda
HygieniKit Milk Collection System and One-Hand Manual
Breastpump.
Each
17146M
$3.10
NA
Parts & Supplies
continued
Silicone Diaphrams. Replacement parts for Ameda
HygieniKit Milk Collection System & One-hand Manual
Breastpump. Retail 2-pack.
Each
17147M
$3.10
NA
Personal-Use Electric Double Breast Pump (Includes: Purely
Yours Breast Pump. Ameda Dual Hygienikit Milk Collection
System with 28.5mm and 30.5mm inserts. One-Hand Manual
Breast Pump Handle Assembly and Microfiber Tote Bag With
Adjustable Shoulder Strap.
Each
17084
$79.00
NA
1
17605
$349.00
$349.00
1
17603
$220.70
$220.70
plus 22.5 mm and 28.5 mm reducing inserts.)
Personal-Use Electric
Double Breastpump.
Requires prior written
approval.⁵
Multi-user Electric
Breastpump (for use in
WIC agency, not for loan.)
Requires prior written
approval.⁵
Ameda Elite™ Electric Breastpump. Multi‐User Electric
Double Breast Pump with cord.
Reconditioned Ameda Elite™ Electric Breastpump.
Multi-user Electric
Multi‐User Electric Double Breast Pump with cord.
Breastpump contintued
Notes:
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]
Rev. January 2016
MN WIC Pump Order Guide Ameda.xlsx
1/26/20163:54 PM