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Pump Order Guide MN WIC 2015 Ameda Order Guide 2015: 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 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 20 17194 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 ) Each 17186 Extra Large Specialty Flanges (XXL/XL) 36.00 mm flange with 32.5 mm insert. Adapts to all Ameda breastpumps and kits. 6 17358 $23.95 Large Specialty Flanges (Lg/Med) 30.5 mm flange with 28.5 insert. Adapts to all Ameda breastpumps and kits. 6 17148P $23.95 Each 17146 $3.10 NA Each 17147 $3.10 NA 1 617657 Each 17084 1 17005 1 17003 Type of Pump / supply Manual Breastpump Double Personal Pump Kit Parts & Supplies Pump Description (Evenflo/Ameda) One-Hand Manual Breastpump, non-sterile, with CustomFit breast flanges (25 mm and 30.5 mm flanges, Price per pump ²,³,⁴ Price per case ²,³,⁴ $245.00 plus 22.5 mm and 28.5 mm reducing inserts.) (Note that some of these parts & supplies Breastpump valves. Replacement parts for Ameda HygieniKit are not part of the Milk Collection System and One-Hand Manual Breastpump. contract pricing but are added here for your convenience in Silicone Diaphrams. Replacement parts for Ameda ordering.) HygieniKit Milk Collection System & One-hand Manual Breastpump. Retail 2-pack. Cavicide, 24oz spray (Ameda)⁶ Personal-Use Electric Double Breastpump. 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 Requires prior written Breast Pump Handle Assembly and Microfiber Tote Bag With Adjustable Shoulder Strap. approval.⁵ Multi-user Electric Ameda Elite™ Electric Breastpump. Multi‐User Electric Breastpump (for Double Breast Pump with cord. use in WIC agency, not for loan.) Requires prior written Reconditioned Ameda Elite™ Electric Breastpump. Multi‐User Electric Double Breast Pump with cord. approval.⁵ $330.00 ask if available & for pricing there may be a shipping charge $81.99 $305.00 $199.00 NA $305.00 $199.00 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. Cavicide or Envirocide are used to clean the PedalPump and the case for electric pumps. Cavicide is listed here for your convenience, but can not be claimed on the pump claim form. They can be treated as a regular WIC expense. Rev. March 2015
