ESBD_567618_1791984780306_Exhibit_H-3 -- Iowa Invoice Examples.pdf
PDF 208 KB Posted
- Attached to
- WIC Infant Formula Rebate
- Solicitation number
- HHS0016707
- Issued by
- Texas
About this file
This document contains rebate invoice examples from the Iowa WIC Program, submitted by two infant formula manufacturers—Mead Johnson and Abbott Laboratories—to the Iowa Department of Public Health for the months of January, February, and March 2026. The invoices detail the redemption of various infant formula products distributed through the WIC program, including powder formulas, liquid concentrates, and ready-to-feed options. Each monthly invoice specifies product UPC codes, descriptions, quantities redeemed, rebate amounts per unit, and total invoice amounts. The Mead Johnson invoices for the three-month period total approximately $4.38 million across multiple Enfamil product lines, while the Abbott Laboratories invoices total approximately $132.80 thousand for Similac Soy Isomil products.
The invoices reflect monthly participation metrics for the Iowa WIC program, including the number of infants served who were breastfed, supplemented with formula, or formula-fed exclusively. Payment is due within 30 days of invoice postmark date. The invoices are addressed to Jonathan Becker at the Iowa Department of Public Health, Lucas State Office Building, with Abbott invoices also sent to Abbott Nutrition at their Stelzer Road facility. Each invoice includes a certification statement confirming the accuracy of the information provided. These rebate invoices serve as examples of the documentation and billing procedures used in the WIC program's formula rebate system, demonstrating the volume and financial scope of manufacturer rebates returned to the state program.
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21-096 Enfamil 12.5oz Infant Pwd 36,695 20.812 $763,696.34
IOWA WIC PROGRAM
Mead Johnson Rebate Invoice Redemption Month: January 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
AMOUNT
21-018 Enfamil Gentlease 12.4oz Pwd 24,939 22.945 $572,225.36
21-013 Enfamil AR 12.9oz Pwd 4,140 25.025 $103,603.50
21-130 Enfamil NeuroPro Gentlease 32oz RTF 241 8.088 $1,949.21
21-100 Enfamil Infant 13oz Liq Concentrate 141 5.506 $776.35
21-129 Enfamil NeuroPro Infant 32oz. RTF 359 8.164 $2,930.88
21-130 Enfamil NeuroPro Gentlease 6pk-8oz RTF 46 13.488 $620.45
21-101 Enfamil Reguline 12.4oz Pwd 1,830 24.518 $44,867.94
21-129 Enfamil NeuroPro Infant 6pk-8oz. RTF 130 12.618 $1,640.34
Formula Fed
8,509
Total
13,855
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
TOTALS $1,492,310.35
Infants Served During Month:
Breastfed
2,318
Supplemented with Formula
3,028
321 E. 12th Street Evansville, IN 47721-0001 Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn:
Attn: Jonathan Becker 2400 West Lloyd Expressway
21-096 Enfamil 12.5oz Infant Pwd 34,680 20.812 $721,760.16
Mead Johnson Rebate Invoice Redemption Month: February 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
AMOUNT
21-018 Enfamil Gentlease 12.4oz Pwd 23,933 22.945 $549,142.69
21-013 Enfamil AR 12.9oz Pwd 4,015 25.025 $100,475.38
21-130 Enfamil NeuroPro Gentlease 32oz RTF 214 8.088 $1,730.83
21-100 Enfamil Infant 13oz Liq Concentrate 138 5.506 $759.83
21-129 Enfamil NeuroPro Infant 32oz. RTF 411 8.164 $3,355.40
21-130 Enfamil NeuroPro Gentlease 6pk-8oz RTF 40 13.488 $539.52
21-101 Enfamil Reguline 12.4oz Pwd 1,725 24.518 $42,293.55
21-129 Enfamil NeuroPro Infant 6pk-8oz. RTF 94 12.618 $1,186.09
Formula Fed
8,423
Total
13,753
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
TOTALS $1,421,243.45
Infants Served During Month:
Breastfed
2,334
Supplemented with Formula
2,996
Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn:
Formula Fed
8,467
Total
13,736
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
TOTALS $1,461,748.92
Infants Served During Month:
Breastfed
2,348
Supplemented with Formula
2,921
21-101 Enfamil Reguline 12.4oz Pwd 1,658 24.518 $40,650.84
21-129 Enfamil NeuroPro Infant 6pk-8oz. RTF 87 12.618 $1,097.77
21-129 Enfamil NeuroPro Infant 32oz. RTF 523 8.164 $4,269.77
21-130 Enfamil NeuroPro Gentlease 6pk-8oz RTF 42 13.488 $566.50
21-130 Enfamil NeuroPro Gentlease 32oz RTF 165 8.088 $1,334.52
21-100 Enfamil Infant 13oz Liq Concentrate 104 5.506 $572.62
21-018 Enfamil Gentlease 12.4oz Pwd 24,271 22.945 $556,898.10
21-013 Enfamil AR 12.9oz Pwd 4,260 25.025 $106,606.50
21-096 Enfamil 12.5oz Infant Pwd 36,025 20.812 $749,752.30
IOWA WIC PROGRAM
Mead Johnson Rebate Invoice Redemption Month: March 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
AMOUNT
Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn:
321 E. 12th Street Department 106711, RP2-2 Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn: Abbott Nutrition Attn: Jonathan Becker 3300 Stelzer Road
Formula Fed
8,509
Total
13,855
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
TOTALS $45,697.39
Infants Served During Month:
Breastfed
2,318
Supplemented with Formula
3,028
21-033 Similac Soy Isomil 32oz RTF 46 2.29 $105.34
21-032 Similac Soy Isomil 13oz Conc 42 4.8 $201.60
21-031 Similac Soy Isomil 12.4oz Pwd 2,177 20.85 $45,390.45
IOWA WIC PROGRAM
Abbott Laboratories Rebate Invoice Redemption Month: January 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
Abbott Laboratories Rebate Invoice Redemption Month: February 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
AMOUNT
21-031 Similac Soy Isomil 12.4oz Pwd 2,072 20.85 $43,201.20
21-032 Similac Soy Isomil 13oz Conc 58 4.8 $278.40
21-033 Similac Soy Isomil 32oz RTF 41 2.29 $93.89
TOTALS $43,573.49
Infants Served During Month:
Breastfed
2,334
Supplemented with Formula
2,996
Formula Fed
8,423
Total
13,753
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
321 E. 12th Street Department 106711, RP2-2 Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn: Abbott Nutrition Attn: Jonathan Becker 3300 Stelzer Road
321 E. 12th Street Department 106711, RP2-2 Des Moines, IA 50319-0075
Iowa Department of Public Health Send Rebate Invoice to:
Lucas State Office Building, 3rd Floor Attn: Abbott Nutrition Attn: Jonathan Becker 3300 Stelzer Road
Formula Fed
8,467
Total
13,736
I certify that the above information is true and correct to the best of my knowledge.
Payment is due within 30 days of invoice postmark date.
TOTALS $43,532.62
Infants Served During Month:
Breastfed
2,348
Supplemented with Formula
2,921
21-033 Similac Soy Isomil 32oz RTF 28 2.29 $64.12
21-032 Similac Soy Isomil 13oz Conc 47 4.8 $225.60
21-031 Similac Soy Isomil 12.4oz Pwd 2,074 20.85 $43,242.90
IOWA WIC PROGRAM
Abbott Laboratories Rebate Invoice Redemption Month: March 2026
UPC DESCRIPTION REDEEMED
REBATE
AMOUNT
INVOICE
| 1 - Mead Johnson Rebate Invoice - January 2026 |
| FNRebateEBTInvoice |
| 2 - Mead Johnson Invoice - February 2026 |
| FNRebateEBTInvoice |
| 3 - Mead Johnson Invoice - March 2026 |
| FNRebateEBTInvoice |
| 4 - Abbott Rebate Invoice - January 2026 |
| FNRebateEBTInvoice |
| 5 - Abbott Invoice - February 2026 |
| FNRebateEBTInvoice |
| 6 - Abbott Invoice - March 2026 |
| FNRebateEBTInvoice |
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