Louisiana Department of Health & Hospitals | Bruce Greenstein, Secretary

 Welcome to the WIC Clinical Services Provider Application Web Page

Thank you for your interest in becoming a Clinical Services Provider for the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Clinical Services Providers help to offer eligible Louisiana families the benefits of the WIC program including a nutritious food package, nutrition education, breastfeeding supportive services and healthcare referrals.

Individuals and organizations who are interested in becoming a WIC Clinical Services Provider should first review the WIC Service Specifications Document which explains the basic requirements. If the basic requirements for becoming a WIC Clinical Services Provider are applicable to you or your organization, the WIC Contract Application may then be completed and submitted to the Nutrition Services Division/Louisiana WIC State Agency using any of the following methods.

•  Complete the WIC Contract Application and then click the submit button in the top right hand corner of the document

 

• Save the application to your computer and email  to shera.gardner@la.gov

 

• Fax the application to the Nutrition Services Division/Louisiana WIC State Agency: Fax Number (225) 342-8312

 

• Mail the application to the following address:  Attention: Shera Gardner, 628 North 4th Street, Bin #4, Baton Rouge, Louisiana, 70802

 All completed applications will be reviewed by the Nutrition Services Division/WIC State Agency. Approval of an applicant's request to provide WIC Services depends upon available funding. If you have any questions about the application or application procedure, please contact, Shera Gardner, Contact Manager, at (225) 342-7897.