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Colorado WIC Program Price List
Instructions:
Please enter the HIGHEST cost WIC ALLOWED item that your store stocks.
Pleaser remember to enter correct information and date.
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* Indicates required question
WIC ID Number
*
Your answer
Store Name & Number
*
Your answer
Date
*
MM
/
DD
/
YYYY
Contact Name
*
Your answer
Contact Number
*
Your answer
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This form was created inside of State.co.us Executive Branch.
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