SO lt.2

Sheet1
LAPORAN STOCK OPNAME
Nomor CuttOff
No ItemID Nama
1 00024 ALBOTHYL OVULA
2 00091 NASONEX NASAL SPRAY 140
3 00123 BRICASMA TURBUHALER 0.5MG
4 00149 INFUS MANITOL 20% 500ML (INHEALTH)
5 00566 INFUS OTSU D10 + 1/5 NS 500 ML(N5)
6 00764 TORASIC INJ 30MG/ML
7 00807 VOLTAREN EC TAB 50MG
8 00953 OTSU MGSO4 20% 25ML
9 01207 FARGOXIN TAB 0.25MG
10 01272 G.CLONIDINE TAB 0.15MG
11 01360 PK KRISTAL 5GR (KMNO4)
12 01596 PLASMINEX INJ
13 02020 KALNEX INJ 500MG(INHEALTH)
14 02054 SIBITAL INJ 200MG
15 02155 HAND RUB E-CARE 500ML
16 02206 G.GEMFIBROZIL CAP 300MG (INHEALTH)
17 02237 BRICASMA TURBUHALER 0.5MG(INHEALTH)
18 02249 INFUS M20/MANITOL 500ML
19 02536 G.HYDROCORTISON 2.5% CREAM 5 GR (INHEALTH)
20 02647 SUPL. L BIO SACH
21 02660 ANTIHEMOROID SUPP(INHEALTH)
22 02679 G.RIFAMPICIN CAP 300MG(INHEALTH)
23 02825 ZINKID SYRUP 100ML (INHEALTH)
24 02834 PAMOL SUPP 125MG (INHEALTH)
25 03146 XYLOCAINE 2% JELLY 10 GRAM
26 03342 PAMOL SUPP 125MG
27 03499 PAMOL SUPP 250MG
28 03555 G.ACARBOSE TAB 100 MG (BPJS)
29 03665 G.HALOPERIDOL TAB 5 MG(BPJS)
30 03701 G.METFORMIN TAB 850MG (BPJS)
31 03703 G.METHISOPRINOL TAB 500MG
32 03724 G.RAMIPRIL TAB 5 MG (BPJS)
33 03737 SUPL. TENTEX ROYAL CAP
34 03738 G.NIFEDIPINE TAB 10MG (BPJS)
35 03973 THYROZOL TAB 10MG(BPJS)
36 04020 DULCOLAX SUPP INFANT 5MG (BPJS)
37 04063 G.RIFAMPICIN CAP 300MG (BPJS)
38 04080 G.CLONIDINE TAB 0.15MG(BPJS)
39 04140 G.DEXKETOPROFEN INJ 25MG/ML
40 04272 INFUS MANITOL 20% 250 ML (INHEALTH)
Page 1
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41 04369 G.ACARBOSE TAB 100 MG

42 04470 FARGOXIN TAB 0.25MG (INHEALTH)
43 04496 SANADRYL EXPECT SYRUP 60ML
44 04503 PAMOL SUPP 250MG (INHEALTH)
45 04679 SANTAGESIK TAB
46 04687 DULCOLAX SUPP INFANT 5MG
47 04691 G.ACARBOSE TAB 50 MG (INHEALTH)
48 04837 G.ACETILSISTEIN CAP 200 MG (INHEALTH)
49 04857 G.DEXKETOPROFEN INJ 25MG/ML (INHEALTH)
50 A0007 ABBOCATH NO.14GA
51 A0008 ABBOCATH NO.16GA
52 A0070 BISTURI NO 12
54 A0142 COMBO PACK INFUS G24
55 A0337 FOLLEY CATH 2 WAY CH 22
56 A0531 BENANG MERSILK 2-0 W321H (CT/ETHICON)
57 A0534 BENANG MERSILK 3-0 W546H (RB/ETHICON)
58 A0535 BENANG MERSILK 3-0 W570 01 (TP/ETHICON)
59 A0555 NASAL CANNULA PREMATURE
60 A0590 GLOVES ON STERILE NITRILE
61 A0663 OPSITE POST OP 6,5X5CM
62 A0678 PAKET KASSA OK 2A(10 KASSA NON X-RAY 10 X 10)
63 A0732 BENANG PREMILENE 4-0 2XHR17 (TP/0090902)
64 A0745 BENANG PROLENE 4-0 W8015T (CT/ETHICON)
65 A0781 BENANG SAFIL 4-0 DS19 (CT/BBRAUN)
66 A0800 BENANG SILKAM 4-0 HR17 (TP/BLACK) COO7613
67 A0812 SPALK KAKI 10 X 100CM
71 A0881 SURGICAL CLIPPER BLADE(X9660)
72 A0989 BENANG VICRYL 3-0 J311H (TP/ETHICON)
73 A0993 BENANG VICRYL 5-0 J493H (CT/ETHICON)
74 A1009 WING NEEDLE 25G 3/4 TERUMO
75 A1165 OPSITE POST OP 15,5 X8,5 CM
76 A1327 3 WAY BUNTUT HOSPITECH (BPJS)
77 A1392 SYRINGE 1ML INSULIN ONEMED
78 A1913 BENANG MERSILK 2-0 W321H (CT/ETHICON) (BPJS)
79 A1940 BENANG MERSILK 3-0 W546H (RB/ETHICON) (BPJS)
80 A1957 BENANG PROLENE 7-0 W8702 (TP/ETHICON) (BPJS)
81 A1984 BENANG PROLENE 4-0 W8015T (CT/ETHICON) (BPJS)
82 AL18120003 BENANG PREMILENE 3-0 2XHR26 BBRAUN (TP/20909
83 04818 ARESPIN INJ 4MG/4ML (BPJS) 5s
84 04817 ARESPIN INJ 4MG/4ML 5s
85 00859 ATROPINE INJ 0.25MG/ML
86 03879 ATROPINE INJ 0.25MG/ML(BPJS)
87 00860 BUSCOPAN INJ 20MG/ML
88 00837 CATAPRES INJ 150 MICROGRAM/ML
89 03890 CATAPRES INJ 150 MICROGRAM/ML(BPJS)
Page 2
Sheet1
90 02532 CATAPRES INJ 150 MICROGRAM/ML(INHEALTH)

91 01650 CEDOCARD INJ 10MG/10ML (INHEALTH) 10s
92 00830 CEDOCARD INJ 10MG/10ML 10s
93 03524 CLOPEDIN 50MG INJ 2ML
94 00057 COMBIVENT UDV 2.5ML
95 03857 COMBIVENT UDV 2.5ML(BPJS)@
96 02196 COMBIVENT UDV 2.5ML(INHEALTH)
97 02695 CORDARONE INJ 150MG/3ML (INHEALTH) 30s
98 00974 CORDARONE INJ 150MG/3ML 6s
99 00246 CORTIDEX INJ 5MG/ML
100 01115 EXTRACE INJ 500MG/5ML
101 03861 FARGOXIN INJ (BPJS) 5s
102 00835 FARGOXIN INJ 5s
103 04035 FARSORBID INJ (BPJS)
104 01213 FENTANYL 0.05MG/ML INJ 2ML
105 04481 FIBRION 1.500.000 IU
106 01279 FLIXOTIDE NEBULES
107 03856 FRESOFOL 1% INJ (BPJS)@
108 00888 G.AMINOPHYLLINE INJ 240MG/10ML
109 03570 G.AMINOPHYLLINE INJ 240MG/10ML (BPJS)
110 02906 G.AMINOPHYLLINE INJ 240MG/10ML (INHEALTH)
111 01518 G.ASAM TRANEKSAMAT INJ 500 MG
112 03581 G.ASAM TRANEKSAMAT INJ 500 MG (BPJS)
113 OB18080032 G.ASAM TRANEKSAMAT INJ 500 MG (INHEALTH)*
114 00889 G.CALCII GLUCONAS INJ 1GR/10ML
115 04071 G.CALCII GLUCONAS INJ 1GR/10ML(BPJS)
116 02635 G.CALCII GLUCONAS INJ 1GR/10ML(INHEALTH)
117 02111 G.CITICOLINE INJ 250MG
118 00964 G.DEXAMETHASONE INJ 5MG/ML
119 00975 G.DIPHENHYDRAMIN INJ 10MG/1ML
120 00890 G.EPHEDRIN INJ 50MG/ML
121 04025 G.EPHEDRIN INJ 50MG/ML (BPJS)
122 04512 G.EPHEDRIN INJ 50MG/ML (INHEALTH)
123 00892 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE)
124 04027 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE) (BPJS)
125 02513 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE)(INHEALT
126 00375 G.FUROSEMIDE INJ 20MG/2ML
127 03908 G.FUROSEMIDE INJ 20MG/2ML (BPJS)
128 01498 G.KETOROLAC INJ 3%
129 03683 G.KETOROLAC INJ 3%(BPJS)
130 02001 G.KETOROLAC INJ 3%(INHEALTH)
131 00960 G.LIDOCAINE INJ 2%
132 03687 G.LIDOCAINE INJ 2% (BPJS)
133 04508 G.LIDOCAINE INJ 2% (INHEALTH)
134 03696 G.MECOBALAMIN INJ 500MCG 10s
135 03539 G.NICARDIPINE INJ 10MG
136 03720 G.NICARDIPINE INJ 10MG (BPJS)
137 04406 G.NICARDIPINE INJ 10MG (INHEALTH)
138 04409 G.NOREPINEPHRINE BITARTRATE INJ 4MG/4ML (INH
Page 3
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139 01563 G.ONDANSETRON INJ 4MG/2ML

140 03748 G.ONDANSETRON INJ 4MG/2ML (BPJS)
141 02086 G.ONDANSETRON INJ 4MG/2ML (INHEALTH)
142 00020 G.ONDANSETRON INJ 8 MG/4 ML
143 03750 G.ONDANSETRON INJ 8MG/4ML (BPJS)
144 02604 G.ONDANSETRON INJ 8MG/4ML (INHEALTH)
145 00544 G.PHENYTOIN INJ 50MG/ML
146 04037 G.PHENYTOIN INJ 50MG/ML (BPJS)
147 02824 G.PHENYTOIN INJ 50MG/ML (INHEALTH)
148 01025 G.PHYTOMENADIONE/VITAMIN K INJ 10MG/ML
149 03762 G.PHYTOMENADIONE/VITAMIN K INJ 10MG/ML (BPJS)
150 01153 G.PIRACETAM INJ 3 GR/15ML
151 01490 G.RANITIDINE INJ 50MG/2ML
152 03727 G.RANITIDINE INJ 50MG/2ML (BPJS)
153 02003 G.RANITIDINE INJ 50MG/2ML (INHEALTH)
154 00823 G.TRAMADOL INJ 100MG/2ML
155 03791 G.TRAMADOL INJ 100MG/2ML (BPJS)
156 02339 G.TRAMADOL INJ 100MG/2ML(INHEALTH)
157 03004 GOTROPIL INJ 3GR/15ML (PIRACETAM)
158 00649 GRANON INJ 3ML 5s
159 00863 IKAPHEN INJ 100MG/2ML
160 00456 KALNEX INJ 500MG/5ML 10s
161 01551 KETESSE INJ 2.5%
162 00976 LASIX INJ
163 01745 LEVEMIR FLEXPEN
164 02089 LEVEMIR FLEXPEN(INHEALTH)
165 02938 LODOMER INJ
166 04866 METOPAIN INJ 30MG/ 1ML 6s
167 01112 MORPHIN 10MG INJ 1ML
168 02330 NEUROBION 5000 INJ
169 02668 NEUROBION 5000 INJ(INHEALTH)
170 01036 NOKOBA INJ 0.4MG/ML 2ML
171 04030 NOKOBA INJ 0.4MG/ML 2ML(BPJS)
172 02515 NOKOBA INJ 0.4MG/ML 2ML(INHEALTH)
173 03468 NTG (NITROGLYCERIN) INJ 10ML
174 04525 NTG (NITROGLYCERIN) INJ 10ML (INHEALTH)
175 04012 OTSU MEYLON 8.4 % 25ML(BPJS)
176 04228 PETHIDIN INJ 100MG/2ML
177 00619 PRIMPERAN INJ 10MG/2ML
178 04117 PRIMPERAN INJ 10MG/2ML (INHEALTH)
179 02592 PROANES 1 % INJ
180 03224 PROANES 1 % INJ(INHEALTH)
181 OB18040006 PROANES 1% INJ (BPJS)
182 00631 PULMICORT RESPULES 0.5MG/2ML(0.25 MG)
183 02978 PULMICORT RESPULES 0.5MG/2ML(0.25 MG)(INHEAL
184 00640 RAIVAS INJ 4MG/4ML
185 00643 RANTIN INJ 50 MG/2 ML
186 02971 RATIVOL INJ 30 MG/ML 5s
187 00644 RECOFOL N INJ 10 MG/ML 20 ML
Page 4
Sheet1
188 04680 SANTAGESIK INJ 1GR/2ML 5s

189 00685 SEDACUM INJ 15MG/3ML 5s
190 00686 SEDACUM INJ 5MG/5ML 10s
191 03351 SERUM ANTI TETANUS BIOSAT 1.5 (ATS 1500 UI)
192 00019 STESOLID INJ 10 MG/2 ML
193 01014 SYNTOCINON INJ 10s
194 03144 TETAGAM INJ 250 INTERNATIONAL UNIT 1ML
195 02547 TETAGAM INJ 250 INTERNATIONAL UNIT 1ML(INHEAL
196 00027 TRAMAL INJ 100MG/2ML
197 OB19030004 TROVENSIS INJ 4MG/2ML 5s
198 02613 TROVENSIS INJ 8MG/4ML 5s
199 02184 UDOPA INJ 40MG/ML
200 03360 VALISANBE INJ 10MG/2ML
201 02256 VENTOLIN NEBULES 2.5 MG (INHEALTH)
202 00936 VENTOLIN NEBULES 2.5MG
203 00532 VIT. NEUROSANBE INJ 3ML
204 00812 VOMCERAN INJ 4MG/2ML
205 00814 VOMCERAN INJ 8MG/4ML
206 01077 ALCO PLUS DMP SYRUP 100ML
207 01709 ALCO PLUS SYRUP 100ML
208 02626 ALOCLAIR PLUS MOUTHWASH 60ML
209 00038 AMOXSAN DRY SYRUP 60ML
210 00039 AMOXSAN FORTE DRY SYRUP 60ML
211 00041 AMOXSAN PAED DROP 15ML
212 03072 AQUAPAK 340 ML/STERIFLO
213 04088 ATAROC SYRUP 60ML
214 04615 ATOPICLAIR LOTION 120ML
215 00669 AVAMYS NASAL SPRAY
216 02278 AVAMYS NASAL SPRAY(INHEALTH)
217 02379 AZOMAX DRY SYRUP
218 04374 AZTRIN DRY SYRUP
219 02262 BETADINE FEM HYGINE 60 ML
220 00082 BETADINE GARGLE 190ML
221 04437 BETADINE GARGLE 190ML (INHEALTH)
222 00089 BETADINE SOL 15 ML
223 00090 BETADINE SOL 30 ML
224 00083 BETADINE SOL 5ML
225 04636 BETADINE SOL 60ML
226 00973 BISOLVON DROPS 50ML
227 OB18080005 CEFAROX DRY SYRUP 100MG/5ML
228 00135 CEFAT DRY SYRUP 60ML
229 00136 CEFAT FORTE DRY SYRUP 60ML
230 00142 CEFSPAN DRY SYRUP 30 ML
231 01940 CELESTAMIN SYRUP 60 ML
232 04356 CERINI ORAL DROP
233 03523 CERINI SYRUP 60ML
234 00233 CLANEKSI DRY SYRUP 60ML
235 04303 CLANEKSI DRY SYRUP 60ML(INHEALTH)
236 00234 CLANEKSI FORTE DRY SYRUP 60ML
Page 5
Sheet1
237 01591 CLARITIN SYRUP 60 ML

238 01094 COMBANTRIN SUSP 10ML
239 01482 COMTUSI SYRUP 60ML
240 02930 CONSTIPEN SYRUP 120ML
241 04895 D-VIT SYRUP 100ML
242 02063 DAKTARIN POWDER 20 GR
243 03141 DARYAZINC DROP
244 03140 DARYAZINC SYRUP
245 01629 DESOLEX LOTION 10ML
246 01459 DEXYCLAV DRY SYRUP 60ML
247 01460 DEXYCLAV FORTE DRY SYRUP 60ML
248 02745 EPEXOL DROP 20ML
249 02746 EPEXOL FORTE SYRUP 60ML
250 00317 EPEXOL SYRUP 120ML
251 04619 EPISAN SUSP 100ML (INHEALTH)
252 03125 EPISAN SUSP 200ML
253 OB18080008 ESTIN SYRUP 5MG/5ML 60ML
254 03046 FIXIPHAR DRY SYRUP 30ML
255 OB19030011 FIXIPHAR DRY SYRUP 60ML
256 01608 FLEET ENEMA 133 ML
257 02542 FLEET ENEMA 133 ML(INHEALTH)
258 04487 FLUIMUCIL DRY SYRUP 75ML
259 01030 FORUMEN EAR DROP 10ML
260 03035 G.AMBROXOL ELIXIR 15MG/5ML
261 03574 G.AMOXICILLIN DRY SYRUP 125MG/5MG 60 ML (BPJS
262 00921 G.AMOXICILLIN DRY SYRUP 125MG/5ML 60ML
263 00252 G.AMOXICILLIN DRY SYRUP 125MG/5ML 60ML(INHEAL
264 02457 G.ANTASIDA DOEN SYRUP 60ML
265 03579 G.ANTASIDA DOEN SYRUP 60ML (BPJS)
266 03882 G.AZITHROMYCIN SYRUP 200MG/5ML (BPJS)
267 03599 G.CEFADROXIL DRY SYRUP 125 MG/5 ML (BPJS)
268 02491 G.CEFADROXIL DRY SYRUP 125 MG/5 ML SYRUP
269 02221 G.CEFADROXIL DRY SYRUP 125 MG/5 ML SYRUP (IN
270 04704 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP
271 03838 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP (BP
272 04662 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP (IN
273 00179 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML
274 03605 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML (BPJS)
275 02664 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML (INHEALTH
276 02960 G.CETIRIZINE SYRUP 5MG/5ML 60ML
277 03968 G.CETIRIZINE SYRUP 5MG/5ML 60ML (BPJS)
278 02766 G.CETIRIZINE SYRUP 5MG/5ML 60ML (INHEALTH)
279 03638 G.DOMPERIDONE DROP 5MG/ML(BPJS)
280 04886 G.DOMPERIDONE DROP 5MG/ML(INHEALTH)
281 04295 G.DOMPERIDONE SYRUP 5MG/5ML
282 04324 G.DOMPERIDONE SYRUP 5MG/5ML 60ML (INHEALTH)
283 03639 G.DOMPERIDONE SYRUP 5MG/5ML(BPJS)
284 04208 G.IBUPROFEN SYRUP 100MG/5ML
285 04120 G.IBUPROFEN SYRUP 100MG/5ML (BPJS)
Page 6
Sheet1
286 03246 G.IBUPROFEN SYRUP 100MG/5ML (INHEALTH)

287 03841 G.IBUPROFEN SYRUP 200 MG/5 ML (BPJS)
288 02678 G.PARACETAMOL DROP 100MG/ML 15ML
289 04046 G.PARACETAMOL DROP 100MG/ML 15ML(BPJS)
290 04278 G.PARACETAMOL DROP 100MG/ML 15ML(INHEALTH)
291 00908 G.PARACETAMOL SYRUP 60ML
292 03757 G.PARACETAMOL SYRUP 60ML (BPJS)@
293 02282 G.PARACETAMOL SYRUP 60ML (INHEALTH)
294 03984 G.SUCRALFATE SUSP 100ML
295 03911 GELOFUSIN INFUS 500ML (BPJS)
296 04854 HARMONIA ACNE SERIES(MCS SS)
297 OB18070003 HARMONIA ACNE SOLUTION 10ML
298 02781 HARMONIA FACIAL WASH N
299 02782 HARMONIA FACIAL WASH O
300 02436 HARMONIA SERUM VIT C
301 02757 HERB. PSIDII SYRUP 60ML
302 00920 HERB. SILEX SYRUP 100ML
303 02210 HISTRINE DROP 10MG/ ML
304 03335 HISTRINE DROP 10MG/ ML (INHEALTH)
305 04231 INFUS D10 (GLUCOSE 10%)500ML (BPJS)
306 03923 INFUS D5 + 1/4 NS 500ML DP (N4) (BPJS)
307 04230 INFUS D5(GLUCOSE 5%) 500 ML (BPJS)
308 03910 INFUS FUTROLIT 500ML (BPJS)
309 04005 INFUS INFUMAL 10% / MARTOS 10% 500 ML DP (BPJS
310 04004 INFUS MANITOL 20% 500ML (BPJS)
311 04101 INFUS NS 100 ML(NATRIUM KLORIDA(BPJS)
312 00577 INFUS NS 1000ML (NATRIUM KLORIDA)UNICAP
313 03123 INFUS NS 1000ML (NATRIUM KLORIDA)UNICAP (INHE
314 04097 INFUS NS 500ML (NATRIUM KLORIDA)SP (BPJS)
315 03878 INFUS RING AS/ASERING 500ML SP(BPJS)
316 04053 INFUS TRIDEX 27A 500ML/ KA EN 3A(BPJS)
317 04055 INFUS TRIDEX 27B 500ML/ KA EN 3B(BPJS)
318 01970 INPEPSA SYRUP 200 ML
319 04216 INTERZINC SYRUP 100ML (INHEALTH)
320 00093 IPROX SYRUP
321 01377 ISOPRINOSINE SYRUP 60 ML
322 01074 ISPRINOL SYRUP 60 ML
323 02257 KLAPER ALL OVER OIL 100ML
324 01139 LACTULAX SYRUP 60 ML
325 01633 LASAL EXPECT SYRUP 100ML
326 01634 LASAL SYRUP 100ML
327 04676 LAXADINE SYRUP 30ML (BPJS)
328 00881 LAXADINE SYRUP 60 ML (INHEALTH)
329 02115 LAXADINE SYRUP 60ML
330 02299 LEVOPRONT SYRUP 120ML
331 02454 LOPROX NAILLACQUER SOL 1.5GR
332 04897 MINOSEP GARGLE 0.1% 150ML(HIJAU)
333 01300 MINOSEP GARGLE 0.2% 150ML (MERAH)
334 01636 MUCOPECT 15MG/5ML PED SYRUP 60ML
Page 7
Sheet1
335 01287 MUCOPECT 30MG/5ML ADULT SYRUP 60 ML

336 00164 MUCOPECT 7.5MG/ML DROP 20ML
337 00521 MYCOSTATIN ORAL SUSP 12 ML
338 03454 MYCOSTATIN ORAL SUSP 30 ML
339 00523 MYLANTA LIQUID 150 ML
340 03290 NARFOZ SYRUP 4MG/5ML 30 ML
341 03094 NECIBLOK SUSP 200 ML
342 00528 NEO KAOLANA SYRUP 120ML
343 02500 NOROID SOOTHING LOTION 200ML
344 OB18110003 NOSFOCIN SYRUP 120ML
345 01242 NOVALGIN SYRUP 60ML
346 00549 NYMIKO DROP 12ML
347 04467 NYMIKO DROP 12ML (INHEALTH)
348 00942 OBH COMBI BATUK BERDAHAK MENTHOL 100ML
349 00273 OBH COMBI PLUS BATUK FLU MENTHOL 100ML
350 01905 OBH SYRUP 100ML
351 02245 OBH SYRUP 100ML (INHEALTH)
352 01294 OBH SYRUP 200 ML
353 02050 OBH SYRUP 200ML(INHEALTH)
354 03038 OREZINC SYRUP
355 00955 OTSU D40 25ML
356 02571 OTSU D40 25ML(INHEALTH)
357 04041 OTSU KCL (KALIUM KLORIDA) 7,46% 25ML(BPJS)
358 02572 OTSU KCL(KALIUM KLORIDA) 7,46% 25ML(INHEALTH)
359 00952 OTSU KCL(KALIUM KLORIDA)7,46% 25ML
360 00514 OTSU MEYLON 8.4 % 25ML
361 02577 OTSU MEYLON 8.4 % 25ML(INHEALTH)
362 04042 OTSU WFI 25 ML (BPJS)
363 00267 OZEN DROP 12ML
364 00260 OZEN SYRUP 60 ML
365 00440 PLANTACID FORTE SYRUP
366 01550 PLANTACID SYRUP 100ML
367 01880 POLYSILANE SUSP 180ML
368 03159 POVIDONE IODINE 10% (ECODINE) 10ML
369 01731 PRAXION DROP 100 MG/ML
370 01732 PRAXION SUSP 120 MG/5ML
371 01733 PRAXION SUSP 250 MG/5 ML
372 00622 PROFILAS SYRUP 60 ML
373 04372 PROGINA CARE 100ML
374 OB18040004 PROPEPSA SUSP 200ML
375 00202 PRORIS FORTE SYRUP 50 ML
376 00223 PRORIS SYRUP 60ML
377 02242 RANIVEL 60 ML SYRUP
378 01632 RENALYTE 200ML
379 01790 RHINATHIOL ROMETHAZINE SYRUP 100ML
380 00657 RHINOFED SUSP
381 00602 RHINOS JUNIOR SYRUP
382 00614 RHINOS NEO DROP
383 02430 RITEZ SYRUP 60ML
Page 8
Sheet1
384 02652 SALICYL TALK (INHEALTH)

385 00666 SANADRYL DMP SYRUP 120ML
386 04569 SANADRYL DMP SYRUP 120ML (INHEALTH)
387 00667 SANADRYL EXPECT SYRUP 120ML
388 04563 SANADRYL EXPECT SYRUP 120ML (INHEALTH)
389 00673 SANMOL DROP 20ML
390 02749 SANMOL INFUS 1 G / 100ML
391 04502 SANMOL INFUS 1 G / 100ML(INHEALTH)
392 00674 SANMOL SYRUP 60ML
393 01899 SANOSKIN MELLADERM PLUS 20 G
394 01928 SANOSKIN OXY GEL 30 G
395 00679 SANPRIMA SYRUP 60ML
396 02948 SIRPLUS SYRUP 100 ML
397 00729 SPORETIK DRY SYRUP 30ML
398 01371 SUPL. APIALYS SYRUP 100ML
399 02755 SUPL. ELKANA CL EMULSI 120 ML
400 01990 SUPL. FEROGLOBIN KID DROP
401 01614 SUPL. FEROGLOBIN SYRUP 100ML
402 00094 SUPL. FUCOIDAN SYRUP 120ML
403 00423 SUPL. IMBOOST FORCE SYRUP 120 ML
404 00424 SUPL. IMBOOST KIDS SYRUP 120 ML
405 01601 SUPL. LIKURMIN SYRUP 100ML
406 04651 SUPL. MOZUKU SYRUP 60ML
407 04692 SUPL. VIUSID SYRUP 100ML
408 01730 TEMPRA DROP 15ML
409 01734 TEMPRA FORTE SYRUP 60ML
410 01560 TEMPRA SYRUP 60ML
411 04279 TOPICARE PLUS CERAMIDE 100 GR
412 00767 TREMENZA SYRUP 60ML
413 04131 TREMENZA SYRUP 60ML (INHEALTH)
414 OB19040007 VACTIV SYR 5MCG/ML 60ML
415 00795 VECTRINE DRY SYRUP 175MG/5ML
416 02715 VESTEIN DRY SYRUP
417 OB19020019 VESTEIN DRY SYRUP (INHEALTH)
418 03465 VIRIDIS SYRUP 250MG/5ML
419 00304 VIT. ELKANA SYRUP 60ML
420 00815 VOMETA DROP 10ML
421 00738 VOMETA SUSP 60ML
422 00870 VOSEDON SYRUP 60ML
423 OB18080024 ZEMINDO SYRUP 60ML
424 02688 ZINKID SYRUP 100ML
425 A0439 KASSA STERIL 16/16
426 01417 NEPHRISOL VANILA
427 01927 SERETIDE 125 INHALER
428 01281 SERETIDE 50 INHALER
429 02357 SERETIDE 50 INHALER(INHEALTH)
430 02106 SERETIDE DISKUS 100
431 01923 SERETIDE DISKUS 250
432 00741 SYMBICORT 160/ 4.5 UG 120 DOSIS
Page 9
Sheet1
433 00742 SYMBICORT 160/ 4.5 UG 60 DOSIS

434 02666 SYMBICORT 160/ 4.5 UG 60 DOSIS(INHEALTH)
435 00070 BAQUINOR FORTE CAPT 20s
436 00214 CERINI CAPT 20s
437 00232 CLANEKSI CAPT
438 04592 DIVALPI EC CAPLET 250MG
439 00326 ERYSANBE CAP 500 MG
440 00925 G.ASAM MEFENAMAT TAB 500MG
441 02026 G.ASAM MEFENAMAT TAB 500MG(INHEALTH)
442 02070 G.AZITHROMYCIN TAB 500 MG (INHEALTH)
443 03958 G.IRBESARTAN TAB 150MG(BPJS)
444 01424 G.RIFAMPICIN CAP 300MG
445 03730 G.RIFAMPICIN CAP 600 MG (BPJS)
447 00016 HERB. VENOSMIL CAP 200 MG 20s
448 00411 HERCLOV CAPT 50s
449 01859 IRVASK CAPT 150MG 30s
450 01860 IRVASK CAPT 300MG 30s
451 00497 MEFINAL CAPT 500 MG
452 00533 NEUROSANBE PLUS CAPT
453 01847 PRIMADOL CAPL
454 00527 PRORIS CAPT
455 00661 RIFAMTIBI CAPT 600MG
456 03132 SANPRIMA FORTE CAPT
457 00722 SELOXY AA CAPT 30s
458 03530 SINCRONIK CAPT 30s
459 01441 SISTENOL CAPT
460 00308 SULCOLON CAPT 500 MG
461 04601 SUPL. ASTAPLUS CAPT 30s
462 03214 SUPL. CAR Q TAB 100MG 30s
463 04596 SUPL. FOLDA CAP 30s
464 03532 SUPL. GCM CAPLET 30s
465 04594 SUPL. MAXTOTEN CAP
466 01937 SUPL. NOCID TAB
467 01569 SUPL. SELOXY CAPT 30s
468 00839 SUPL. ZEGAVIT CAPT 50s
469 00784 TUZALOS CAPT
470 00072 VIT. BECOM C CAPT
471 OB18080022 VOXIN CAPT 500MG
472 00300 ALDISA SR CAP 50s
473 00037 AMOXSAN CAP 500MG
474 03163 APRION CAP 75MG 10s
475 01461 ARTRODAR CAP 50 MG 30s
476 01418 AVODART CAP 0.5MG 30s
477 03881 AVODART CAP 0.5MG(BPJS)@ 30s
478 02435 AVODART CAP 0.5MG(INHEALTH) 30s
479 04561 CALOS (CACO3) 500MG CHEW TAB (INHEALTH) 60s
480 OB18080004 CEFAROX CAP 100MG 20s
481 00134 CEFAT CAP 500 MG
Page 10
Sheet1
482 00140 CEFSPAN CAP 100 MG 30s

483 00141 CEFSPAN TAB 200 MG 10s
484 00144 CELEBREX CAP 100MG 30s
485 00484 CELEBREX CAP 200MG 30s
486 00293 DOGMATIL CAP 50 MG
487 01788 FIXIPHAR CAP 100MG
488 03025 FIXIPHAR CAP 200MG
489 04869 FLUCORAL CAP 150 MG (INHEALTH) 10s
490 00359 FLUCORAL CAP 150 MG 10s
491 01206 FLUIMUCIL CAP 200MG 60s
492 03553 G.ACETILSISTEIN CAP 200 MG
493 00916 G.CEFADROXIL CAP 500MG
494 03600 G.CEFADROXIL CAP 500MG (BPJS)
495 01519 G.CEFIXIME CAP 100MG
496 03603 G.CEFIXIME CAP 100MG(BPJS)
497 00676 G.CEFIXIME CAP 100MG(INHEALTH)
498 02329 G.CEFIXIME CAP 200MG
499 04514 G.CEFIXIME CAP 200MG (INHEALTH)
500 00969 G.CETIRIZINE TAB 10 MG
501 00358 G.CLINDAMYCINE CAP 150 MG
502 01991 G.CLINDAMYCINE CAP 150MG (INHEALTH)
503 00900 G.CLINDAMYCINE CAP 300MG
504 02049 G.CLINDAMYCINE CAP 300MG (INHEALTH)
505 03624 G.CLINDAMYCINE CAP 300MG(BPJS)
506 02280 G.DOXYCYCLINE CAP 100 MG(INHEALTH)
507 00903 G.DOXYCYCLINE CAP 100MG
508 02568 G.ERYTHROMYCIN CAP 250 MG (INHEALTH)
509 04453 G.FENOFIBRATE CAP 100MG
510 03647 G.FENOFIBRATE CAP 100MG(BPJS)
511 04297 G.FENOFIBRATE CAP 100MG(INHEALTH)
512 04329 G.FENOFIBRATE CAP 300MG
513 03648 G.FENOFIBRATE CAP 300MG(BPJS)
514 04298 G.FENOFIBRATE CAP 300MG(INHEALTH)
515 02623 G.FLUCONAZOLE CAP 150MG
516 03905 G.FLUCONAZOLE CAP 150MG (BPJS)
517 03654 G.GABAPENTINE CAP 300MG
518 04566 G.GABAPENTINE CAP 300MG (BPJS)
519 00824 G.GEMFIBROZIL CAP 300MG
520 03659 G.GEMFIBROZIL CAP 300MG(BPJS)
521 01520 G.ITRACONAZOLE CAP 100MG
522 03451 G.ITRACONAZOLE CAP 100MG (INHEALTH)
523 01273 G.LANSOPRAZOLE CAP 30MG
524 03684 G.LANSOPRAZOLE CAP 30MG (BPJS)
525 01993 G.LANSOPRAZOLE CAP 30MG(INHEALTH)
526 04091 G.MECOBALAMIN CAP 500MG
527 03695 G.MECOBALAMIN CAP 500MG (BPJS)
528 00895 G.OMEPRAZOLE CAP 20MG
529 03745 G.OMEPRAZOLE CAP 20MG (BPJS)
530 01999 G.OMEPRAZOLE CAP 20MG(INHEALTH)
Page 11
Sheet1
531 01969 G.PHENYTOIN CAP 100 MG

532 02340 G.PHENYTOIN CAP 100 MG(INHEALTH)
533 03895 G.PHENYTOIN CAP 100MG (BPJS)
534 04121 G.PREGABALIN CAP 75MG
535 03729 G.RIFAMPICIN CAP 450 MG (BPJS)
537 02134 G.RIFAMPICIN CAP 450MG(INHEALTH)
538 00915 G.TRAMADOL CAP 50MG
539 02080 G.TRAMADOL CAP 50MG (INHEALTH)
540 03795 G.URSODEOXYCHOLIC ACID CAPSUL 250MG
541 OB18080009 GASTROLAN CAP 30MG 20s
542 02672 HARNAL D CAP 0.2MG(INHEALTH) 28s
543 02354 HERB. INLACIN 100MG CAP 30s
544 00733 HERB. STIMUNO FORTE CAP
545 00105 IKAPHEN CAP 100MG
546 00711 INCIDAL OD CAP
547 04338 INHIPUMP CAP 20MG 7s
548 00256 INTERDOXIN CAP 100MG
549 00451 KALMECO CAP 500MG
550 OB19020004 KALNEX TAB 500MG (INHEALTH)
551 A0434 KAPSUL KOSONG NO. 1
552 A0435 KAPSUL KOSONG NO.0
556 01307 LANCID CAP 30MG
557 00473 LAPRAZ CAP 20s
558 01686 LASAL CAP 2MG
559 OB19010006 LIVAPRO SS CAP 50s
560 01538 LYRICA CAP 150MG 14s
561 02306 LYRICA CAP 150MG(INHEALTH) 14s
562 01539 LYRICA CAP 75MG 14s
563 03226 LYRICA CAP 75MG(INHEALTH) 14s
564 00499 MEGABAL CAP 100s
565 01434 METHYCOBAL CAP 500 MICROGRAM
566 00515 MEZATRIN CAP 250 MG
567 04871 MEZATRIN CAP 250 MG (INHEALTH)
568 00961 NEPATIC CAP 300MG
569 00530 NEURONTIN CAP 300MG 100s
570 04248 NIRCEF CAP 100MG 10s
571 03088 NITROKAF RETARD 2,5 MG CAP
572 04028 NITROKAF RETARD 2,5 MG CAP (BPJS)
573 02284 NITROKAF RETARD 2,5 MG CAP (INHEALTH)
574 00606 NOLIPO CAP 500MG
575 02840 NOMIKA TAB 100MG
576 01853 NUCEF CAP 100MG 30s
577 00470 OMZ CAPS 20MG
578 04864 PLETAAL SR CAP 100 MG (INHEALTH) 30s
579 04626 PLETAAL SR CAP 100 MG 30s
Page 12
Sheet1
580 00145 PRADAXA CAP 110MG

581 02363 PRADAXA CAP 110MG(INHEALTH)
582 03438 PRAZOTEC CAP 30MG 20s
583 00624 PROLIC CAP 150 MG 100s
584 00625 PROLIC CAP 300 MG 100s
585 03080 PROVELYN CAP 150MG 14s
586 03081 PROVELYN CAP 75MG 14s
587 00634 PUMPITOR CAP 20s
588 00659 RHINOS SR CAP
589 04862 RHINOS SR CAP (INHEALTH)
590 02587 SALOFALK TAB 250 MG
591 00706 SICLIDON CAP 100MG 20s
592 02831 SPORACID CAP 100MG
593 00727 SPORETIK CAP 100MG
594 04820 SPORETIK CAP 200MG
595 04457 STAFORIN CAP 500MG
596 00403 SUPL. ASTATIN CAP 20s
597 04296 SUPL. CORMEGA SOFT CAP 30s
598 03112 SUPL. FLORAGYN CAP 30s
599 01889 SUPL. FORNEURO CAP 30s
600 01725 SUPL. FUCOIDAN 100 CAP
601 01888 SUPL. GLISODIN CAP 30s
602 00949 SUPL. HEPAMAX CAP
603 04282 SUPL. LIPROQY CAPS
604 04639 SUPL. MOZUKU CAP 30s
605 02485 SUPL. NEULIN PS CAPS 30s
606 03525 SUPL. OSTEOPOR CAP
607 00529 SUPL. PHARMATON FORMULA CAPT
608 04478 SUPL. PROBIOSTIM CAP
609 01422 SUPL. SANGOBION CAP
610 04868 SUPL. SANGOBION CAP (INHEALTH)
611 00476 SUPL. STARMUNO CAP
612 01985 TRAMAL CAP 50MG 50s
613 01533 TROLIP CAP 300MG 30s
614 00787 URDAHEX CAP 30s
615 04448 URDEX CAP 30s
616 03517 UROTRACTIN CAP 400MG (INHEALTH) 60s
617 00789 UROTRACTIN CAP 400MG 60s
618 00794 VECTRINE CAP 300MG 20s
619 OB19030012 VESTEIN CAP (INHEALTH) 20s
620 01794 ZEMYC CAP 50 MG 10s
621 01159 ACNE FELDIN (KUMERFELDI) 110ML
622 01017 ALKOHOL 70% 100 ML
623 04241 ALOCLAIR PLUS SPRAY 15ML
624 03880 AVAMYS NASAL SPRAY(BPJS)@
625 01886 CALADINE LOT 95ML
626 04191 ELOCON LOTION 30 ML
627 03033 G.PARACETAMOL INFUS 1GR/100ML
628 03756 G.PARACETAMOL INFUS 1GR/100ML (BPJS)
Page 13
Sheet1
629 01089 GELOFUSIN INFUS 500ML

630 01858 HARMONIA CLARIFYING FACIAL CLEANSER-PHa 4%
631 01942 HARMONIA CLARIFYING G A 2%
632 01943 HARMONIA CLARIFYING G A 4%
633 01857 HARMONIA GLYCODERM 10%
634 02786 HARMONIA LOOSE POWDER N
635 02787 HARMONIA LOOSE POWDER O
636 02784 HARMONIA TONER N
637 02785 HARMONIA TONER O / AHA
638 00563 INFUS D10 (GLUCOSE 10%)500ML
639 00570 INFUS D5(GLUCOSE 5%)100 ML
640 00098 INFUS WFI (WATER FOR INJECTION)1000ML
641 01293 KETOMED SS 60ML
642 00178 MINYAK KAYU PUTIH 120ML
643 00365 MINYAK TELON 100 ML
644 02482 NARFOZ SYRUP 4MG/5ML 60 ML
645 00573 OTSU MANITOL 20% 250 ML
646 00954 OTSU MGSO4 40% 25ML
647 00576 OTSU NS (NATRIUM KLORIDA) 25 ML
648 04323 OTSU NS (NATRIUM KLORIDA) 25 ML (INHEALTH)
649 00956 OTSU SALIN 3% 500ML
650 00580 OTSU WFI 25 ML
651 02043 OTSU WFI 25 ML (INHEALTH)
652 01627 PARASOL LOTION 30 SPF
653 01007 PHISOHEX 50 ML
654 01805 REGROU 30ML
655 03073 REGROU FORTE 30ML
656 01493 RIVANOL 0.1% IKA 200 ML
657 01505 SALICYL MENTHOL TALK
658 01140 SALICYL TALK
659 01447 SLEEK BABY DESINFECTAN/CLEANSER
660 00745 TANTUM VERDE 120 ML
661 00935 VENTOLIN INHALER 100 MICROGRAM
662 01044 ACID SALICYLIC (ACSAL CAS) PULVIS
663 01002 BIOCREAM 20GR
664 01544 NATRIUM CHLORIDA PH (NACL) PULVIS
665 01047 VASELIN
666 00095 GLYCERIN PH 1 LITER
667 OB19040004 HUMULIN R 100IU INJ 10ML
668 01042 LIQUOR CARBONIS DETERGENTS (LCD) LIQUID
669 02214 OLEUM BERGAMOT FCF
670 02893 POVIDONE 10% 1000ML(STARDINE/BETADINE)
671 OB18040007 G.MOXIFLOXACIN TAB 400MG
672 OB18070002 MAXPRINOL SYRUP 250/5ML
673 OB18090014 BURNAZIN CREAM 500GR
674 OB18090015 CEPEZET TAB 100MG
675 OB18110008 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB (BPJS)
676 OB19020005 G.NATRIUM DIKLOFENAK TAB 25MG (INHEALTH )
677 00352 FLADYSTIN OVULA
Page 14
Sheet1
678 02303 FLAGYSTATIN OVULA

679 00396 NEO GYNOXA OVULA
680 03220 NEO GYNOXA OVULA (INHEALTH)
681 02377 VAGIZOL 500MG OVULA(INHEALTH)
685 A0196 WASH GLOVES T3-TOWEL
686 A0059 3 WAY BUNTUT
687 A0017 ACTIMOVE VERTEBRACE L
688 A0018 ACTIMOVE VERTEBRACE M
689 A0019 ACTIMOVE VERTEBRACE S
690 A0027 ALKOHOL SWAB+CHLORHEXIDINE
691 A0037 ARM SLING SIZE L
692 A0038 ARM SLING SIZE M
693 A0039 ARM SLING SIZE S
694 A0040 ARM SLING SIZE XL
695 A1081 BACTERIAL FILTER ADULT HME
696 A0054 BACTIGRAS 10X10
697 A1507 BACTIGRAS 10X10(BPJS)
698 A0107 BENANG CATGUT CHROMIC 2-0 J983H (ETHICON)
699 A0109 BENANG CATGUT CHROMIC 3-0 G122T (ETHICON)**
700 A2116 BENANG CATGUT CHROMIC 3-0 G122T (ETHICON)** (
701 A2115 BENANG CATGUT PLAIN 2-0 1872T (ETHICON) (BPJS)
702 A0111 BENANG CATGUT PLAIN 2-0 1872T (ETHICON)**
703 A2135 BENANG CATGUT PLAIN 4-0 JH121T (CT/ETHICON) C
704 A0533 BENANG MERSILK 3-0 W328H (CT/ETHICON)
705 A1973 BENANG MERSILK 3-0 W328H (CT/ETHICON) (BPJS)
706 A0537 BENANG MERSILK 4-0 W582 (RB/ETHICON)
707 A2074 BENANG MERSILK 4-0 W582 (RB/ETHICON) (BPJS)
708 A0729 BENANG PREMILENE 2-0 DS24 (CT/0090236)
709 A0731 BENANG PREMILENE 3-0 DS19 (CT/0090521)
710 A1180 BENANG PREMILENE 4-0 DS19 (CT/C2090520)
711 A1484 BENANG PREMILENE 4-0 DS19 (CT/C2090520) (BPJS)
712 A1592 BENANG PROLENE 2-0 8833H (TP/ETHICON)
713 A0742 BENANG PROLENE 2-0 8833H (TP/ETHICON) (BPJS)
714 A1931 BENANG PROLENE 2-0 W8026T (CT/ETHICON) (BPJS)
715 A0743 BENANG PROLENE 2-0 W8026T (CT/ETHICON)**
716 A0744 BENANG PROLENE 3-0 W8684 (CT/ETHICON)
717 A1625 BENANG PROLENE 3-0 W8684 (CT/ETHICON) (BPJS)
718 A1914 BENANG PROLENE 5-0 W527 (CT/ETHICON) (BPJS)
719 A0748 BENANG PROLENE 5-0 W527(CT/ETHICON)**
720 A0751 BENANG PROLENE 6-0 W8706 (TP/ETHICON)
723 A0077 BLOOD SET BPJS
724 A0078 BLOOD SET TERUMO TBA200L002+
725 A0081 BOTOL COKLAT 100 CC
Page 15
Sheet1

728 A0086 BOTOL COKLAT LEBAR 50 CC
729 A0153 CONNECTING TUBE(MPCS)
730 A0207 ELECTRODE ECG PAED
731 A0206 ELECTRODE ECG/TREADMILL ADULT
732 A0263 ETT CUFF KINGKING NO.7.5
733 A0287 ETT NO 7 (100/199/070)PORTEX
734 A0288 ETT NO 7.5 (100/199/075)PORTEX
735 A0289 ETT NO 8 (100/199/080)PORTEX
736 A0301 EXTENSION TUBE 1.5 ML 150 CM
737 A0311 FEEDING TUBE 3.5 FR 35 CM TERUMO(NGT)
738 A0313 FEEDING TUBE 5 FR 40 CM TERUMO(NGT)
741 A0319 FINGER SENSOR NEO
751 A0343 FOLLEY CATH 2 WAY SILICON CH 16
754 A0347 FOLLEY CATH 3 WAY CH 18 RUSCH
758 A0352 GLOVES GAMMEX NO 6
759 A0353 GLOVES GAMMEX NO 6.5
761 A0355 GLOVES GAMMEX NO 7.5
763 A0367 GLOVES ON STERILE
764 A0375 GUEDEL NO. 100MM
767 A2045 HME FILTER (PORTABLE) BY-GL-4(170522)
768 A0417 INFUS SET PEDIATRIC TERUMO TKA200LK
769 A0420 INTRAFIX SAFESET
770 A0422 INTUBATION STYLET(MANDRIN) NO.10 SIZE M 4MM
771 A0424 INTUBATION STYLET(MANDRIN) NO.6 SIZE S
772 A0425 INTUBATION STYLET(MANDRIN)NO.14 SIZE L 4.3MM
773 A0062 IV CANNULA G18
Page 16
Sheet1

778 A1390 IV DRESSING 6X7CM (WINNER)
779 A1132 KAIN MORI/KAIN KAFAN
780 A0440 KASSA VERBAND 4Y X 10CM
783 A0457 KERTAS PUYER
784 A0462 KONDOM CATH L
785 A0463 KONDOM CATH M
786 A0464 KONDOM CATH S
787 A0469 LEUKOCREPE 10 CM X 4.5M(4)8240
788 A0470 LEUKOCREPE 15 CM X 4.5M(6)8245
789 A0471 LEUKOCREPE 7.5 CM X 4.5M(3)8238
790 A0475 LEUKOPLAST 5CM X 4.5M (2`) 1624H
791 A0476 LEUKOPLAST 7.5CM x 4.5M (3`) 1625H
792 A0518 MASKER JILBAB/KARET/TALI
793 A0541 MICROPORE 1 X 10 YDS TM15351
794 A0542 MICROPORE 1/2 X 10 YDS TM15350
795 A0543 MICROPORE 2 X 10 YDS TM15352
796 A0552 NASAL CANNULA ADULT
797 A0553 NASAL CANNULA INFANT/NEONATE
798 A0554 NASAL CANNULA PEDIATRIC
799 A0559 NASOPHARYNGEAL AIRWAY NO 7 PORTEX(NPA)
800 A0563 NEBULIZER MASK ADULT MICROMIST (A0201)
801 A0565 NEBULIZER MASK PEDIATRIC MICROMIST
802 A0566 NEEDLE 18 G 1-1/2` TERUMO
805 A0572 NEEDLE 24 G 1` TERUMO
806 A0573 NEEDLE 25 G 1` TERUMO
807 A0575 NEEDLE 26 G 1/2` TERUMO
808 A0576 NEEDLE 27 G 1/2` TERUMO
809 A0583 NEEDLE MICROFINE 31 G
810 A1156 NEEDLE NOVO TWIST 32G X 5MM
811 A0592 NON REBREATHING MASK PEDIATRIC (NRM)
812 A0591 NON REBREATHING MASK ADULT (NRM)
813 A0677 OXYGEN TUBING (SO-1170)
814 A0682 PAKET KASSA RI 2(5 KASSA 5X5)
815 A0683 PAKET KASSA RI 3(10 KASSA 5X5)
816 A0708 PISAU CUKUR
817 A0717 POT PLASTIK 10 CC
822 A0758 RAPID RHINO NASAL PAC 5.5CM ANTERIOR RR 551
823 A0759 RAPID RHINO NASAL PAC 7.5 CM WITH BALLOON RR
824 A0762 REBREATHING MASK ADULT
Page 17
Sheet1
825 A0761 REBREATHING MASK PED

826 A0764 RECTAL TUBE NO 20
827 A1330 RECTAL TUBE NO.20 (BPJS)
828 A1260 RECTAL TUBE NO.28
829 A0774 RING PESARIUM NO 65
833 A1461 ROLL TAMPON VK
834 A1048 SANOSKIN FOAM 10X10 CM
835 A1058 SANOSKIN MELLADERM PLUS TULLE 10X10 CM
836 A1192 SECURITY SEAL
837 A0788 SENDOK OBAT
838 A0801 SIMPLE MASK(OXYGEN MASK) ADULT (8110)
839 A0802 SIMPLE MASK(OXYGEN MASK) PED 1122
840 A0803 SINGLE BLOOD BAG 250CC (PLEBOTOMY)
841 AL19010023 SPALK TANGAN 5 X 10CM
842 A0817 SPALK TANGAN 5 X 12CM
846 A0821 SPALK TRIPLE LUGINA 10X13X50CM
847 A0822 SPALK TRIPLE LUGINA 10X15X85CM
848 A0833 STERI STRIP 1/2x4 R1547
849 A1103 STERI STRIP 25MM X 125MM R1548
850 A0850 STOMACH TUBE FR 10 JMS(NGT)
851 A0851 STOMACH TUBE FR 12 TERUMO(NGT)
854 A0857 STOMACH TUBE FR 16(NGT) SILICON STARDEC
855 A0858 STOMACH TUBE FR 18 JMS(NGT)
857 A1324 STOMACH TUBE/NGT FR 16 (BPJS)
858 A0863 SUCTION BAG LINER 2L WHITE/GREEN
859 A0865 SUCTION CATHETER CH 06
865 A0889 SYRINGE 10ML ONEMED
866 A0890 SYRINGE 10ML TERUMO
868 A0891 SYRINGE 1ML TUBERCULIN TERUMO
Page 18
Sheet1

877 A0903 SYRINGE CATHETER TIP 50ML ONEMED
878 A0902 SYRINGE CATHETER TIP 50ML TERUMO
879 A0913 TEGADERM 7X8.5CM TM1633
880 A0916 TEGADERM PED 5X5.7CM TM1610
881 A0939 TONGUE SPATEL KAYU
882 A1160 TRANSOFIX (4090500)
883 A0962 UNDERPAD DEWASA 60X90CM
884 A1015 URINE BAG
885 A2044 VENTILATOR BREATHING CIRCUIT (PORTABLE) 5100
886 A1008 WING NEEDLE 23G 3/4 TERUMO
887 02778 HARMONIA AH 8
888 04628 HARMONIA BIOLASTIN (BLS)
889 02438 HARMONIA EYE GEL
890 OB18070015 HARMONIA LIGHTENING ESSENCE
891 02777 HARMONIA MOISTURIZER MAK
892 04176 HARMONIA SERUM VIT C+ANTI AGING
893 01866 HARMONIA SUNBLOCK CREAM SPF 35
894 02779 HARMONIA SUNBLOCK CREAM SPF 40
897 03242 CATAFLAM FAST 50MG 9s
898 00883 FLUIMUCIL GRANUL 200MG 30s
899 00449 KALITAKE SACH 5GR 20s
900 02312 KALITAKE SACH 5GR(INHEALTH) 20s
901 01267 MONURIL GRANUL 3GR
902 01202 PHAROLIT ORANGE SACH
903 02638 SEQUEST SACHET
904 01181 SMECTA SACH 3GR 30s
905 02900 SUPL. GCM FORTE SACHET 30s
906 01068 SUPL. LACTO B SACH 1GR 40s
907 01960 SUPL. PROBIOKID SACHET 10s
908 02967 GELAFUSAL INFUS
909 02979 GELAFUSAL INFUS(INHEALTH)
910 02723 INFUS D10 (GLUCOSE 10%)500ML(INHEALTH)
911 00432 INFUS D5 + 1/4 NS 500ML DP (N4)
912 02579 INFUS D5 + 1/4 NS 500ML DP (N4) (INHEALTH)
913 00430 INFUS D5(GLUCOSE 5%) 500ML DP
914 02570 INFUS D5(GLUCOSE 5%) 500ML(INHEALTH)
915 04887 INFUS D5(GLUCOSE 5%)100 ML (BPJS)
916 02632 INFUS FUTROLIT 500ML (INHEALTH)
917 01693 INFUS FUTROLIT 500ML DP
918 03101 INFUS INFUMAL 10% / MARTOS 10% 500 ML DP
919 03093 INFUS NS 100 ML(NATRIUM KLORIDA)
920 02573 INFUS NS 500ML (NATRIUM KLORIDA)(INHEALTH)
921 00433 INFUS NS 500ML (NATRIUM KLORIDA)DP
922 00435 INFUS RING AS/ASERING 500ML
Page 19
Sheet1
923 02585 INFUS RING AS/ASERING 500ML(INHEALTH)

924 02575 INFUS RL (RINGER LACTATE) 500ML (INHEALTH)
925 00436 INFUS RL (RINGER LACTATE) 500ML DP
926 OB19010014 INFUS RL (RINGER LACTATE) 500ML SP
927 04064 INFUS RL (RINGER LACTATE) 500ML SP (BPJS)
928 02091 INFUS TRIDEX 27A 500ML(INHEALTH)
929 00564 INFUS TRIDEX 27A 500ML/KA EN 3A 500ML
930 02042 INFUS TRIDEX 27B 500ML(INHEALTH)
931 00565 INFUS TRIDEX 27B 500ML/ KA EN 3B
932 02887 INFUS TRIDEX PLAIN /KA EN 1B
933 04043 INFUS TRIDEX PLAIN/KA EN 1B 500ML (BPJS)
934 OB19010010 ANTIHEMOROID SUPP
935 00887 BORAGINOL S SUPP
936 00941 DULCOLAX SUPP ADULT 10MG
937 02633 DULCOLAX SUPP ADULT 10MG(INHEALTH)
938 04567 DULCOLAX SUPP INFANT 5MG (INHEALTH)
939 00005 FAKTU SUPP
940 00460 KALTROFEN SUPP
941 02406 PROFECOM 100 MG SUPPOS
942 01508 PROFENID SUPP 100MG
943 02509 PROFENID SUPP 100MG(INHEALTH)
944 00629 PRONALGES SUPP 100 MG
945 01019 PRORIS SUPP 125MG
946 00028 TRAMAL SUPP 10s
947 00827 ULTRAPROCT N SUPP
948 01348 LANTUS SOLOSTAR
949 02092 LANTUS SOLOSTAR INJ(INHEALTH)
950 01846 NOVOMIX FLEXPEN
951 02098 NOVOMIX FLEXPEN(INHEALTH)
952 04034 NOVORAPID FLEXPEN (BPJS)
953 01981 NOVORAPID FLEXPEN(ACTRAPID)
954 02031 NOVORAPID FLEXPEN(INHEALTH)
955 03544 REMOPAIN PREFILLED SYRINGE
956 00007 ACPULSIF TAB 5 MG 50s
957 00008 ACRAN TAB 150 MG 30s
958 00282 ADALAT OROS TAB 30MG 30s
959 03866 ADALAT OROS TAB 30MG(BPJS)@
960 02243 ADALAT OROS TAB 30MG(INHEALTH)
961 03086 AERIUS TAB 5MG 30s
962 00017 ALLORIS TAB 100s
963 01467 AMINEFRON TAB
964 03383 AMTOCORT TAB 4 MG 30s
965 00042 ANALSIK CAPT
966 04593 AR-GOUT TAB 0.5MG
967 01429 ARCOXIA TAB 120MG 30s
970 00025 ASCARDIA TAB 80MG 100s
971 01187 ASPAR K TAB 300MG
Page 20
Sheet1
972 02316 ASPAR K TAB 300MG(INHEALTH)

973 01129 ASPILET TAB 80MG
974 02129 ASPILET TAB 80MG(INHEALTH)
975 02384 ATOFAR TAB 20 MG 30s
976 01198 AVELOX TAB 400MG
977 02110 AVELOX TAB 400MG(INHEALTH)
978 02236 AZOMAX TAB 500MG 10s
979 02847 AZTRIN TAB 500MG 6s
980 01305 BESTALIN TAB
981 OB19030007 BETASERC TAB 24MG (INHEALTH) 20s
982 01515 BETASERC TAB 24MG 20s
983 03158 BICROLID CAPT 500 MG 30s
984 01370 BLOPRESS TAB 16MG 14s
985 01369 BLOPRESS TAB 8 MG 14s
986 00118 BRAXIDIN TAB 100s
987 03217 BRAXIDIN TAB(INHEALTH)
988 04259 BRILINTA TAB 90MG (BPJS) 56s
989 03441 BRILINTA TAB 90MG 56s
990 04211 BRILINTA TAB 90MG(INHEALTH) 56s
991 00287 BUSCOPAN PLUS TAB 100s
992 00374 BUSCOPAN TAB 10MG 100s
993 04114 BUSCOPAN TAB 10MG(INHEALTH)
994 03550 CALOS (CACO3) 500MG CHEW TAB 60s
995 02935 CANDERIN TAB 16MG 30s
996 02976 CANDERIN TAB 16MG(INHEALTH) 30s
997 02934 CANDERIN TAB 8MG 30s
998 02975 CANDERIN TAB 8MG(INHEALTH) 30s
999 01405 CARDIO ASPIRIN TAB
1000 01749 CATAFLAM TAB 25MG 50s
1001 01757 CATAFLAM TAB 50MG 50s
1002 00526 CEDOCARD TAB 5MG 60s
1003 00698 CELESTAMINE TAB
1004 01881 CETINAL TAB 10MG 30s
1005 00714 CLARITIN TAB
1006 OB19020014 CLIDIAZ TAB 30s
1007 00387 COMBANTRIN TAB 250MG 50s
1008 03995 CONCOR TAB 2.5MG (BPJS)
1009 00043 CONCOR TAB 2.5MG 100s
1010 00247 CORTIDEX TAB 100s
1011 01766 CPG TAB 75MG 30s
1012 00248 CRAVIT TAB 500 MG 10s
1013 00251 CRESTOR TAB 20MG 30s
1014 02888 CRIPSA TAB 2.5MG 30s
1015 04896 D-VIT FT TAB 30s
1016 OB18110002 DESTAVELL TAB 5MG 30s
1017 04000 DIAMICRON MR TAB 60MG (BPJS)@ 30s
1018 04265 DIAMICRON MR TAB 60MG (INHEALTH) 30s
1019 01373 DIAMICRON MR TAB 60MG 30s
1020 00616 DIVASK 5MG TAB 30s
Page 21
Sheet1
1021 01269 DOLO NEUROBION TAB

1022 00296 DRAMAMINE TAB 100s
1023 01133 DULCOLAX TAB 5MG
1024 02529 DULCOLAX TAB 5MG(INHEALTH)
1025 02926 DUODART TAB 0.5MG
1026 01984 EFISOL C LOZENGES TAB
1027 00318 EPEXOL TAB 30MG 100s
1028 04682 EPRINOC TAB 50MG
1029 01935 EPSONAL TABLET 100s
1030 02936 ERICAF TAB 1MG
1031 02569 ERICAF TAB 1MG(INHEALTH)
1032 01211 ESILGAN TAB 1 MG
1033 01254 ESILGAN TAB 2MG
1034 OB18080006 ESTIN TAB 10MG
1035 03405 EUTHYROX TAB 50 MICROGRAM
1036 03475 EUTHYROX TAB 50 MICROGRAM(INHEALTH)
1037 01387 EZETROL TAB 10 MG 30s
1038 OB19040008 EZOCON TAB 40MG 30s
1039 OB19050004 FEBURIC TAB 80MG
1040 00347 FG TROCHES MEIJI TAB 120s
1041 01671 FLUIMUCIL EFF TAB 600MG 10s
1042 00364 FOLAVIT TAB 400MICROGRAM 100s
1043 00368 FORDESIA TAB 30s
1044 00370 FORMYCO TAB 50s
1045 00372 FORRES TAB 50MG 50s
1046 04442 FORXIGA TAB 10MG 28s
1047 00380 FREGO TAB 10 MG 50s
1048 00381 FREGO TAB 5 MG 50s
1049 01128 FRISIUM TAB 10 MG
1050 04694 G.ACARBOSE TAB 50 MG
1051 03556 G.ACARBOSE TAB 50 MG (BPJS)
1052 03559 G.ACYCLOVIR TAB 200 MG (BPJS)
1053 00958 G.ACYCLOVIR TAB 200MG
1054 00335 G.ACYCLOVIR TAB 200MG (INHEALTH)
1055 03560 G.ACYCLOVIR TAB 400 MG (BPJS)
1056 00959 G.ACYCLOVIR TAB 400MG
1057 02079 G.ACYCLOVIR TAB 400MG(INHEALTH)
1058 01902 G.ALBENDAZOLE TAB 400MG
1059 00919 G.ALLOPURINOL TAB 100 MG
1060 03562 G.ALLOPURINOL TAB 100 MG (BPJS)
1061 00088 G.ALLOPURINOL TAB 100 MG (INHEALTH)
1062 02286 G.ALLOPURINOL TAB 300 MG
1063 03563 G.ALLOPURINOL TAB 300 MG (BPJS)
1064 01214 G.ALLOPURINOL TAB 300 MG(INHEALTH)
1065 03564 G.ALPRAZOLAM TAB 0.25 MG
1066 03565 G.ALPRAZOLAM TAB 0.5 MG
1067 04245 G.ALPRAZOLAM TAB 1 MG
1068 03566 G.ALPRAZOLAM TAB 1 MG (BPJS)@
1069 03573 G.AMBROXOL TAB 30 MG (BPJS)
Page 22
Sheet1
1070 00820 G.AMBROXOL TAB 30MG

1071 02385 G.AMBROXOL TAB 30MG (INHEALTH)
1072 03571 G.AMITRIPTYLINE TAB 25 MG (BPJS)
1073 00132 G.AMITRIPTYLINE TAB 25MG
1074 02645 G.AMITRIPTYLINE TAB 25MG(INHEALTH)
1075 01869 G.AMLODIPINE TAB 10MG
1076 00395 G.AMLODIPINE TAB 10MG (INHEALTH)
1077 03551 G.AMLODIPINE TAB 10MG(BPJS)
1078 03554 G.AMLODIPINE TAB 5 MG (BPJS)
1079 01870 G.AMLODIPINE TAB 5MG
1080 01029 G.AMOXICILLIN CAPT 500MG
1081 03575 G.AMOXICILLIN CAPT 500MG (BPJS)
1082 00110 G.AMOXICILLIN CAPT 500MG (INHEALTH)
1083 02103 G.ANTALGIN TAB 500MG(INHEALTH)
1084 03580 G.ASAM MEFENAMAT TAB 500 MG (BPJS)
1085 04203 G.ASAM TRANEKSAMAT TAB 500MG
1086 04882 G.ASAM TRANEKSAMAT TAB 500MG (INHEALTH)
1087 04630 G.ATORVASTATIN TAB 10MG
1088 02852 G.ATORVASTATIN TAB 20 MG
1089 OB18090004 G.ATORVASTATIN TAB 20 MG (BPJS)
1090 03584 G.AZITHROMYCIN TAB 500 MG (BPJS)
1091 02088 G.AZITHROMYCIN TAB 500MG
1092 03588 G.BETAHISTIN TAB 6 MG
1093 OB18100003 G.BETAHISTIN TAB 6 MG (BPJS)
1094 03587 G.BETAHISTIN TAB 6 MG (INHEALTH)
1095 01098 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB
1096 OB18070011 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB (INHEA
1097 01149 G.BISOPROLOL FUMARATE TAB 5MG
1098 03592 G.BISOPROLOL FUMARATE TAB 5MG (BPJS)
1099 01994 G.BISOPROLOL FUMARATE TAB 5MG (INHEALTH)
1100 02816 G.CANDESARTAN TAB 16MG
1101 04072 G.CANDESARTAN TAB 16MG(BPJS)@
1102 02815 G.CANDESARTAN TAB 8MG
1103 04073 G.CANDESARTAN TAB 8MG(BPJS)@
1104 03595 G.CAPTOPRIL TAB 12,5MG (BPJS)
1105 00965 G.CAPTOPRIL TAB 12.5MG
1106 00438 G.CAPTOPRIL TAB 12.5MG(INHEALTH)
1107 00966 G.CAPTOPRIL TAB 25MG
1108 03596 G.CAPTOPRIL TAB 25MG (BPJS)
1109 00608 G.CAPTOPRIL TAB 25MG(INHEALTH)
1110 00653 G.CEFADROXIL CAP 500MG (INHEALTH)
1111 03612 G.CETIRIZINE TAB 10 MG(BPJS)
1112 02069 G.CETIRIZINE TAB 10 MG(INHEALTH)
1113 00224 G.CHLORPHENON (CTM) TAB 4 MG
1114 03614 G.CHLORPHENON (CTM) TAB 4 MG (BPJS)
1115 02829 G.CILOSTAZOL TAB 100MG
1116 OB18120008 G.CILOSTAZOL TAB 100MG (BPJS)
1117 03618 G.CIPROFLOXACIN TAB 500 MG(BPJS)
1118 00858 G.CIPROFLOXACIN TAB 500MG
Page 23
Sheet1
1119 02101 G.CIPROFLOXACIN TAB 500MG(INHEALTH)

1120 00715 G.CLOBAZAM TAB 10MG
1121 03625 G.CLOBAZAM TAB 10MG(BPJS)
1122 01975 G.CLOPIDOGREL TAB 75MG
1123 03626 G.CLOPIDOGREL TAB 75MG (BPJS)
1124 01546 G.CO AMOXICLAV TAB 625MG
1125 00337 G.DEXAMETHASONE TAB 0.5MG
1126 03632 G.DEXAMETHASONE TAB 0.5MG(BPJS)@
1127 04215 G.DEXKETOPROFEN TAB 25MG
1128 01524 G.DIAZEPAM TAB 2MG
1129 00970 G.DIGOXIN TAB 0.25MG
1130 03862 G.DIGOXIN TAB 0.25MG (BPJS)
1131 02563 G.DIMENHYDRINATE TAB 50MG
1132 04006 G.DIMENHYDRINATE TAB 50MG (BPJS)
1133 02181 G.DIMENHYDRINATE TAB 50MG (INHEALTH)
1134 02093 G.DOMPERIDONE TAB 10 MG
1135 02567 G.DOMPERIDONE TAB 10 MG (INHEALTH)
1136 03637 G.DOMPERIDONE TAB 10MG(BPJS)
1137 03641 G.DOXYCYCLINE CAP 100MG(BPJS)
1138 02946 G.EPERISONE TAB 50MG
1139 OB19010011 G.EPERISONE TAB 50MG (INHEALTH)
1140 03644 G.EPERISONE TAB 50MG(BPJS)
1141 00971 G.ETHAMBUTOL TAB 500MG
1142 03646 G.ETHAMBUTOL TAB 500MG(BPJS)
1143 03651 G.FLUNARIZINE TAB 10MG
1144 02386 G.FLUNARIZINE TAB 5MG
1145 03652 G.FLUNARIZINE TAB 5MG(BPJS)
1146 00907 G.FUROSEMIDE TAB 40MG
1147 03653 G.FUROSEMIDE TAB 40MG(BPJS)
1148 02105 G.FUROSEMIDE TAB 40MG(INHEALTH)
1149 04445 G.GABAPENTINE CAP 300MG (INHEALTH)*
1150 01553 G.GLIMEPIRIDE TAB 1MG
1151 03655 G.GLIMEPIRIDE TAB 1MG(BPJS)
1152 02137 G.GLIMEPIRIDE TAB 1MG(INHEALTH)
1157 02640 G.GLIMEPIRIDE TAB 3MG (INHEALTH)
1162 03662 G.GLIQUIDONE TAB 30 MG(BPJS)
1163 03819 G.GLIQUIDONE TAB 30MG
1164 00758 G.GRISEOFULVIN TAB 125MG
1165 03660 G.GRISEOFULVIN TAB 125MG(BPJS)
1166 02990 G.HALOPERIDOL TAB 5 MG
1167 00284 G.HYDROCHLOROTHIAZIDE (HCT) TAB 25MG
Page 24
Sheet1
1168 03668 G.IBUPROFEN TAB 200 MG(BPJS)

1169 00826 G.IBUPROFEN TAB 200MG
1170 04520 G.IBUPROFEN TAB 400 MG
1171 03667 G.IBUPROFEN TAB 400 MG(BPJS)
1172 04093 G.IRBESARTAN TAB 150MG
1173 04217 G.IRBESARTAN TAB 150MG (INHEALTH)
1174 04094 G.IRBESARTAN TAB 300MG
1175 04300 G.IRBESARTAN TAB 300MG (INHEALTH)
1176 03842 G.IRBESARTAN TAB 300MG(BPJS)
1177 04308 G.ISONIAZIDE (INH)TAB 100MG (INHEALTH)
1178 03957 G.ISONIAZIDE (INH)TAB 100MG(BPJS)
1179 01425 G.ISONIAZIDE (INH)TAB 300MG
1180 03956 G.ISONIAZIDE (INH)TAB 300MG(BPJS)
1181 02133 G.ISONIAZIDE (INH)TAB 300MG(INHEALTH)
1182 02123 G.ISOSORBIDE DINITRATE(ISDN) TAB 5 MG(INHEALTH
1183 01024 G.ISOSORBIDE DINITRATE(ISDN) TAB 5MG
1184 04039 G.ISOSORBIDE DINITRATE(ISDN) TAB 5MG (BPJS)
1185 04202 G.KALIUM/POTASSIUM DIKLOFENAK TAB 25MG
1186 03673 G.KALIUM/POTASSIUM DIKLOFENAK TAB 25MG (BPJS
1187 03674 G.KALIUM/POTASSIUM DIKLOFENAK TAB 50MG
1188 04858 G.KALIUM/POTASSIUM DIKLOFENAK TAB 50MG (INHE
1189 01259 G.KETOCONAZOLE TAB 200MG
1190 03677 G.KETOCONAZOLE TAB 200MG (BPJS)
1191 02012 G.KETOCONAZOLE TAB 200MG(INHEALTH)
1192 03678 G.KETOPROFEN TAB 100MG
1193 04253 G.KETOPROFEN TAB 100MG (INHEALTH)
1194 03680 G.KETOPROFEN TAB 50MG
1195 04252 G.KETOPROFEN TAB 50MG (INHEALTH)
1196 02929 G.KETOROLAC TAB 10MG
1197 01247 G.LEVOFLOXACIN TAB 500MG
1198 03685 G.LEVOFLOXACIN TAB 500MG (BPJS)
1199 01998 G.LEVOFLOXACIN TAB 500MG (INHEALTH)
1200 00878 G.LORATADINE TAB 10MG
1201 03692 G.LORATADINE TAB 10MG (BPJS)
1202 02862 G.LORATADINE TAB 10MG (INHEALTH)
1203 02337 G.LOSARTAN TAB 50MG
1204 01150 G.MELOXICAM TAB 15MG
1205 01996 G.MELOXICAM TAB 15MG(INHEALTH)
1206 01154 G.MELOXICAM TAB 7.5MG
1207 01995 G.MELOXICAM TAB 7.5MG(INHEALTH)
1208 03572 G.METAMIZOLE TAB 500MG/G.ANTALGIN TAB 500 MG
1209 00048 G.METAMIZOLE TAB 500MG/G.ANTALGIN TAB 500MG
1210 01156 G.METFORMIN TAB 500MG
1211 03700 G.METFORMIN TAB 500MG (BPJS)
1212 02013 G.METFORMIN TAB 500MG(INHEALTH)
1213 02408 G.METFORMIN TAB 850MG
1214 02277 G.METFORMIN TAB 850MG(INHEALTH)
1215 04301 G.METHYLPREDNISOLONE TAB 16MG
Page 25
Sheet1
1217 03710 G.METHYLPREDNISOLONE TAB 4MG (BPJS)

1218 01997 G.METHYLPREDNISOLONE TAB 4MG (INHEALTH)
1220 03707 G.METHYLPREDNISOLONE TAB 8MG (BPJS)
1221 02617 G.METHYLPREDNISOLONE TAB 8MG (INHEALTH)
1222 00894 G.METRONIDAZOLE TAB 500MG
1223 03713 G.METRONIDAZOLE TAB 500MG (BPJS)
1224 00906 G.METRONIDAZOLE TAB 500MG(INHEALTH)
1225 01522 G.NATRIUM DIKLOFENAK TAB 25MG
1226 03716 G.NATRIUM DIKLOFENAK TAB 25MG (BPJS)
1227 01523 G.NATRIUM DIKLOFENAK TAB 50MG
1228 03715 G.NATRIUM DIKLOFENAK TAB 50MG (BPJS)
1229 00617 G.NATRIUM DIKLOFENAK TAB 50MG (INHEALTH)
1230 00821 G.NIFEDIPINE TAB 10MG
1231 02259 G.NIFEDIPINE TAB 10MG (INHEALTH)
1232 00896 G.OFLOXACIN TAB 400MG
1233 02000 G.OFLOXACIN TAB 400MG(INHEALTH)
1234 03209 G.ONDANSETRON TAB 4MG
1235 03747 G.ONDANSETRON TAB 4MG (BPJS)
1236 02085 G.ONDANSETRON TAB 4MG(INHEALTH)
1237 02040 G.ONDANSETRON TAB 8MG
1238 03749 G.ONDANSETRON TAB 8MG (BPJS)
1239 02034 G.ONDANSETRON TAB 8MG(INHEALTH)
1240 03135 G.PANTOPRAZOLE TAB 20MG
1241 03117 G.PANTOPRAZOLE TAB 40MG
1242 04254 G.PANTOPRAZOLE TAB 40MG (INHEALTH)
1243 00909 G.PARACETAMOL TAB 500MG
1244 03758 G.PARACETAMOL TAB 500MG (BPJS)
1245 00400 G.PARACETAMOL TAB 500MG (INHEALTH)
1246 01249 G.PHYTOMENADIONE/VITAMIN K TAB 10MG
1247 03761 G.PHYTOMENADIONE/VITAMIN K TAB 10MG (BPJS)
1248 02687 G.PHYTOMENADIONE/VITAMIN K TAB 10MG(INHEALT
1249 00153 G.PROPRANOLOL TAB 10 MG
1250 03709 G.PROPRANOLOL TAB 10 MG (BPJS)
1251 02601 G.PROPRANOLOL TAB 10 MG (INHEALTH)
1252 00910 G.PYRAZINAMIDE TAB 500MG
1253 03722 G.PYRAZINAMIDE TAB 500MG (BPJS)
1254 04650 G.RAMIPRIL TAB 10 MG
1255 03963 G.RAMIPRIL TAB 5 MG
1256 04527 G.RAMIPRIL TAB 5 MG (INHEALTH)
1257 00641 G.RANITIDINE TAB 150MG
1258 03726 G.RANITIDINE TAB 150MG (BPJS)
1259 02016 G.RANITIDINE TAB 150MG (INHEALTH)
1260 03448 G.REBAMIPIDE TAB 100MG
1261 01262 G.SALBUTAMOL TAB 2 MG
1262 02139 G.SALBUTAMOL TAB 2 MG(INHEALTH)
1263 03734 G.SALBUTAMOL TAB 2MG (BPJS)
1264 01031 G.SALBUTAMOL TAB 4 MG
1265 02620 G.SALBUTAMOL TAB 4 MG(INHEALTH)
Page 26
Sheet1
1266 03736 G.SALBUTAMOL TAB 4MG (BPJS)

1267 01151 G.SIMVASTATIN TAB 10MG
1268 03779 G.SIMVASTATIN TAB 10MG (BPJS)
1269 00501 G.SIMVASTATIN TAB 10MG (INHEALTH)
1270 01195 G.SIMVASTATIN TAB 20MG
1271 03780 G.SIMVASTATIN TAB 20MG (BPJS)
1272 02023 G.SIMVASTATIN TAB 20MG(INHEALTH)
1273 02758 G.SPIRONOLACTON TAB 100 MG (INHEALTH)
1274 02721 G.SPIRONOLACTON TAB 100MG
1275 03782 G.SPIRONOLACTON TAB 100MG (BPJS)
1276 02800 G.SPIRONOLACTON TAB 25MG
1277 03783 G.SPIRONOLACTON TAB 25MG (BPJS)
1278 02158 G.SPIRONOLACTON TAB 25MG (INHEALTH)
1279 03061 G.TRIAMCINOLONE TAB 4MG
1280 03109 G.TRIAMCINOLONE TAB 4MG(INHEALTH)
1281 01374 G.VITAMIN B COMPLEX TAB
1282 03917 G.VITAMIN B COMPLEX TAB (BPJS)
1283 02788 G.VITAMIN B COMPLEX TAB (INHEALTH)
1284 01250 G.VITAMIN B12 TAB 25 MICROGRAM
1285 02118 G.VITAMIN B12 TAB 25 MICROGRAM(INHEALTH)
1286 OB19050010 G.VITAMIN B12 TAB 50 MICROGRAM
1287 OB19050011 G.VITAMIN B12 TAB 50 MICROGRAM (INHEALTH)
1288 01375 G.VITAMIN B6 TAB 10MG
1289 00806 G.VITAMIN C TAB 100MG
1290 00545 G.VITAMIN C TAB 50MG
1291 03804 G.VITAMIN C TAB 50MG (BPJS)
1292 02876 G.VITAMIN C TAB 50MG(INHEALTH)
1293 04155 G.ZINC TAB 20MG
1294 03798 G.ZINC TAB 20MG (BPJS)
1295 01717 GLUCOPHAGE TAB 500MG 100s
1296 04299 GLUCOPHAGE XR TAB 500MG (INHEALTH) 120s
1297 01562 GLUCOPHAGE XR TAB 500MG 120s
1298 04270 GLUCOPHAGE XR TAB 750MG (INHEALTH) 120s
1299 04351 GLUCOPHAGE XR TAB 750MG 120s
1300 02253 GLURENORM TAB 30MG (INHEALTH) 100s
1301 01085 GLURENORM TAB 30MG 100s
1302 OB18090007 GRANON TAB 1MG 10s
1303 04678 GRATIZIN TAB 10MG
1304 03922 HARNAL D CAP 0.2MG (BPJS) 28s
1305 01218 HARNAL D CAP 0.2MG 28s
1306 03925 HARNAL TAB (OCAS) 400 MICROGRAM (BPJS) 30s
1307 01920 HARNAL TAB (OCAS) 400 MICROGRAM 30s
1308 02667 HARNAL TAB (OCAS) 400 MICROGRAM(INHEALTH) 30
1309 04658 HERB. ARDIUM TAB 1000MG 30s
1310 00253 HERB. CURCUMA TAB 100s
1311 00880 HERB. NORIT TAB
1312 01455 HERB. TEBOKAN SPESIAL TAB 80MG 30s
1313 00413 HEXILON TAB 16 MG 30s
Page 27
Sheet1

1316 04256 HEXYMER TAB 2 MG (INHEALTH) 100s
1317 03374 HEXYMER TAB 2 MG 100s
1318 01891 HISTRINE FT 10 TAB 30s
1319 01827 HISTRINE FT 5 TAB 30s
1320 02903 IKALEP TAB 250MG 30s
1321 00926 INOXIN 400 TAB 150s
1322 02324 INOXIN 400 TAB(INHEALTH) 150s
1323 OB18070014 INTERLAC CHEW TAB
1324 00607 IRBOSYD TAB
1325 01378 ISOPRINOSINE TAB 500MG 8s
1326 01071 ISPRINOL TAB 500MG 8s
1327 03323 JANUMET TAB 50 MG/1000 MG 28s
1328 03322 JANUMET TAB 50 MG/500 MG 28s
1329 01564 JANUVIA TAB 100 MG 28s
1330 01698 JANUVIA TAB 50 MG 28s
1331 OB18080028 JARDIANCE TAB 10MG 30s
1332 OB18080029 JARDIANCE TAB 25MG 30s
1333 00455 KALNEX TAB 500MG
1334 00457 KALTROFEN TAB 100 30s MG
1335 00459 KALTROFEN TAB 50MG 30s
1336 00465 KENACORT TAB 4 MG
1337 01303 KETESSE TAB 25MG 50s
1338 01402 KETOSTERIL TAB
1339 01677 KETRICIN TAB
1340 01069 KSR TAB
1341 04086 KSR TAB (BPJS)@
1342 02045 KSR TAB(INHEALTH)
1343 01681 LANAKELOID TAB
1344 01716 LASIX TAB
1345 OB19020012 LAZAFIN TAB 500MG 30s
1346 02649 LEVAZIDE TAB
1347 00477 LEVOCIN TAB 500 MG 18s
1348 04199 LEVOPAR TAB (BPJS)
1349 04141 LEXATRANS TAB 500MG
1350 02007 LEXATRANS TAB 500MG (INHEALTH)
1351 02364 LIPANTHYL PENTA TAB 145 MG
1352 04501 LIPANTHYL SUPRA 160MG TAB
1353 00478 LIPITOR TAB 10MG 30s
1354 03515 LIPITOR TAB 20MG (INHEALTH) 90s
1357 04286 LIPITOR TAB 40MG(INHEALTH) 90s
1358 01911 LIZOR TAB
1359 00481 LODIA TAB 2 MG 60s
1360 OB18090002 MADOPAR D TAB (BPJS) 30s
1361 01070 MADOPAR D TAB 30s
1362 03508 MALTOFER CHEW TAB (INHEALTH) 30s
1363 00756 MALTOFER CHEW TAB 30s
Page 28
Sheet1
1364 OB18070001 MAXPRINOL TAB 500MG 8s

1365 01777 MEIACT TAB 200 MG 20s
1366 03411 MERISLON TAB 12MG
1367 04519 MERISLON TAB 12MG (INHEALTH)
1368 00509 METRIX TAB 4 MG 30s
1369 01952 METVELL TAB 0.125MG 30s
1370 00512 MEXPHARM TAB 15 MG 20s
1371 00513 MEXPHARM TAB 7.5 MG 20s
1372 04110 MINIASPI TABLET 80MG
1373 04257 MINIASPI TABLET 80MG (BPJS)
1374 04307 MINIASPI TABLET 80MG (INHEALTH)
1375 04826 MOPRIN TAB 500MG 10s
1376 00551 MOTILIUM TAB 10MG
1377 01747 MUCOPECT TAB 30MG
1378 01050 MUCOSTA TAB
1379 04558 MUCOSTA TAB (INHEALTH)
1380 OB19010002 MXN TAB 400MG 10s
1381 01432 MYLANTA TAB
1382 00517 MYONAL TAB 50MG 100s
1383 03425 N-ACE TAB 200MG 30s
1384 03017 NALETAL TAB 100MG 30s
1385 01726 NALETAL TAB 50MG 30s
1386 01282 NALGESTAN TAB
1387 03084 NARFOZ TAB 4MG 12s
1388 01565 NARFOZ TAB 8 MG 12s
1389 04347 NEBILET TAB 5MG 28s
1390 00033 NEO MERCAZOLE TAB 100s
1391 00340 NEOZEP FORTE TAB 100s
1392 00876 NEURALGIN RX TAB
1393 00130 NEUROFENAC PLUS TAB 100s
1394 00531 NEUROSANBE 5000 TABLET
1395 01742 NEVOX XR TAB 500MG 30s
1396 02215 NEW DIATABS TAB (INHEALTH)
1397 00336 NEW DIATABS TAB 100s
1398 00269 NEXIUM TAB 20MG 28s
1399 00270 NEXIUM TAB 40MG 28s
1400 00546 NORVASK TAB 10MG 30s
1401 00547 NORVASK TAB 5MG 30s
1402 02073 NORVASK TAB 5MG(INHEALTH) 100s
1403 01758 NOVALGIN TAB
1404 00550 OCUSON TAB
1405 04824 ORINOX TAB 120MG 30s
1406 04825 ORINOX TAB 90MG 30s
1407 OB18120013 OSTGEN TAB 30s
1408 01778 OZEN TAB 10MG 30s
1409 00343 PANADOL CAPT
1410 00344 PANADOL COLD&FLU CAPT
1411 00342 PANADOL EXTRA CAPT
1412 01842 PARATUSIN TAB
Page 29
Sheet1
1413 00586 PARIET TAB 10 MG 14s

1414 00587 PARIET TAB 20 MG 14s
1415 00361 PEHADOXIN FORTE TAB 100s
1416 03428 PLADOGREL TAB 75MG
1417 00357 PLASMINEX TAB 100s
1418 01084 PLAVIX TAB 75MG 28s
1419 00600 PLETAAL TAB 100 MG 30s
1420 04263 PLETAAL TAB 50 MG (INHEALTH) 100s
1421 00601 PLETAAL TAB 50 MG 100s
1422 01201 POLYSILANE TAB
1423 00636 PONSTAN FCT TAB
1424 00872 PREMASTON TAB 30s
1425 00059 PRESEPT TAB 5GR 50s
1426 00613 PRIDESIA TAB 5 MG
1427 02193 PRIMOLUT N TAB (INHEALTH) 30s
1428 01080 PRIMOLUT N TAB 30s
1429 00421 PRIMPERAN TAB 10MG
1430 04689 PRO TB 2 TAB 28s
1431 04582 PRO TB 4 TAB 28s
1432 00621 PROFERTIL TAB 10s
1433 00623 PROFILAS TAB 50s
1434 04353 PROSOGAN FD TAB 30MG 28s
1435 OB18090009 PROSPIDE TAB 100MG 100s
1436 OB18090011 PROSTACOM TAB (INHEALTH) 30s
1437 01964 PROSTACOM TAB 30s
1438 01450 PROVERA TAB 10MG 30s
1439 00635 PURICEMIA TAB
1440 01678 QUIDEX TAB 500MG*
1441 01712 QUINOBIOTIC TAB 500MG
1442 00642 RANTIN TAB 150 MG
1443 04595 REBAMAX TAB 100MG 30s
1444 04061 RECOLFAR TAB (BPJS) 30s
1445 04500 RECOLFAR TAB (INHEALTH) 30s
1446 00646 RECOLFAR TAB 30s
1447 02296 RENADINAC TAB 50MG
1448 03821 RENAMID TAB 2MG (INHEALTH)
1449 01767 RENATOR 500MG TAB*
1450 02180 RETAPHYL SR TAB(INHEALTH)
1451 00658 RHINOFED TAB
1452 01472 RIBAVIRIN 200 MG TABLET (COPEGUS)
1453 03822 RICOVIR TAB 300MG
1454 OB18050007 RIFABIOTIC TAB 600MG
1455 02035 RIFASTAR 4FDC TAB
1456 02161 RIFASTAR 4FDC TAB(INHEALTH)
1457 01982 RIKLONA TAB 2MG
1458 03500 RITEZ FT TAB 10MG 30s
1459 04104 RIZODAL TAB 1MG 20s
1460 03037 RYDIAN TAB 10 MG (CETIRIZINE)
1461 01232 SALOFALK TAB 500MG
Page 30
Sheet1
1462 03174 SANEXON TAB 16 MG 30s

1463 00670 SANEXON TAB 4MG 100s
1464 02962 SANMOL FORTE TAB 650 MG
1465 03083 SANMOL TAB 500MG
1466 00680 SANPRIMA TAB
1467 00683 SANTIBI PLUS TAB
1468 00682 SANTIBI TAB 500MG
1469 02949 SEBIVO TAB (INHEALTH) 28s
1470 01868 SEBIVO TAB 28s
1471 02443 SERLOF TAB 50MG 30s
1472 00699 SEROQUEL TAB 100MG 60s
1473 00704 SHAROX TAB 500MG 20s
1474 01971 SIBELIUM TAB 10MG
1475 04616 SIBELIUM TAB 5MG
1476 04242 SIFROL ER 0.375MG (BPJS) 30s
1477 02378 SIFROL ER 0.375MG(INHEALTH) 30s
1478 02244 SIFROL TAB 0.125MG 30s
1479 01436 SIFROL TAB 0.25MG 30s
1480 01487 SIMARC-2 TAB 100s
1481 02126 SIMARC-2 TAB(INHEALTH) 100s
1482 03533 SIMPROFEN TAB 25MG 30s
1483 01033 SIRDALUD TAB 2MG
1484 03367 SIRPLUS TABLET
1485 00726 SPIRASIN TAB 500MG
1486 00472 SPIROLA TAB 100MG 50s
1487 00618 SPIROLA TAB 25MG 50s
1488 01480 SPIROPENT TAB 20 MICROGRAM
1489 01682 SPORANOX TAB 28s
1490 00761 STALEVO 100/25/200 MG TAB 30s
1491 03074 STATOR TAB 20 MG 30s
1492 03010 STENIROL TAB 16MG 50s
1495 01188 STUGERON TAB 25MG
1496 OB18080026 SULFITIS TAB 500MG 30s
1497 OB18090003 SULFITIS TAB 500MG(INHEALTH) 30s
1498 01052 SUMAGESIC TAB
1499 03621 SUPL G.CITICOLINE TAB 500 MG
1500 04900 SUPL. CALNIC PLUS TAB 30s
1501 04899 SUPL. CALNIC TAB 30s
1502 01004 SUPL. CAVIT D3 TAB
1503 02763 SUPL. CAVIT D3 TAB(INHEALTH)
1504 03260 SUPL. CYSTONE TAB
1505 04697 SUPL. EZYGARD FORTE TAB 30s
1506 04132 SUPL. G.FOLIC ACID TAB 1MG
1507 03649 SUPL. G.FOLIC ACID TAB 1MG(BPJS)
1508 02705 SUPL. GLUCOSAMIN TAB 500MG
1509 00578 SUPL. HEZANDRA TAB 30s
1510 00597 SUPL. IMBOOST FORCE TAB
Page 31
Sheet1
1511 00583 SUPL. IMBOOST TAB

1512 04491 SUPL. INBUMIN TAB 30s
1513 00486 SUPL. LYCOXY TAB 30MG 30s
1514 04266 SUPL. MALTOFER FOL CHEW TAB (INHEALTH) 30s
1515 01666 SUPL. MALTOFER FOL CHEW TAB 30s
1516 01690 SUPL. PROZA TAB 30s
1517 01929 SUPL. RENALOF CAPS
1518 00307 SUPL. RILLUS TAB CHEWABLE 30s
1519 02977 SUPL. STARFOLAT TAB 400MCG (INHEALTH) 100s
1520 00802 SUPL. THERAGRAN M TAB
1521 02769 SYSMUCO TAB 30s
1522 01877 TANTUM LOZ 12s
1523 01226 TEGRETOL CR TAB 200MG
1524 01379 TEGRETOL TAB 200MG
1525 01117 TELFAST HD TAB 180MG 10s
1526 01118 TELFAST OD TAB 120MG 100s
1527 01265 TELFAST OD TAB 120MG(INHEALTH) 100s
1528 00755 TENSIVASK TAB 10MG 50s
1529 00856 THROMBO ASPILETS TAB 80MG
1530 04531 THROMBO ASPILETS TAB 80MG (INHEALTH)
1531 02025 THYROZOL TAB 10MG
1532 04422 THYROZOL TAB 10MG(INHEALTH)
1533 02863 THYROZOL TAB 5MG
1534 02447 THYROZOL TAB 5MG(INHEALTH)
1535 01494 TORASIC TAB 10MG
1536 OB18120010 TORASIC TAB 10MG (INHEALTH)
1537 04294 TRAJENTA (LINAGLIPTIN) TAB 5MG (INHEALTH) 30s
1538 02858 TRAJENTA (LINAGLIPTIN) TAB 5MG 30s
1539 04829 TRAJENTA DUO 2.5MG/1000MG FCT TAB 30s
1540 04863 TRAJENTA DUO 2.5MG/500MG FCT TAB (INHEALTH) 3
1541 04227 TRAJENTA DUO 2.5MG/500MG FCT TAB 30s
1542 00768 TREMENZA TAB
1543 04244 TREMENZA TAB (INHEALTH)
1544 03527 TRENTAL FCT 400MG TAB
1545 00772 TRICHODAZOL TAB 500MG
1546 01660 TRILAC TAB 4MG 30s
1547 01737 TROVENSIS TAB 8MG 10s
1548 01221 TRUVAZ TAB 20MG 30s
1549 02913 UNALIUM TAB 10MG
1550 04360 URDAHEX CAP(INHEALTH) 30s
1551 01366 URISPAS TAB 200MG 30s
1552 01558 UROGETIX CAPT 100MG
1553 04092 UROGETIX CAPT 100MG(INHEALTH)
1554 00790 VALISANBE TAB 2MG
1555 00875 VALISANBE TAB 5MG
1556 03458 VALISANBE TAB 5MG (INHEALTH)
1557 00793 VBLOC TAB 6.25MG 30s
1558 04812 VESICARE TAB 10 MG 30s
1559 04322 VESICARE TAB 5 MG (INHEALTH) 30s
Page 32
Sheet1
1560 01708 VESICARE TAB 5 MG 30s

1561 01368 VESTEIN CAP 20s
1562 03464 VIRIDIS TAB 500 MG 10s
1563 02102 VIT. NEURODEX TAB
1564 00534 VIT. NEUROSANBE TAB
1565 OB19010008 VIT. NEUROSANBE TAB (INHEALTH)
1566 00146 VOLTAREN SR TAB 75 MG 50s
1567 00811 VOMCERAN TAB 4MG 10s
1568 00813 VOMCERAN TAB 8MG 10s
1569 00816 VOMETA FLASH TAB 10MG 50s
1570 OB18080021 VOMISTOP FT TAB 30s
1571 04492 VOMIZOLE TAB 40MG 10s
1572 00819 VOSEDON TAB
1573 01703 XANAX TAB 0.5 MG
1574 04655 XANAX TAB 1 MG
1575 02248 XARELTO TAB 10MG(INHEALTH) 10s
1576 OB19050003 XARELTO TAB 15MG 28s
1577 04706 XEPAZYM CAP 50s
1578 04597 XIETY TAB 10MG
1579 00297 ZALDIAR TAB 10s
1580 00785 ZEMYC TAB 150MG 3s
1581 OB19020007 ZITANID TAB 30s
1582 03339 ZITHRAX TAB 500 MG 6s
1583 00844 ZITHROMAX TAB 500MG 3s
1584 01280 ZYLORIC TAB 100MG
1585 01713 ZYLORIC TAB 300 MG
1586 00850 ZYPRAZ TAB 0.25MG
1587 00851 ZYPRAZ TAB 0.5MG
1588 00852 ZYPRAZ TAB 1MG
1589 01646 ACUATIM CREAM 10GR
1590 00345 ALOCLAIR PLUS GEL 8ML
1591 03348 ATOPICLAIR CREAM 40ML
1592 02713 BACTODERM CREAM 2% 5GR
1593 03474 BACTODERM CREAM 2% 5GRAM(INHEALTH)
1594 01238 BENOSON CREAM 5GR
1595 01662 BENOSON G CREAM 10GR
1596 01661 BENOSON M CREAM 5GR
1597 01237 BENOSON N CREAM 5GR
1598 03099 BENZOLAC CL CREAM 10GR
1599 00066 BETASON CREAM 5GR
1600 01203 BIOPLACENTON GEL 15 GR
1601 01210 BURNAZIN CREAM 35GR
1602 02292 BURNAZIN CREAM 35GR(INHEALTH)
1603 02894 CARMED 10% CREAM 40GR
1604 02798 CARMED 20% CREAM 40GR
1605 01395 CATHEJELL WITH LIDOCAIN
1606 00228 CINOLON CREAM 10GR
1607 00227 CINOLON N CREAM 10GR
1608 00166 COUNTERPAIN CREAM 30 GR
Page 33
Sheet1
1609 00185 COUNTERPAIN PXM 25 GR

1610 04894 DAIVOBET GEL 15GR
1611 01936 DAIVOBET OINT 15 G
1612 03504 DAIVOBET OINT 30 GR (INHEALTH)
1613 02892 DAIVONEX OINT 30G
1614 01598 DAKTARIN CREAM 5GR
1615 01702 DECUBAL CREAM 20 GRAM
1616 03488 DERMANIDE CREAM 10GRAM(INHEALTH)
1617 02240 DERMATIX ULTRA 15 GR
1618 04660 DERMOVEL 0.1% CREAM 10GR
1619 04588 DERMOVEL 0.1% CREAM 10GR (INHEALTH)
1620 01977 DESOLEX CREAM 10GR
1621 01622 DIPROGENTA CREAM 10 GR
1622 01623 DIPROGENTA OINT 5GR
1623 01295 DIPROSONE OV CREAM 10GR
1624 01298 DIPROSONE OV OINT 5GR
1625 01027 DUMIN RECTAL TUBE 125MG/2.5ML
1626 00934 DUMIN RECTAL TUBE 250MG/4ML
1627 01647 ELOCON CREAM 10GR
1628 01635 ELOCON OINT 10GR
1629 03032 ELOX 0,1% CREAM 5GR
1630 01961 ESPERSON CREAM 15 GR
1631 02790 EVALEN GEL 0.1% 10GR
1632 01502 FAKTU OINT 20 GR
1633 00355 FLAMAR EMULGEL 20 GR
1634 01082 FLAMAR EMULGEL 20GR (INHEALTH)
1635 00369 FORMYCO CREAM 10GR
1636 04424 FUCILEX CREAM 2% 5GR
1637 03907 FUCILEX CREAM 2% 5GRAM(BPJS)
1638 03483 FUCILEX CREAM 2% 5GRAM(INHEALTH)
1639 01835 FULADIC CREAM 5GR
1640 01246 G.ACYCLOVIR 5% CREAM 5GR
1641 03586 G.BETAMETASON 0,1 % CREAM 5GR (BPJS)
1642 02844 G.BETAMETASON 0.1% CREAM 5GR
1643 02149 G.BETAMETASON 0.1% CREAM 5GR (INHEALTH)
1644 04359 G.DESOXIMETASONE CREAM 0.25% 15GR
1645 03631 G.DESOXIMETASONE CREAM 0.25% 15GR (BPJS)
1646 OB19050012 G.DESOXIMETASONE OINT 0.25% 15GR
1647 04210 G.DESOXIMETASONE OINT 0.25% 15GR (INHEALTH)
1648 00825 G.GENTAMYCIN OINT 0.1% 5GR
1649 00873 G.HYDROCORTISON 1% CREAM 5GR
1650 03935 G.HYDROCORTISON 1% CREAM 5GR (BPJS)
1651 03666 G.HYDROCORTISON 2.5% CREAM (BPJS)
1652 00874 G.HYDROCORTISON 2.5% CREAM 5GR
1653 03358 G.KETOCONAZOLE CREAM 2% 10GR
1654 03676 G.KETOCONAZOLE CREAM 2% 10GR (BPJS)
1655 OB19050005 G.KETOCONAZOLE CREAM 2% 10GR (INHEALTH)
1656 02612 G.MICONAZOLE CREAM 2 % 10GR (INHEALTH)
1657 01248 G.MICONAZOLE CREAM 2 % 10GR
Page 34
Sheet1
1658 03814 G.MOMETASONE CREAM 10GR

1659 03714 G.MOMETASONE CREAM 10GR (BPJS)
1660 01863 GLYCORE 8 CREAM
1661 01321 HARMONIA ACNE SPOT
1662 03052 HEMOLOK GEL 15GR
1663 00584 HERB. MEBO OINT 20GR
1664 03160 INERSON 0.25% OINT 15GR(INHEALTH)
1665 00458 KALTROFEN GEL 2.5% 30 GR
1666 00464 KENACORT A CREAM 10 GR
1667 00466 KENALOG IN ORABASE 5 GR
1668 00397 KETRICIN ORABASE 0.1% 5GR
1669 01637 KLODERMA CREAM 10GR
1670 02907 KLODERMA OINTMENT 10GR
1671 01275 MEDERMA CREAM 20GR(PROAKTIF GEL)
1672 03406 MEDI-KLIN GEL 15G
1673 00981 MEDIFLEX CREAM 75GR
1674 04206 MEDIQUIN 5% CREAM 15G
1675 01364 MELANOX ES 15GR
1676 01625 MELANOX FORTE 4%
1677 00977 MICROLAX ENEMA
1678 01325 MOFACORT 0.1% CREAM 10GR
1679 02905 MOFACORT 0.1% OINTMENT 10GR
1680 03481 MOISDERM 20% 20GRAM(INHEALTH)
1681 00520 MYCO Z OINT 10 GR
1682 01167 NEBACETIN OINT 5GR
1683 01315 NIACEF GEL 15GR
1684 02452 NOROID SOOTHING CREAM 80ML
1685 02151 NOVELL SMOOTHING CREAM
1686 01711 OSTEOR C CREAM 60GR
1687 01896 PARASOL CREAM 20GR
1688 01628 PARASOL CREAM 33 SPF
1689 OB18040012 PIBAKSIN OINT 10GR
1690 04673 PIBAKSIN OINT 10GR (INHEALTH)
1691 00591 PIROFEL GEL 20GR
1692 02797 PIROTOP CREAM 10GR
1693 03307 PRODIVA VAGINAL GEL
1694 01607 SAGALON CREAM 10GR
1695 00662 SAGESTAM CREAM 10GR
1696 01584 SCABIMITE CREAM 10 GR
1697 02537 SCABIMITE CREAM 10 GR(INHEALTH)
1698 04590 SEBCLAIR CREAM 30ML
1699 01438 SOFT U DERM 40 GR
1700 01023 STESOLID RECTAL TUBE 10MG/2.5ML
1701 01022 STESOLID RECTAL TUBE 5MG/2.5ML
1702 02477 TERMISIL CREAM 10GR
1703 00978 THROMBOPOB GEL 20GR
1704 01339 ULTRAPROCT N CREAM 10 GR
1705 01142 VITACID 0.05% CREAM 20GR
1706 01143 VITACID 0.1% CREAM 20 GR
Page 35
Sheet1
1707 01761 VOLTAREN EMULGEL 1% 50GR

1708 04395 ZOLORAL 2 % CREAM
1709 02759 ZOLORAL 2 % CREAM(KETOCONAZOL)(INHEALTH)
1710 03418 FARSORBID INJ
1711 04526 FARSORBID INJ (INHEALTH)
1712 04533 FIBRION 1.500.000 IU (INHEALTH)
1713 00918 G.CEFTRIAXONE INJ 1GR
1714 03611 G.CEFTRIAXONE INJ 1GR(BPJS)
1715 OB18060011 G.DIPHENHYDRAMIN INJ 150MG/15ML
1716 03636 G.DOBUTAMINE INJ 250MG/5ML
1717 04410 G.DOBUTAMINE INJ 250MG/5ML (BPJS)
1718 04449 G.DOBUTAMINE INJ 250MG/5ML (INHEALTH)
1719 01183 G.METHYLPREDNISOLONE INJ 125MG
1720 03704 G.METHYLPREDNISOLONE INJ 125MG (BPJS)
1721 02359 G.METHYLPREDNISOLONE INJ 125MG(INHEALTH)
1722 03492 G.NOREPINEPHRINE BITARTRATE INJ 4MG/4ML
1723 02899 G.OMEPRAZOLE INJ 40MG
1724 03746 G.OMEPRAZOLE INJ 40MG (BPJS)
1725 03079 G.PANTOPRAZOLE INJ 40MG
1726 03421 INOTROP INJ 250MG/5ML
1727 00271 NEXIUM INJ 40MG
1728 02699 NEXIUM INJ 40MG (INHEALTH)
1729 00932 PPD 2 TU 1.5 ML
1730 04838 PROXIUM INJ 40MG
1731 03122 PUMPISEL INJ
1732 04557 PUMPISEL INJ (INHEALTH)
1733 02736 PUMPITOR INJ
1734 01473 SEMAX SOL 0.1% 3 ML
1735 04535 UDOPA INJ 40MG/ML (INHEALTH)
1736 00929 VAKSIN TETANUS TOXOIDT 5ML
1737 03916 VAKSIN VERORAB 0.5M (BPJS)
1738 01793 VAKSIN VERORAB 0.5ML
1739 00215 VIT. CERNEVIT INJ
Page 36
Sheet1
PNAME
DEPARTEMEN INSTALASI FARMASI
GUDANG GUDANG FARMASI LANTAI 2
CO19060001 DiSetujuiOleh ERWIN

Satuan CostDasar Stok CutOff Stok Fisik Stok Selisih
00024 20166.67 3 3 0
00091 311850 1 1 0
00123 113300 1 1 0
00149 88825 1 1 0
00566 17710 1 1 0
00764 36666.67 0 0 0
00807 6669 104 104 0
00953 10010 7 14 7
01207 319 42 42 0
01272 266.2 4 4 0
01360 4125 4 4 0
01596 13332 0 0 0
02020 8800 8 8 0
02054 9900 9 9 0
02155 171600 2 2 0
02206 460.8 13 13 0
02237 113300 1 1 0
02249 91080 0 0 0
02536 4911 2 2 0
02647 7700 7 7 0
02660 3300 2 2 0
02679 840 50 50 0
02825 27225 1 1 0
02834 6500.38 12 12 0
03146 64534.14 0 0 0
03342 12980 8 8 0
03499 18810 4 4 0
03555 1625.03 0 0 0
03665 96 2 2 0
03701 407.55 100 100 0
03703 5500 0 0 0
03724 635 30 30 0
03737 17228.42 20 20 0
03738 140.93 0 0 0
03973 1286 0 0 0
04020 6000 3 3 0
04063 1200 58 58 0
04080 266.2 31 31 0
04140 26400 6 6 0
04272 39999.99 0 0 0
Page 37
Sheet1
04369 1912 0 0 0
04470 319 58 58 0
04496 10560 0 0 0
04503 9500 3 3 0
04679 654.5 52 52 0
04687 15491.67 1 1 0
04691 1097 30 30 0
04837 880 72 72 0
04857 20240 6 6 0
A0007 26620 2 2 0
A0008 26620 4 4 0
A0070 3366 0 0 0
A0071 3960 5 5 0
A0142 21900 36 36 0
A0337 18755 3 3 0
A0531 53423.33 2 2 0
A0534 60793 1 1 0
A0535 66770 2 2 0
A0555 64350 4 4 0
A0590 737 44 44 0
A0663 9900 0 0 0
A0678 45000 0 0 0
A0732 183150 0 0 0
A0745 139883.34 0 0 0
A0781 125235 0 0 0
A0800 89719.3 2 2 0
A0812 62000 0 0 0
A0813 45000 0 0 0
A0814 60000 0 0 0
A0815 42000 0 0 0
A0881 94600 1 1 0
A0989 133466.66 1 1 0
A0993 124483.33 0 0 0
A1009 12320 10 10 0
A1165 25300 0 0 0
A1327 29700 13 13 0
A1392 808.5 17 17 0
A1913 37396.7 1 1 0
A1940 60793.33 1 1 0
A1957 218487.5 0 0 0
A1984 121605 0 0 0
AL18120003 295168.5 0 0 0
AMPUL 44660 8 8 0
AMPUL 77000 4 4 0
AMPUL 2200 6 6 0
AMPUL 1595 9 9 0
AMPUL 35909.5 11 11 0
AMPUL 70490.5 2 2 0
AMPUL 33900 2 2 0
Page 38
Sheet1
AMPUL 42120 0 0 0
AMPUL 69300 0 0 0
AMPUL 86625 7 7 0
AMPUL 25850 0 0 0
AMPUL 18111.01 53 53 0
AMPUL 4550 22 22 0
AMPUL 10556.9 27 27 0
AMPUL 40075.75 7 7 0
AMPUL 40075.75 12 12 0
AMPUL 6699 16 16 0
AMPUL 22000 0 0 0
AMPUL 30030 0 0 0
AMPUL 38500 5 5 0
AMPUL 54054 2 2 0
AMPUL 48400 3 3 0
AMPUL 4180000 1 1 0
AMPUL 21054 10 10 0
AMPUL 11308 11 11 0
AMPUL 6496.88 27 27 0
AMPUL 6496.88 2 2 0
AMPUL 5632.13 2 2 0
AMPUL 6930 5 5 0
AMPUL 4000 12 12 0
AMPUL 4180 3 3 0
AMPUL 22083.33 8 8 0
AMPUL 22083.33 5 5 0
AMPUL 17000 5 5 0
AMPUL 14300 41 41 0
AMPUL 2402.4 14 14 0
AMPUL 1695.1 0 0 0
AMPUL 27500 5 5 0
AMPUL 24750 3 3 0
AMPUL 22000 2 2 0
AMPUL 9500 9 9 0
AMPUL 9500 10 10 0
AMPUL 9500.23 10 10 0
AMPUL 3542 81 81 0
AMPUL 3410 45 45 0
AMPUL 16038 35 35 0
AMPUL 5292.54 28 28 0
AMPUL 6415 21 21 0
AMPUL 1760 15 15 0
AMPUL 1760 0 0 0
AMPUL 1320 5 5 0
AMPUL 8800 6 6 0
AMPUL 88000 6 6 0
AMPUL 23649 0 0 0
AMPUL 85800 3 3 0
AMPUL 59400 0 0 0
Page 39
Sheet1
AMPUL 7700 14 14 0
AMPUL 5100 24 24 0
AMPUL 3300 25 25 0
AMPUL 18480 18 18 0
AMPUL 5100.01 21 21 0
AMPUL 5500 22 22 0
AMPUL 56005 8 8 0
AMPUL 44804.1 25 25 0
AMPUL 16500 2 2 0
AMPUL 4766.67 19 19 0
AMPUL 4766.67 2 2 0
AMPUL 20526 6 6 0
AMPUL 7040 19 19 0
AMPUL 2464 34 34 0
AMPUL 2200 10 10 0
AMPUL 6913.5 6 6 0
AMPUL 4481.4 4 4 0
AMPUL 7682 3 3 0
AMPUL 53900 4 4 0
AMPUL 127050 5 5 0
AMPUL 87450 0 0 0
AMPUL 15400 9 9 0
AMPUL 51700 3 3 0
AMPUL 17870.16 15 15 0
AMPUL 198553.19 1 1 0
AMPUL 152999.99 0 0 0
AMPUL 12523.5 1 1 0
AMPUL 21541.66 10 10 0
AMPUL 34049.95 3 3 0
AMPUL 10300.02 14 14 0
AMPUL 9100 12 12 0
AMPUL 94600 2 2 0
AMPUL 94600 2 2 0
AMPUL 94600 1 1 0
AMPUL 71500 3 3 0
AMPUL 60060 9 9 0
AMPUL 6448 0 0 0
AMPUL 19481 3 3 0
AMPUL 11367 3 3 0
AMPUL 7000 3 3 0
AMPUL 84590 0 0 0
AMPUL 53000 0 0 0
AMPUL 84590 0 0 0
AMPUL 23939.25 52 52 0
AMPUL 19301.54 21 21 0
AMPUL 104500 0 0 0
AMPUL 20900 0 0 0
AMPUL 39248 8 8 0
AMPUL 104500 7 7 0
Page 40
Sheet1
AMPUL 9988 2 2 0
AMPUL 55000 13 13 0
AMPUL 25300 13 13 0
AMPUL 165000 0 0 0
AMPUL 12584 0 0 0
AMPUL 13913.35 0 0 0
AMPUL 212300 0 0 0
AMPUL 206800 0 0 0
AMPUL 39160 0 0 0
AMPUL 36300 15 15 0
AMPUL 73766 9 9 0
AMPUL 25685 4 4 0
AMPUL 18843 11 11 0
AMPUL 9600 4 4 0
AMPUL 10381.14 7 7 0
AMPUL 5467 34 34 0
AMPUL 31900 0 0 0
AMPUL 60500 11 11 0
BOTTLE 46200 2 2 0
BOTTLE 57200 2 2 0
BOTTLE 90750 1 1 0
BOTTLE 24090 0 0 0
BOTTLE 34210 1 1 0
BOTTLE 24035 0 0 0
BOTTLE 82500 2 2 0
BOTTLE 51150 4 4 0
BOTTLE 306900 4 4 0
BOTTLE 173250 0 0 0
BOTTLE 135828 1 1 0
BOTTLE 101750 0 0 0
BOTTLE 115500 0 0 0
BOTTLE 25850 0 0 0
BOTTLE 24035 0 0 0
BOTTLE 15706.88 2 2 0
BOTTLE 10857 10 10 0
BOTTLE 19085 7 7 0
BOTTLE 4235 14 14 0
BOTTLE 32450 3 3 0
BOTTLE 84920 0 0 0
BOTTLE 88000 4 4 0
BOTTLE 45980 2 2 0
BOTTLE 79530 3 3 0
BOTTLE 108900 5 5 0
BOTTLE 66155.1 2 2 0
BOTTLE 67650 2 2 0
BOTTLE 42680 1 1 0
BOTTLE 56980 2 2 0
BOTTLE 56980 1 1 0
BOTTLE 75570 2 2 0
Page 41
Sheet1
BOTTLE 84491 0 0 0
BOTTLE 15862 1 1 0
BOTTLE 38610 2 2 0
BOTTLE 79200 3 3 0
BOTTLE 33000 0 0 0
BOTTLE 47586 0 0 0
BOTTLE 36300 0 0 0
BOTTLE 33000 0 0 0
BOTTLE 28270 6 6 0
BOTTLE 57200 2 2 0
BOTTLE 84150 2 2 0
BOTTLE 40370 0 0 0
BOTTLE 29700 2 2 0
BOTTLE 18480 4 4 0
BOTTLE 52470 4 4 0
BOTTLE 84150 0 0 0
BOTTLE 57750 0 0 0
BOTTLE 74800 3 3 0
BOTTLE 126500 0 0 0
BOTTLE 107250 0 0 0
BOTTLE 83344 1 1 0
BOTTLE 58850 0 0 0
BOTTLE 27390 0 0 0
BOTTLE 6600 5 5 0
BOTTLE 3500 0 0 0
BOTTLE 5500 0 0 0
BOTTLE 3960 0 0 0
BOTTLE 11489.5 1 1 0
BOTTLE 11489.5 2 2 0
BOTTLE 60500 0 0 0
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Sheet1
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Page 108
SO lt.2 (16.6.19)
No Nama Satuan CostDasar

554 KAPSUL KOSONG NO.2 CAPSUL 50
1379 MUCOSTA TAB (INHEALTH) TABLET 3550.01
1311 HERB. NORIT TAB TABLET 525
1540 TRAJENTA DUO 2.5MG/500MG FCT TAB (INHEALTH) 3TABLET 8000
842 SPALK TANGAN 5 X 12CM PIECES 13000
894 HARMONIA SUNBLOCK CREAM SPF 40 POT 48400
915 INFUS D5(GLUCOSE 5%)100 ML (BPJS) SOFTBAG 14025
319 INTERZINC SYRUP 100ML (INHEALTH) BOTTLE 19800
932 INFUS TRIDEX PLAIN /KA EN 1B SOFTBAG 28512
1116 G.CILOSTAZOL TAB 100MG (BPJS) TABLET 10450
1645 G.DESOXIMETASONE CREAM 0.25% 15GR (BPJS) TUBE 13310
1408 OZEN TAB 10MG 30s TABLET 4766.67
8 OTSU MGSO4 20% 25ML 00953 10010
646 OTSU MGSO4 40% 25ML FLASH 10010
628 G.PARACETAMOL INFUS 1GR/100ML (BPJS) FLASH 30387.5
1369 METVELL TAB 0.125MG 30s TABLET 2723
627 G.PARACETAMOL INFUS 1GR/100ML FLASH 66000
1541 TRAJENTA DUO 2.5MG/500MG FCT TAB 30s TABLET 9153.94
1 ALBOTHYL OVULA 00024 20166.67
2 NASONEX NASAL SPRAY 140 00091 311850
3 BRICASMA TURBUHALER 0.5MG 00123 113300
4 INFUS MANITOL 20% 500ML (INHEALTH) 00149 88825
5 INFUS OTSU D10 + 1/5 NS 500 ML(N5) 00566 17710
6 TORASIC INJ 30MG/ML 00764 36666.67
7 VOLTAREN EC TAB 50MG 00807 6669
9 FARGOXIN TAB 0.25MG 01207 319
10 G.CLONIDINE TAB 0.15MG 01272 266.2
11 PK KRISTAL 5GR (KMNO4) 01360 4125
12 PLASMINEX INJ 01596 13332
13 KALNEX INJ 500MG(INHEALTH) 02020 8800
14 SIBITAL INJ 200MG 02054 9900
15 HAND RUB E-CARE 500ML 02155 171600
16 G.GEMFIBROZIL CAP 300MG (INHEALTH) 02206 460.8
17 BRICASMA TURBUHALER 0.5MG(INHEALTH) 02237 113300
18 INFUS M20/MANITOL 500ML 02249 91080
19 G.HYDROCORTISON 2.5% CREAM 5 GR (INHEALTH) 02536 4911
20 SUPL. L BIO SACH 02647 7700
21 ANTIHEMOROID SUPP(INHEALTH) 02660 3300
22 G.RIFAMPICIN CAP 300MG(INHEALTH) 02679 840
23 ZINKID SYRUP 100ML (INHEALTH) 02825 27225
24 PAMOL SUPP 125MG (INHEALTH) 02834 6500.38
25 XYLOCAINE 2% JELLY 10 GRAM 03146 64534.14
26 PAMOL SUPP 125MG 03342 12980
27 PAMOL SUPP 250MG 03499 18810
28 G.ACARBOSE TAB 100 MG (BPJS) 03555 1625.03
29 G.HALOPERIDOL TAB 5 MG(BPJS) 03665 96
30 G.METFORMIN TAB 850MG (BPJS) 03701 407.55
Page 109
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31 G.METHISOPRINOL TAB 500MG 03703 5500

32 G.RAMIPRIL TAB 5 MG (BPJS) 03724 635
33 SUPL. TENTEX ROYAL CAP 03737 17228.42
34 G.NIFEDIPINE TAB 10MG (BPJS) 03738 140.93
35 THYROZOL TAB 10MG(BPJS) 03973 1286
36 DULCOLAX SUPP INFANT 5MG (BPJS) 04020 6000
37 G.RIFAMPICIN CAP 300MG (BPJS) 04063 1200
38 G.CLONIDINE TAB 0.15MG(BPJS) 04080 266.2
39 G.DEXKETOPROFEN INJ 25MG/ML 04140 26400
40 INFUS MANITOL 20% 250 ML (INHEALTH) 04272 39999.99
41 G.ACARBOSE TAB 100 MG 04369 1912
42 FARGOXIN TAB 0.25MG (INHEALTH) 04470 319
43 SANADRYL EXPECT SYRUP 60ML 04496 10560
44 PAMOL SUPP 250MG (INHEALTH) 04503 9500
45 SANTAGESIK TAB 04679 654.5
46 DULCOLAX SUPP INFANT 5MG 04687 15491.67
47 G.ACARBOSE TAB 50 MG (INHEALTH) 04691 1097
48 G.ACETILSISTEIN CAP 200 MG (INHEALTH) 04837 880
49 G.DEXKETOPROFEN INJ 25MG/ML (INHEALTH) 04857 20240
50 ABBOCATH NO.14GA A0007 26620
51 ABBOCATH NO.16GA A0008 26620
52 BISTURI NO 12 A0070 3366
53 BISTURI NO 15 A0071 3960
54 COMBO PACK INFUS G24 A0142 21900
55 FOLLEY CATH 2 WAY CH 22 A0337 18755
56 BENANG MERSILK 2-0 W321H (CT/ETHICON) A0531 53423.33
57 BENANG MERSILK 3-0 W546H (RB/ETHICON) A0534 60793
58 BENANG MERSILK 3-0 W570 01 (TP/ETHICON) A0535 66770
59 NASAL CANNULA PREMATURE A0555 64350
60 GLOVES ON STERILE NITRILE A0590 737
61 OPSITE POST OP 6,5X5CM A0663 9900
62 PAKET KASSA OK 2A(10 KASSA NON X-RAY 10 X 10) A0678 45000
63 BENANG PREMILENE 4-0 2XHR17 (TP/0090902) A0732 183150
64 BENANG PROLENE 4-0 W8015T (CT/ETHICON) A0745 139883.34
65 BENANG SAFIL 4-0 DS19 (CT/BBRAUN) A0781 125235
66 BENANG SILKAM 4-0 HR17 (TP/BLACK) COO7613 A0800 89719.3
67 SPALK KAKI 10 X 100CM A0812 62000
68 SPALK KAKI 10 X 75CM A0813 45000
69 SPALK KAKI 10 X 90CM A0814 60000
70 SPALK KAKI 8 X 60CM A0815 42000
71 SURGICAL CLIPPER BLADE(X9660) A0881 94600
72 BENANG VICRYL 3-0 J311H (TP/ETHICON) A0989 133466.66
73 BENANG VICRYL 5-0 J493H (CT/ETHICON) A0993 124483.33
74 WING NEEDLE 25G 3/4 TERUMO A1009 12320
75 OPSITE POST OP 15,5 X8,5 CM A1165 25300
76 3 WAY BUNTUT HOSPITECH (BPJS) A1327 29700
77 SYRINGE 1ML INSULIN ONEMED A1392 808.5
78 BENANG MERSILK 2-0 W321H (CT/ETHICON) (BPJS) A1913 37396.7
79 BENANG MERSILK 3-0 W546H (RB/ETHICON) (BPJS) A1940 60793.33
Page 110
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80 BENANG PROLENE 7-0 W8702 (TP/ETHICON) (BPJS) A1957 218487.5

81 BENANG PROLENE 4-0 W8015T (CT/ETHICON) (BPJS)A1984 121605
82 BENANG PREMILENE 3-0 2XHR26 BBRAUN (TP/20909AL18120003 295168.5
83 ARESPIN INJ 4MG/4ML (BPJS) 5s AMPUL 44660
84 ARESPIN INJ 4MG/4ML 5s AMPUL 77000
85 ATROPINE INJ 0.25MG/ML AMPUL 2200
86 ATROPINE INJ 0.25MG/ML(BPJS) AMPUL 1595
87 BUSCOPAN INJ 20MG/ML AMPUL 35909.5
88 CATAPRES INJ 150 MICROGRAM/ML AMPUL 70490.5
89 CATAPRES INJ 150 MICROGRAM/ML(BPJS) AMPUL 33900
90 CATAPRES INJ 150 MICROGRAM/ML(INHEALTH) AMPUL 42120
91 CEDOCARD INJ 10MG/10ML (INHEALTH) 10s AMPUL 69300
92 CEDOCARD INJ 10MG/10ML 10s AMPUL 86625
93 CLOPEDIN 50MG INJ 2ML AMPUL 25850
94 COMBIVENT UDV 2.5ML AMPUL 18111.01
95 COMBIVENT UDV 2.5ML(BPJS)@ AMPUL 4550
96 COMBIVENT UDV 2.5ML(INHEALTH) AMPUL 10556.9
97 CORDARONE INJ 150MG/3ML (INHEALTH) 30s AMPUL 40075.75
98 CORDARONE INJ 150MG/3ML 6s AMPUL 40075.75
99 CORTIDEX INJ 5MG/ML AMPUL 6699
100 EXTRACE INJ 500MG/5ML AMPUL 22000
101 FARGOXIN INJ (BPJS) 5s AMPUL 30030
102 FARGOXIN INJ 5s AMPUL 38500
103 FARSORBID INJ (BPJS) AMPUL 54054
104 FENTANYL 0.05MG/ML INJ 2ML AMPUL 48400
105 FIBRION 1.500.000 IU AMPUL 4180000
106 FLIXOTIDE NEBULES AMPUL 21054
107 FRESOFOL 1% INJ (BPJS)@ AMPUL 11308
108 G.AMINOPHYLLINE INJ 240MG/10ML AMPUL 6496.88
109 G.AMINOPHYLLINE INJ 240MG/10ML (BPJS) AMPUL 6496.88
110 G.AMINOPHYLLINE INJ 240MG/10ML (INHEALTH) AMPUL 5632.13
111 G.ASAM TRANEKSAMAT INJ 500 MG AMPUL 6930
112 G.ASAM TRANEKSAMAT INJ 500 MG (BPJS) AMPUL 4000
113 G.ASAM TRANEKSAMAT INJ 500 MG (INHEALTH)* AMPUL 4180
114 G.CALCII GLUCONAS INJ 1GR/10ML AMPUL 22083.33
115 G.CALCII GLUCONAS INJ 1GR/10ML(BPJS) AMPUL 22083.33
116 G.CALCII GLUCONAS INJ 1GR/10ML(INHEALTH) AMPUL 17000
117 G.CITICOLINE INJ 250MG AMPUL 14300
118 G.DEXAMETHASONE INJ 5MG/ML AMPUL 2402.4
119 G.DIPHENHYDRAMIN INJ 10MG/1ML AMPUL 1695.1
120 G.EPHEDRIN INJ 50MG/ML AMPUL 27500
121 G.EPHEDRIN INJ 50MG/ML (BPJS) AMPUL 24750
122 G.EPHEDRIN INJ 50MG/ML (INHEALTH) AMPUL 22000
123 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE) AMPUL 9500
124 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE) (BPJS) AMPUL 9500
125 G.EPINEPHRINE INJ 1MG/ML (ADRENALINE)(INHEALTAMPUL 9500.23
126 G.FUROSEMIDE INJ 20MG/2ML AMPUL 3542
127 G.FUROSEMIDE INJ 20MG/2ML (BPJS) AMPUL 3410
128 G.KETOROLAC INJ 3% AMPUL 16038
Page 111
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129 G.KETOROLAC INJ 3%(BPJS) AMPUL 5292.54

130 G.KETOROLAC INJ 3%(INHEALTH) AMPUL 6415
131 G.LIDOCAINE INJ 2% AMPUL 1760
132 G.LIDOCAINE INJ 2% (BPJS) AMPUL 1760
133 G.LIDOCAINE INJ 2% (INHEALTH) AMPUL 1320
134 G.MECOBALAMIN INJ 500MCG 10s AMPUL 8800
135 G.NICARDIPINE INJ 10MG AMPUL 88000
136 G.NICARDIPINE INJ 10MG (BPJS) AMPUL 23649
137 G.NICARDIPINE INJ 10MG (INHEALTH) AMPUL 85800
138 G.NOREPINEPHRINE BITARTRATE INJ 4MG/4ML (INH AMPUL 59400
139 G.ONDANSETRON INJ 4MG/2ML AMPUL 7700
140 G.ONDANSETRON INJ 4MG/2ML (BPJS) AMPUL 5100
141 G.ONDANSETRON INJ 4MG/2ML (INHEALTH) AMPUL 3300
142 G.ONDANSETRON INJ 8 MG/4 ML AMPUL 18480
143 G.ONDANSETRON INJ 8MG/4ML (BPJS) AMPUL 5100.01
144 G.ONDANSETRON INJ 8MG/4ML (INHEALTH) AMPUL 5500
145 G.PHENYTOIN INJ 50MG/ML AMPUL 56005
146 G.PHENYTOIN INJ 50MG/ML (BPJS) AMPUL 44804.1
147 G.PHENYTOIN INJ 50MG/ML (INHEALTH) AMPUL 16500
148 G.PHYTOMENADIONE/VITAMIN K INJ 10MG/ML AMPUL 4766.67
149 G.PHYTOMENADIONE/VITAMIN K INJ 10MG/ML (BPJS)AMPUL 4766.67
150 G.PIRACETAM INJ 3 GR/15ML AMPUL 20526
151 G.RANITIDINE INJ 50MG/2ML AMPUL 7040
152 G.RANITIDINE INJ 50MG/2ML (BPJS) AMPUL 2464
153 G.RANITIDINE INJ 50MG/2ML (INHEALTH) AMPUL 2200
154 G.TRAMADOL INJ 100MG/2ML AMPUL 6913.5
155 G.TRAMADOL INJ 100MG/2ML (BPJS) AMPUL 4481.4
156 G.TRAMADOL INJ 100MG/2ML(INHEALTH) AMPUL 7682
157 GOTROPIL INJ 3GR/15ML (PIRACETAM) AMPUL 53900
158 GRANON INJ 3ML 5s AMPUL 127050
159 IKAPHEN INJ 100MG/2ML AMPUL 87450
160 KALNEX INJ 500MG/5ML 10s AMPUL 15400
161 KETESSE INJ 2.5% AMPUL 51700
162 LASIX INJ AMPUL 17870.16
163 LEVEMIR FLEXPEN AMPUL 198553.19
164 LEVEMIR FLEXPEN(INHEALTH) AMPUL 152999.99
165 LODOMER INJ AMPUL 12523.5
166 METOPAIN INJ 30MG/ 1ML 6s AMPUL 21541.66
167 MORPHIN 10MG INJ 1ML AMPUL 34049.95
168 NEUROBION 5000 INJ AMPUL 10300.02
169 NEUROBION 5000 INJ(INHEALTH) AMPUL 9100
170 NOKOBA INJ 0.4MG/ML 2ML AMPUL 94600
171 NOKOBA INJ 0.4MG/ML 2ML(BPJS) AMPUL 94600
172 NOKOBA INJ 0.4MG/ML 2ML(INHEALTH) AMPUL 94600
173 NTG (NITROGLYCERIN) INJ 10ML AMPUL 71500
174 NTG (NITROGLYCERIN) INJ 10ML (INHEALTH) AMPUL 60060
175 OTSU MEYLON 8.4 % 25ML(BPJS) AMPUL 6448
176 PETHIDIN INJ 100MG/2ML AMPUL 19481
177 PRIMPERAN INJ 10MG/2ML AMPUL 11367
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178 PRIMPERAN INJ 10MG/2ML (INHEALTH) AMPUL 7000

179 PROANES 1 % INJ AMPUL 84590
180 PROANES 1 % INJ(INHEALTH) AMPUL 53000
181 PROANES 1% INJ (BPJS) AMPUL 84590
182 PULMICORT RESPULES 0.5MG/2ML(0.25 MG) AMPUL 23939.25
183 PULMICORT RESPULES 0.5MG/2ML(0.25 MG)(INHEALAMPUL 19301.54
184 RAIVAS INJ 4MG/4ML AMPUL 104500
185 RANTIN INJ 50 MG/2 ML AMPUL 20900
186 RATIVOL INJ 30 MG/ML 5s AMPUL 39248
187 RECOFOL N INJ 10 MG/ML 20 ML AMPUL 104500
188 SANTAGESIK INJ 1GR/2ML 5s AMPUL 9988
189 SEDACUM INJ 15MG/3ML 5s AMPUL 55000
190 SEDACUM INJ 5MG/5ML 10s AMPUL 25300
191 SERUM ANTI TETANUS BIOSAT 1.5 (ATS 1500 UI) AMPUL 165000
192 STESOLID INJ 10 MG/2 ML AMPUL 12584
193 SYNTOCINON INJ 10s AMPUL 13913.35
194 TETAGAM INJ 250 INTERNATIONAL UNIT 1ML AMPUL 212300
195 TETAGAM INJ 250 INTERNATIONAL UNIT 1ML(INHEALAMPUL 206800
196 TRAMAL INJ 100MG/2ML AMPUL 39160
197 TROVENSIS INJ 4MG/2ML 5s AMPUL 36300
198 TROVENSIS INJ 8MG/4ML 5s AMPUL 73766
199 UDOPA INJ 40MG/ML AMPUL 25685
200 VALISANBE INJ 10MG/2ML AMPUL 18843
201 VENTOLIN NEBULES 2.5 MG (INHEALTH) AMPUL 9600
202 VENTOLIN NEBULES 2.5MG AMPUL 10381.14
203 VIT. NEUROSANBE INJ 3ML AMPUL 5467
204 VOMCERAN INJ 4MG/2ML AMPUL 31900
205 VOMCERAN INJ 8MG/4ML AMPUL 60500
206 ALCO PLUS DMP SYRUP 100ML BOTTLE 46200
207 ALCO PLUS SYRUP 100ML BOTTLE 57200
208 ALOCLAIR PLUS MOUTHWASH 60ML BOTTLE 90750
209 AMOXSAN DRY SYRUP 60ML BOTTLE 24090
210 AMOXSAN FORTE DRY SYRUP 60ML BOTTLE 34210
211 AMOXSAN PAED DROP 15ML BOTTLE 24035
212 AQUAPAK 340 ML/STERIFLO BOTTLE 82500
213 ATAROC SYRUP 60ML BOTTLE 51150
214 ATOPICLAIR LOTION 120ML BOTTLE 306900
215 AVAMYS NASAL SPRAY BOTTLE 173250
216 AVAMYS NASAL SPRAY(INHEALTH) BOTTLE 135828
217 AZOMAX DRY SYRUP BOTTLE 101750
218 AZTRIN DRY SYRUP BOTTLE 115500
219 BETADINE FEM HYGINE 60 ML BOTTLE 25850
220 BETADINE GARGLE 190ML BOTTLE 24035
221 BETADINE GARGLE 190ML (INHEALTH) BOTTLE 15706.88
222 BETADINE SOL 15 ML BOTTLE 10857
223 BETADINE SOL 30 ML BOTTLE 19085
224 BETADINE SOL 5ML BOTTLE 4235
225 BETADINE SOL 60ML BOTTLE 32450
226 BISOLVON DROPS 50ML BOTTLE 84920
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227 CEFAROX DRY SYRUP 100MG/5ML BOTTLE 88000

228 CEFAT DRY SYRUP 60ML BOTTLE 45980
229 CEFAT FORTE DRY SYRUP 60ML BOTTLE 79530
230 CEFSPAN DRY SYRUP 30 ML BOTTLE 108900
231 CELESTAMIN SYRUP 60 ML BOTTLE 66155.1
232 CERINI ORAL DROP BOTTLE 67650
233 CERINI SYRUP 60ML BOTTLE 42680
234 CLANEKSI DRY SYRUP 60ML BOTTLE 56980
235 CLANEKSI DRY SYRUP 60ML(INHEALTH) BOTTLE 56980
236 CLANEKSI FORTE DRY SYRUP 60ML BOTTLE 75570
237 CLARITIN SYRUP 60 ML BOTTLE 84491
238 COMBANTRIN SUSP 10ML BOTTLE 15862
239 COMTUSI SYRUP 60ML BOTTLE 38610
240 CONSTIPEN SYRUP 120ML BOTTLE 79200
241 D-VIT SYRUP 100ML BOTTLE 33000
242 DAKTARIN POWDER 20 GR BOTTLE 47586
243 DARYAZINC DROP BOTTLE 36300
244 DARYAZINC SYRUP BOTTLE 33000
245 DESOLEX LOTION 10ML BOTTLE 28270
246 DEXYCLAV DRY SYRUP 60ML BOTTLE 57200
247 DEXYCLAV FORTE DRY SYRUP 60ML BOTTLE 84150
248 EPEXOL DROP 20ML BOTTLE 40370
249 EPEXOL FORTE SYRUP 60ML BOTTLE 29700
250 EPEXOL SYRUP 120ML BOTTLE 18480
251 EPISAN SUSP 100ML (INHEALTH) BOTTLE 52470
252 EPISAN SUSP 200ML BOTTLE 84150
253 ESTIN SYRUP 5MG/5ML 60ML BOTTLE 57750
254 FIXIPHAR DRY SYRUP 30ML BOTTLE 74800
255 FIXIPHAR DRY SYRUP 60ML BOTTLE 126500
256 FLEET ENEMA 133 ML BOTTLE 107250
257 FLEET ENEMA 133 ML(INHEALTH) BOTTLE 83344
258 FLUIMUCIL DRY SYRUP 75ML BOTTLE 58850
259 FORUMEN EAR DROP 10ML BOTTLE 27390
260 G.AMBROXOL ELIXIR 15MG/5ML BOTTLE 6600
261 G.AMOXICILLIN DRY SYRUP 125MG/5MG 60 ML (BPJSBOTTLE 3500
262 G.AMOXICILLIN DRY SYRUP 125MG/5ML 60ML BOTTLE 5500
263 G.AMOXICILLIN DRY SYRUP 125MG/5ML 60ML(INHEALBOTTLE 3960
264 G.ANTASIDA DOEN SYRUP 60ML BOTTLE 11489.5
265 G.ANTASIDA DOEN SYRUP 60ML (BPJS) BOTTLE 11489.5
266 G.AZITHROMYCIN SYRUP 200MG/5ML (BPJS) BOTTLE 60500
267 G.CEFADROXIL DRY SYRUP 125 MG/5 ML (BPJS) BOTTLE 9839.5
268 G.CEFADROXIL DRY SYRUP 125 MG/5 ML SYRUP BOTTLE 9839.5
269 G.CEFADROXIL DRY SYRUP 125 MG/5 ML SYRUP (IN BOTTLE 7379.9
270 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP BOTTLE 16500
271 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP (BPBOTTLE 17820
272 G.CEFADROXIL DRY SYRUP 250 MG/5 ML SYRUP (IN BOTTLE 12375
273 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML BOTTLE 30250
274 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML (BPJS) BOTTLE 14850
275 G.CEFIXIME DRY SYRUP 100MG/5ML 30ML (INHEALTHBOTTLE 11800
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276 G.CETIRIZINE SYRUP 5MG/5ML 60ML BOTTLE 10440.1

277 G.CETIRIZINE SYRUP 5MG/5ML 60ML (BPJS) BOTTLE 10439
278 G.CETIRIZINE SYRUP 5MG/5ML 60ML (INHEALTH) BOTTLE 8500
279 G.DOMPERIDONE DROP 5MG/ML(BPJS) BOTTLE 26400
280 G.DOMPERIDONE DROP 5MG/ML(INHEALTH) BOTTLE 22440
281 G.DOMPERIDONE SYRUP 5MG/5ML BOTTLE 15400
282 G.DOMPERIDONE SYRUP 5MG/5ML 60ML (INHEALTH)BOTTLE 10010
283 G.DOMPERIDONE SYRUP 5MG/5ML(BPJS) BOTTLE 15400
284 G.IBUPROFEN SYRUP 100MG/5ML BOTTLE 11000
285 G.IBUPROFEN SYRUP 100MG/5ML (BPJS) BOTTLE 4195.4
286 G.IBUPROFEN SYRUP 100MG/5ML (INHEALTH) BOTTLE 6260
287 G.IBUPROFEN SYRUP 200 MG/5 ML (BPJS) BOTTLE 6294.2
288 G.PARACETAMOL DROP 100MG/ML 15ML BOTTLE 8250
289 G.PARACETAMOL DROP 100MG/ML 15ML(BPJS) BOTTLE 8500
290 G.PARACETAMOL DROP 100MG/ML 15ML(INHEALTH) BOTTLE 8250
291 G.PARACETAMOL SYRUP 60ML BOTTLE 5500
292 G.PARACETAMOL SYRUP 60ML (BPJS)@ BOTTLE 5500
293 G.PARACETAMOL SYRUP 60ML (INHEALTH) BOTTLE 4697
294 G.SUCRALFATE SUSP 100ML BOTTLE 16030.6
295 GELOFUSIN INFUS 500ML (BPJS) BOTTLE 145015.2
296 HARMONIA ACNE SERIES(MCS SS) BOTTLE 84234
297 HARMONIA ACNE SOLUTION 10ML BOTTLE 32000
298 HARMONIA FACIAL WASH N BOTTLE 39930
299 HARMONIA FACIAL WASH O BOTTLE 45980
300 HARMONIA SERUM VIT C BOTTLE 58300
301 HERB. PSIDII SYRUP 60ML BOTTLE 59400
302 HERB. SILEX SYRUP 100ML BOTTLE 55440
303 HISTRINE DROP 10MG/ ML BOTTLE 79750
304 HISTRINE DROP 10MG/ ML (INHEALTH) BOTTLE 47850
305 INFUS D10 (GLUCOSE 10%)500ML (BPJS) BOTTLE 20900
306 INFUS D5 + 1/4 NS 500ML DP (N4) (BPJS) BOTTLE 12738
307 INFUS D5(GLUCOSE 5%) 500 ML (BPJS) BOTTLE 13120.25
308 INFUS FUTROLIT 500ML (BPJS) BOTTLE 39267.94
309 INFUS INFUMAL 10% / MARTOS 10% 500 ML DP (BPJSBOTTLE 83600
310 INFUS MANITOL 20% 500ML (BPJS) BOTTLE 45650
311 INFUS NS 100 ML(NATRIUM KLORIDA(BPJS) BOTTLE 17820
312 INFUS NS 1000ML (NATRIUM KLORIDA)UNICAP BOTTLE 26895
313 INFUS NS 1000ML (NATRIUM KLORIDA)UNICAP (INHEBOTTLE 19720
314 INFUS NS 500ML (NATRIUM KLORIDA)SP (BPJS) BOTTLE 13048.75
315 INFUS RING AS/ASERING 500ML SP(BPJS) BOTTLE 24860
316 INFUS TRIDEX 27A 500ML/ KA EN 3A(BPJS) BOTTLE 22832
317 INFUS TRIDEX 27B 500ML/ KA EN 3B(BPJS) BOTTLE 12524.27
318 INPEPSA SYRUP 200 ML BOTTLE 85800
320 IPROX SYRUP BOTTLE 49500
321 ISOPRINOSINE SYRUP 60 ML BOTTLE 108281.8
322 ISPRINOL SYRUP 60 ML BOTTLE 82500
323 KLAPER ALL OVER OIL 100ML BOTTLE 43000
324 LACTULAX SYRUP 60 ML BOTTLE 48400
325 LASAL EXPECT SYRUP 100ML BOTTLE 53000
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326 LASAL SYRUP 100ML BOTTLE 28600

327 LAXADINE SYRUP 30ML (BPJS) BOTTLE 24200
328 LAXADINE SYRUP 60 ML (INHEALTH) BOTTLE 41250
329 LAXADINE SYRUP 60ML BOTTLE 41250
330 LEVOPRONT SYRUP 120ML BOTTLE 125000
331 LOPROX NAILLACQUER SOL 1.5GR BOTTLE 209446.6
332 MINOSEP GARGLE 0.1% 150ML(HIJAU) BOTTLE 31900
333 MINOSEP GARGLE 0.2% 150ML (MERAH) BOTTLE 41800
334 MUCOPECT 15MG/5ML PED SYRUP 60ML BOTTLE 54230
335 MUCOPECT 30MG/5ML ADULT SYRUP 60 ML BOTTLE 64625
336 MUCOPECT 7.5MG/ML DROP 20ML BOTTLE 67705
337 MYCOSTATIN ORAL SUSP 12 ML BOTTLE 56650
338 MYCOSTATIN ORAL SUSP 30 ML BOTTLE 116600
339 MYLANTA LIQUID 150 ML BOTTLE 35277
340 NARFOZ SYRUP 4MG/5ML 30 ML BOTTLE 60500
341 NECIBLOK SUSP 200 ML BOTTLE 90200
342 NEO KAOLANA SYRUP 120ML BOTTLE 13640
343 NOROID SOOTHING LOTION 200ML BOTTLE 143000
344 NOSFOCIN SYRUP 120ML BOTTLE 77000
345 NOVALGIN SYRUP 60ML BOTTLE 49567.1
346 NYMIKO DROP 12ML BOTTLE 35310
347 NYMIKO DROP 12ML (INHEALTH) BOTTLE 23000
348 OBH COMBI BATUK BERDAHAK MENTHOL 100ML BOTTLE 10120
349 OBH COMBI PLUS BATUK FLU MENTHOL 100ML BOTTLE 14437.5
350 OBH SYRUP 100ML BOTTLE 12100
351 OBH SYRUP 100ML (INHEALTH) BOTTLE 5400
352 OBH SYRUP 200 ML BOTTLE 19250
353 OBH SYRUP 200ML(INHEALTH) BOTTLE 6600
354 OREZINC SYRUP BOTTLE 35433.2
355 OTSU D40 25ML BOTTLE 10010
356 OTSU D40 25ML(INHEALTH) BOTTLE 8580
357 OTSU KCL (KALIUM KLORIDA) 7,46% 25ML(BPJS) BOTTLE 3223
358 OTSU KCL(KALIUM KLORIDA) 7,46% 25ML(INHEALTH)BOTTLE 7700
359 OTSU KCL(KALIUM KLORIDA)7,46% 25ML BOTTLE 10010
360 OTSU MEYLON 8.4 % 25ML BOTTLE 15180
361 OTSU MEYLON 8.4 % 25ML(INHEALTH) BOTTLE 12980
362 OTSU WFI 25 ML (BPJS) BOTTLE 3000
363 OZEN DROP 12ML BOTTLE 66000
364 OZEN SYRUP 60 ML BOTTLE 55000
365 PLANTACID FORTE SYRUP BOTTLE 29700
366 PLANTACID SYRUP 100ML BOTTLE 10450
367 POLYSILANE SUSP 180ML BOTTLE 31900
368 POVIDONE IODINE 10% (ECODINE) 10ML BOTTLE 1848
369 PRAXION DROP 100 MG/ML BOTTLE 25520
370 PRAXION SUSP 120 MG/5ML BOTTLE 25300
371 PRAXION SUSP 250 MG/5 ML BOTTLE 37000
372 PROFILAS SYRUP 60 ML BOTTLE 71500
373 PROGINA CARE 100ML BOTTLE 34100
374 PROPEPSA SUSP 200ML BOTTLE 93500
Page 116
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375 PRORIS FORTE SYRUP 50 ML BOTTLE 29700

376 PRORIS SYRUP 60ML BOTTLE 25300
377 RANIVEL 60 ML SYRUP BOTTLE 60500
378 RENALYTE 200ML BOTTLE 17710
379 RHINATHIOL ROMETHAZINE SYRUP 100ML BOTTLE 43340
380 RHINOFED SUSP BOTTLE 27500
381 RHINOS JUNIOR SYRUP BOTTLE 36300
382 RHINOS NEO DROP BOTTLE 49500
383 RITEZ SYRUP 60ML BOTTLE 55000
384 SALICYL TALK (INHEALTH) BOTTLE 6240
385 SANADRYL DMP SYRUP 120ML BOTTLE 20460
386 SANADRYL DMP SYRUP 120ML (INHEALTH) BOTTLE 20460
387 SANADRYL EXPECT SYRUP 120ML BOTTLE 15290
388 SANADRYL EXPECT SYRUP 120ML (INHEALTH) BOTTLE 15290
389 SANMOL DROP 20ML BOTTLE 16830
390 SANMOL INFUS 1 G / 100ML BOTTLE 65560
391 SANMOL INFUS 1 G / 100ML(INHEALTH) BOTTLE 39001.64
392 SANMOL SYRUP 60ML BOTTLE 12540
393 SANOSKIN MELLADERM PLUS 20 G BOTTLE 198000
394 SANOSKIN OXY GEL 30 G BOTTLE 346500
395 SANPRIMA SYRUP 60ML BOTTLE 27390
396 SIRPLUS SYRUP 100 ML BOTTLE 14300
397 SPORETIK DRY SYRUP 30ML BOTTLE 89540
398 SUPL. APIALYS SYRUP 100ML BOTTLE 36300
399 SUPL. ELKANA CL EMULSI 120 ML BOTTLE 51150
400 SUPL. FEROGLOBIN KID DROP BOTTLE 35200
401 SUPL. FEROGLOBIN SYRUP 100ML BOTTLE 46200
402 SUPL. FUCOIDAN SYRUP 120ML BOTTLE 93500
403 SUPL. IMBOOST FORCE SYRUP 120 ML BOTTLE 89100
404 SUPL. IMBOOST KIDS SYRUP 120 ML BOTTLE 54670
405 SUPL. LIKURMIN SYRUP 100ML BOTTLE 44000
406 SUPL. MOZUKU SYRUP 60ML BOTTLE 75900
407 SUPL. VIUSID SYRUP 100ML BOTTLE 275000
408 TEMPRA DROP 15ML BOTTLE 43890
409 TEMPRA FORTE SYRUP 60ML BOTTLE 40480
410 TEMPRA SYRUP 60ML BOTTLE 36740
411 TOPICARE PLUS CERAMIDE 100 GR BOTTLE 151250
412 TREMENZA SYRUP 60ML BOTTLE 21450
413 TREMENZA SYRUP 60ML (INHEALTH) BOTTLE 21450
414 VACTIV SYR 5MCG/ML 60ML BOTTLE 36300
415 VECTRINE DRY SYRUP 175MG/5ML BOTTLE 44000
416 VESTEIN DRY SYRUP BOTTLE 40700
417 VESTEIN DRY SYRUP (INHEALTH) BOTTLE 26500
418 VIRIDIS SYRUP 250MG/5ML BOTTLE 63800
419 VIT. ELKANA SYRUP 60ML BOTTLE 23100
420 VOMETA DROP 10ML BOTTLE 43450
421 VOMETA SUSP 60ML BOTTLE 43450
422 VOSEDON SYRUP 60ML BOTTLE 31240
423 ZEMINDO SYRUP 60ML BOTTLE 41250
Page 117
SO lt.2 (16.6.19)
424 ZINKID SYRUP 100ML BOTTLE 30250

425 KASSA STERIL 16/16 BOX 3300
426 NEPHRISOL VANILA BOX 56265
427 SERETIDE 125 INHALER BOX 167706
428 SERETIDE 50 INHALER BOX 147379.1
429 SERETIDE 50 INHALER(INHEALTH) BOX 131299.99
430 SERETIDE DISKUS 100 BOX 222453
431 SERETIDE DISKUS 250 BOX 249309.5
432 SYMBICORT 160/ 4.5 UG 120 DOSIS BOX 487919.3
433 SYMBICORT 160/ 4.5 UG 60 DOSIS BOX 305760.4
434 SYMBICORT 160/ 4.5 UG 60 DOSIS(INHEALTH) BOX 305761.5
435 BAQUINOR FORTE CAPT 20s CAPLET 14564
436 CERINI CAPT 20s CAPLET 3679.5
437 CLANEKSI CAPT CAPLET 12925
438 DIVALPI EC CAPLET 250MG CAPLET 6160
439 ERYSANBE CAP 500 MG CAPLET 2849
440 G.ASAM MEFENAMAT TAB 500MG CAPLET 275
441 G.ASAM MEFENAMAT TAB 500MG(INHEALTH) CAPLET 275
442 G.AZITHROMYCIN TAB 500 MG (INHEALTH) CAPLET 9900
443 G.IRBESARTAN TAB 150MG(BPJS) CAPLET 1425
444 G.RIFAMPICIN CAP 300MG CAPLET 1200
445 G.RIFAMPICIN CAP 600 MG (BPJS) CAPLET 1975
446 G.RIFAMPICIN CAP 600MG CAPLET 2970
447 HERB. VENOSMIL CAP 200 MG 20s CAPLET 10450
448 HERCLOV CAPT 50s CAPLET 15950
449 IRVASK CAPT 150MG 30s CAPLET 11000
450 IRVASK CAPT 300MG 30s CAPLET 14666.66
451 MEFINAL CAPT 500 MG CAPLET 1430
452 NEUROSANBE PLUS CAPT CAPLET 1127.5
453 PRIMADOL CAPL CAPLET 1375
454 PRORIS CAPT CAPLET 968
455 RIFAMTIBI CAPT 600MG CAPLET 6165.5
456 SANPRIMA FORTE CAPT CAPLET 2139.5
457 SELOXY AA CAPT 30s CAPLET 6967
458 SINCRONIK CAPT 30s CAPLET 8250
459 SISTENOL CAPT CAPLET 2200
460 SULCOLON CAPT 500 MG CAPLET 7700
461 SUPL. ASTAPLUS CAPT 30s CAPLET 9350
462 SUPL. CAR Q TAB 100MG 30s CAPLET 11000
463 SUPL. FOLDA CAP 30s CAPLET 4565
464 SUPL. GCM CAPLET 30s CAPLET 6600
465 SUPL. MAXTOTEN CAP CAPLET 8800
466 SUPL. NOCID TAB CAPLET 6763
467 SUPL. SELOXY CAPT 30s CAPLET 5500
468 SUPL. ZEGAVIT CAPT 50s CAPLET 3300
469 TUZALOS CAPT CAPLET 957
470 VIT. BECOM C CAPT CAPLET 1430
471 VOXIN CAPT 500MG CAPLET 38500
472 ALDISA SR CAP 50s CAPSUL 5621
Page 118
SO lt.2 (16.6.19)
473 AMOXSAN CAP 500MG CAPSUL 3410

474 APRION CAP 75MG 10s CAPSUL 7975
475 ARTRODAR CAP 50 MG 30s CAPSUL 9753.34
476 AVODART CAP 0.5MG 30s CAPSUL 10111.53
477 AVODART CAP 0.5MG(BPJS)@ 30s CAPSUL 4935
478 AVODART CAP 0.5MG(INHEALTH) 30s CAPSUL 10111.53
479 CALOS (CACO3) 500MG CHEW TAB (INHEALTH) 60s CAPSUL 916.67
480 CEFAROX CAP 100MG 20s CAPSUL 19800
481 CEFAT CAP 500 MG CAPSUL 10885
482 CEFSPAN CAP 100 MG 30s CAPSUL 24200
483 CEFSPAN TAB 200 MG 10s CAPSUL 38500
484 CELEBREX CAP 100MG 30s CAPSUL 11000.22
485 CELEBREX CAP 200MG 30s CAPSUL 15470.14
486 DOGMATIL CAP 50 MG CAPSUL 3795
487 FIXIPHAR CAP 100MG CAPSUL 19250
488 FIXIPHAR CAP 200MG CAPSUL 33000
489 FLUCORAL CAP 150 MG (INHEALTH) 10s CAPSUL 29700
490 FLUCORAL CAP 150 MG 10s CAPSUL 74800
491 FLUIMUCIL CAP 200MG 60s CAPSUL 6031.67
492 G.ACETILSISTEIN CAP 200 MG CAPSUL 1100
493 G.CEFADROXIL CAP 500MG CAPSUL 1210
494 G.CEFADROXIL CAP 500MG (BPJS) CAPSUL 1210
495 G.CEFIXIME CAP 100MG CAPSUL 2394.59
496 G.CEFIXIME CAP 100MG(BPJS) CAPSUL 1795.94
497 G.CEFIXIME CAP 100MG(INHEALTH) CAPSUL 838.1
498 G.CEFIXIME CAP 200MG CAPSUL 5500
499 G.CEFIXIME CAP 200MG (INHEALTH) CAPSUL 4033.33
500 G.CETIRIZINE TAB 10 MG CAPSUL 385
501 G.CLINDAMYCINE CAP 150 MG CAPSUL 756.02
502 G.CLINDAMYCINE CAP 150MG (INHEALTH) CAPSUL 796.4
503 G.CLINDAMYCINE CAP 300MG CAPSUL 1540
504 G.CLINDAMYCINE CAP 300MG (INHEALTH) CAPSUL 1306
505 G.CLINDAMYCINE CAP 300MG(BPJS) CAPSUL 1375.44
506 G.DOXYCYCLINE CAP 100 MG(INHEALTH) CAPSUL 291.01
507 G.DOXYCYCLINE CAP 100MG CAPSUL 450.53
508 G.ERYTHROMYCIN CAP 250 MG (INHEALTH) CAPSUL 790
509 G.FENOFIBRATE CAP 100MG CAPSUL 2200
510 G.FENOFIBRATE CAP 100MG(BPJS) CAPSUL 1760
511 G.FENOFIBRATE CAP 100MG(INHEALTH) CAPSUL 1350
512 G.FENOFIBRATE CAP 300MG CAPSUL 4400
513 G.FENOFIBRATE CAP 300MG(BPJS) CAPSUL 3080
514 G.FENOFIBRATE CAP 300MG(INHEALTH) CAPSUL 1850
515 G.FLUCONAZOLE CAP 150MG CAPSUL 22000.33
516 G.FLUCONAZOLE CAP 150MG (BPJS) CAPSUL 19800
517 G.GABAPENTINE CAP 300MG CAPSUL 5500
518 G.GABAPENTINE CAP 300MG (BPJS) CAPSUL 4851
519 G.GEMFIBROZIL CAP 300MG CAPSUL 700
520 G.GEMFIBROZIL CAP 300MG(BPJS) CAPSUL 700
521 G.ITRACONAZOLE CAP 100MG CAPSUL 4400
Page 119
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522 G.ITRACONAZOLE CAP 100MG (INHEALTH) CAPSUL 3652

523 G.LANSOPRAZOLE CAP 30MG CAPSUL 1621.6
524 G.LANSOPRAZOLE CAP 30MG (BPJS) CAPSUL 891.88
525 G.LANSOPRAZOLE CAP 30MG(INHEALTH) CAPSUL 561
526 G.MECOBALAMIN CAP 500MG CAPSUL 880
527 G.MECOBALAMIN CAP 500MG (BPJS) CAPSUL 770
528 G.OMEPRAZOLE CAP 20MG CAPSUL 408.32
529 G.OMEPRAZOLE CAP 20MG (BPJS) CAPSUL 408.32
530 G.OMEPRAZOLE CAP 20MG(INHEALTH) CAPSUL 326.66
531 G.PHENYTOIN CAP 100 MG CAPSUL 605
532 G.PHENYTOIN CAP 100 MG(INHEALTH) CAPSUL 484
533 G.PHENYTOIN CAP 100MG (BPJS) CAPSUL 605
534 G.PREGABALIN CAP 75MG CAPSUL 5500
535 G.RIFAMPICIN CAP 450 MG (BPJS) CAPSUL 1870
536 G.RIFAMPICIN CAP 450MG CAPSUL 1870
537 G.RIFAMPICIN CAP 450MG(INHEALTH) CAPSUL 1769.63
538 G.TRAMADOL CAP 50MG CAPSUL 845.75
539 G.TRAMADOL CAP 50MG (INHEALTH) CAPSUL 566.06
540 G.URSODEOXYCHOLIC ACID CAPSUL 250MG CAPSUL 4620
541 GASTROLAN CAP 30MG 20s CAPSUL 15400
542 HARNAL D CAP 0.2MG(INHEALTH) 28s CAPSUL 11000
543 HERB. INLACIN 100MG CAP 30s CAPSUL 5500
544 HERB. STIMUNO FORTE CAP CAPSUL 2475
545 IKAPHEN CAP 100MG CAPSUL 1386
546 INCIDAL OD CAP CAPSUL 3036.4
547 INHIPUMP CAP 20MG 7s CAPSUL 12571.43
548 INTERDOXIN CAP 100MG CAPSUL 7810
549 KALMECO CAP 500MG CAPSUL 2640
550 KALNEX TAB 500MG (INHEALTH) CAPSUL 1900
551 KAPSUL KOSONG NO. 1 CAPSUL 50
556 LANCID CAP 30MG CAPSUL 16225
557 LAPRAZ CAP 20s CAPSUL 12853.5
558 LASAL CAP 2MG CAPSUL 1375
559 LIVAPRO SS CAP 50s CAPSUL 9900
560 LYRICA CAP 150MG 14s CAPSUL 22192.03
561 LYRICA CAP 150MG(INHEALTH) 14s CAPSUL 13650
562 LYRICA CAP 75MG 14s CAPSUL 13450.09
563 LYRICA CAP 75MG(INHEALTH) 14s CAPSUL 8800
564 MEGABAL CAP 100s CAPSUL 1782
565 METHYCOBAL CAP 500 MICROGRAM CAPSUL 4055.84
566 MEZATRIN CAP 250 MG CAPSUL 15532
567 MEZATRIN CAP 250 MG (INHEALTH) CAPSUL 9000
568 NEPATIC CAP 300MG CAPSUL 10780
569 NEURONTIN CAP 300MG 100s CAPSUL 15631.5
570 NIRCEF CAP 100MG 10s CAPSUL 16500
571 NITROKAF RETARD 2,5 MG CAP CAPSUL 2353.18
572 NITROKAF RETARD 2,5 MG CAP (BPJS) CAPSUL 2401.99
Page 120
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573 NITROKAF RETARD 2,5 MG CAP (INHEALTH) CAPSUL 2200

574 NOLIPO CAP 500MG CAPSUL 5098.5
575 NOMIKA TAB 100MG CAPSUL 10175
576 NUCEF CAP 100MG 30s CAPSUL 20350
577 OMZ CAPS 20MG CAPSUL 12833.34
578 PLETAAL SR CAP 100 MG (INHEALTH) 30s CAPSUL 14786.2
579 PLETAAL SR CAP 100 MG 30s CAPSUL 14786.2
580 PRADAXA CAP 110MG CAPSUL 23558.94
581 PRADAXA CAP 110MG(INHEALTH) CAPSUL 15000
582 PRAZOTEC CAP 30MG 20s CAPSUL 13200
583 PROLIC CAP 150 MG 100s CAPSUL 3795
584 PROLIC CAP 300 MG 100s CAPSUL 7711
585 PROVELYN CAP 150MG 14s CAPSUL 16500
586 PROVELYN CAP 75MG 14s CAPSUL 11416.43
587 PUMPITOR CAP 20s CAPSUL 14520
588 RHINOS SR CAP CAPSUL 5225
589 RHINOS SR CAP (INHEALTH) CAPSUL 5224.74
590 SALOFALK TAB 250 MG CAPSUL 7785
591 SICLIDON CAP 100MG 20s CAPSUL 5632
592 SPORACID CAP 100MG CAPSUL 21670
593 SPORETIK CAP 100MG CAPSUL 21208
594 SPORETIK CAP 200MG CAPSUL 30635
595 STAFORIN CAP 500MG CAPSUL 10450
596 SUPL. ASTATIN CAP 20s CAPSUL 6930
597 SUPL. CORMEGA SOFT CAP 30s CAPSUL 11550
598 SUPL. FLORAGYN CAP 30s CAPSUL 13200
599 SUPL. FORNEURO CAP 30s CAPSUL 5866.67
600 SUPL. FUCOIDAN 100 CAP CAPSUL 11550
601 SUPL. GLISODIN CAP 30s CAPSUL 6233.34
602 SUPL. HEPAMAX CAP CAPSUL 9606.66
603 SUPL. LIPROQY CAPS CAPSUL 7480
604 SUPL. MOZUKU CAP 30s CAPSUL 9900
605 SUPL. NEULIN PS CAPS 30s CAPSUL 13200
606 SUPL. OSTEOPOR CAP CAPSUL 4766.66
607 SUPL. PHARMATON FORMULA CAPT CAPSUL 4204.77
608 SUPL. PROBIOSTIM CAP CAPSUL 10505
609 SUPL. SANGOBION CAP CAPSUL 1237.2
610 SUPL. SANGOBION CAP (INHEALTH) CAPSUL 1100
611 SUPL. STARMUNO CAP CAPSUL 8690
612 TRAMAL CAP 50MG 50s CAPSUL 5885
613 TROLIP CAP 300MG 30s CAPSUL 10450
614 URDAHEX CAP 30s CAPSUL 10083.33
615 URDEX CAP 30s CAPSUL 8800
616 UROTRACTIN CAP 400MG (INHEALTH) 60s CAPSUL 3150
617 UROTRACTIN CAP 400MG 60s CAPSUL 3498
618 VECTRINE CAP 300MG 20s CAPSUL 5225
619 VESTEIN CAP (INHEALTH) 20s CAPSUL 2750
620 ZEMYC CAP 50 MG 10s CAPSUL 22000
621 ACNE FELDIN (KUMERFELDI) 110ML FLASH 38500
Page 121
SO lt.2 (16.6.19)
622 ALKOHOL 70% 100 ML FLASH 6930

623 ALOCLAIR PLUS SPRAY 15ML FLASH 93500
624 AVAMYS NASAL SPRAY(BPJS)@ FLASH 173250
625 CALADINE LOT 95ML FLASH 18364.5
626 ELOCON LOTION 30 ML FLASH 324800
629 GELOFUSIN INFUS 500ML FLASH 215050
630 HARMONIA CLARIFYING FACIAL CLEANSER-PHa 4% FLASH 51895
631 HARMONIA CLARIFYING G A 2% FLASH 67641
632 HARMONIA CLARIFYING G A 4% FLASH 90062
633 HARMONIA GLYCODERM 10% FLASH 41140
634 HARMONIA LOOSE POWDER N FLASH 81400
635 HARMONIA LOOSE POWDER O FLASH 77000
636 HARMONIA TONER N FLASH 24200
637 HARMONIA TONER O / AHA FLASH 20570
638 INFUS D10 (GLUCOSE 10%)500ML FLASH 20900
639 INFUS D5(GLUCOSE 5%)100 ML FLASH 18700
640 INFUS WFI (WATER FOR INJECTION)1000ML FLASH 22869
641 KETOMED SS 60ML FLASH 44110
642 MINYAK KAYU PUTIH 120ML FLASH 33000
643 MINYAK TELON 100 ML FLASH 22660
644 NARFOZ SYRUP 4MG/5ML 60 ML FLASH 88000
645 OTSU MANITOL 20% 250 ML FLASH 65459
647 OTSU NS (NATRIUM KLORIDA) 25 ML FLASH 6954.2
648 OTSU NS (NATRIUM KLORIDA) 25 ML (INHEALTH) FLASH 5500
649 OTSU SALIN 3% 500ML FLASH 36300
650 OTSU WFI 25 ML FLASH 6954.2
651 OTSU WFI 25 ML (INHEALTH) FLASH 5500
652 PARASOL LOTION 30 SPF FLASH 84590
653 PHISOHEX 50 ML FLASH 20350
654 REGROU 30ML FLASH 60610
655 REGROU FORTE 30ML FLASH 108735
656 RIVANOL 0.1% IKA 200 ML FLASH 9900
657 SALICYL MENTHOL TALK FLASH 13860
658 SALICYL TALK FLASH 20000
659 SLEEK BABY DESINFECTAN/CLEANSER FLASH 28690
660 TANTUM VERDE 120 ML FLASH 35310
661 VENTOLIN INHALER 100 MICROGRAM FLASH 114452.8
662 ACID SALICYLIC (ACSAL CAS) PULVIS GRAM 1000
663 BIOCREAM 20GR GRAM 1464.1
664 NATRIUM CHLORIDA PH (NACL) PULVIS GRAM 990
665 VASELIN GRAM 109
666 GLYCERIN PH 1 LITER ML 100
667 HUMULIN R 100IU INJ 10ML ML 38599.55
668 LIQUOR CARBONIS DETERGENTS (LCD) LIQUID ML 3992
669 OLEUM BERGAMOT FCF ML 2546
670 POVIDONE 10% 1000ML(STARDINE/BETADINE) ML 55
671 G.MOXIFLOXACIN TAB 400MG OB18040007 33000
672 MAXPRINOL SYRUP 250/5ML OB18070002 82500
673 BURNAZIN CREAM 500GR OB18090014 436590
Page 122
SO lt.2 (16.6.19)
674 CEPEZET TAB 100MG OB18090015 495

675 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB (BPJS) OB18110008 125
676 G.NATRIUM DIKLOFENAK TAB 25MG (INHEALTH ) OB19020005 325.01
677 FLADYSTIN OVULA OVULA 15180
678 FLAGYSTATIN OVULA OVULA 17617.16
679 NEO GYNOXA OVULA OVULA 15620
680 NEO GYNOXA OVULA (INHEALTH) OVULA 9108
681 VAGIZOL 500MG OVULA(INHEALTH) OVULA 5850
682 COMBO PACK INFUS G18 PACK 21900
685 WASH GLOVES T3-TOWEL PACK 12320
686 3 WAY BUNTUT PIECES 52250
687 ACTIMOVE VERTEBRACE L PIECES 455262
688 ACTIMOVE VERTEBRACE M PIECES 455262
689 ACTIMOVE VERTEBRACE S PIECES 455262
690 ALKOHOL SWAB+CHLORHEXIDINE PIECES 157.3
691 ARM SLING SIZE L PIECES 25300
692 ARM SLING SIZE M PIECES 25300
693 ARM SLING SIZE S PIECES 25000
694 ARM SLING SIZE XL PIECES 25000
695 BACTERIAL FILTER ADULT HME PIECES 59950
696 BACTIGRAS 10X10 PIECES 14850
697 BACTIGRAS 10X10(BPJS) PIECES 10840.5
698 BENANG CATGUT CHROMIC 2-0 J983H (ETHICON) PIECES 143641.66
699 BENANG CATGUT CHROMIC 3-0 G122T (ETHICON)** PIECES 74305
700 BENANG CATGUT CHROMIC 3-0 G122T (ETHICON)** (PIECES 52013.5
701 BENANG CATGUT PLAIN 2-0 1872T (ETHICON) (BPJS)PIECES 60214
702 BENANG CATGUT PLAIN 2-0 1872T (ETHICON)** PIECES 86020
703 BENANG CATGUT PLAIN 4-0 JH121T (CT/ETHICON) C PIECES 70551.25
704 BENANG MERSILK 3-0 W328H (CT/ETHICON) PIECES 60096.67
705 BENANG MERSILK 3-0 W328H (CT/ETHICON) (BPJS) PIECES 42067.67
706 BENANG MERSILK 4-0 W582 (RB/ETHICON) PIECES 80850
707 BENANG MERSILK 4-0 W582 (RB/ETHICON) (BPJS) PIECES 56595
708 BENANG PREMILENE 2-0 DS24 (CT/0090236) PIECES 101398
709 BENANG PREMILENE 3-0 DS19 (CT/0090521) PIECES 119427
710 BENANG PREMILENE 4-0 DS19 (CT/C2090520) PIECES 133897.5
711 BENANG PREMILENE 4-0 DS19 (CT/C2090520) (BPJS)PIECES 93728.25
712 BENANG PROLENE 2-0 8833H (TP/ETHICON) PIECES 132330
713 BENANG PROLENE 2-0 8833H (TP/ETHICON) (BPJS) PIECES 92631
714 BENANG PROLENE 2-0 W8026T (CT/ETHICON) (BPJS)PIECES 121605
715 BENANG PROLENE 2-0 W8026T (CT/ETHICON)** PIECES 139883.33
716 BENANG PROLENE 3-0 W8684 (CT/ETHICON) PIECES 126316.67
717 BENANG PROLENE 3-0 W8684 (CT/ETHICON) (BPJS) PIECES 109780
718 BENANG PROLENE 5-0 W527 (CT/ETHICON) (BPJS) PIECES 70147
719 BENANG PROLENE 5-0 W527(CT/ETHICON)** PIECES 100210
720 BENANG PROLENE 6-0 W8706 (TP/ETHICON) PIECES 203683.33
721 BISTURI NO 10 PIECES 3564
722 BISTURI NO 11 PIECES 3960
Page 123
SO lt.2 (16.6.19)
723 BLOOD SET BPJS PIECES 7700

724 BLOOD SET TERUMO TBA200L002+ PIECES 28050
725 BOTOL COKLAT 100 CC PIECES 2640
728 BOTOL COKLAT LEBAR 50 CC PIECES 1540
729 CONNECTING TUBE(MPCS) PIECES 38500
730 ELECTRODE ECG PAED PIECES 8250
731 ELECTRODE ECG/TREADMILL ADULT PIECES 5390
732 ETT CUFF KINGKING NO.7.5 PIECES 75000
733 ETT NO 7 (100/199/070)PORTEX PIECES 104500
734 ETT NO 7.5 (100/199/075)PORTEX PIECES 104500
735 ETT NO 8 (100/199/080)PORTEX PIECES 104500
736 EXTENSION TUBE 1.5 ML 150 CM PIECES 40004.5
737 FEEDING TUBE 3.5 FR 35 CM TERUMO(NGT) PIECES 42350
738 FEEDING TUBE 5 FR 40 CM TERUMO(NGT) PIECES 20790
741 FINGER SENSOR NEO PIECES 220000
742 FOLLEY CATH 2 WAY CH 10 PIECES 66550
751 FOLLEY CATH 2 WAY SILICON CH 16 PIECES 135000
754 FOLLEY CATH 3 WAY CH 18 RUSCH PIECES 75000
758 GLOVES GAMMEX NO 6 PIECES 13000
759 GLOVES GAMMEX NO 6.5 PIECES 13000
761 GLOVES GAMMEX NO 7.5 PIECES 13000
763 GLOVES ON STERILE PIECES 715
764 GUEDEL NO. 100MM PIECES 13200
767 HME FILTER (PORTABLE) BY-GL-4(170522) PIECES 66000
768 INFUS SET PEDIATRIC TERUMO TKA200LK PIECES 20900
769 INTRAFIX SAFESET PIECES 33000
770 INTUBATION STYLET(MANDRIN) NO.10 SIZE M 4MM PIECES 150000
771 INTUBATION STYLET(MANDRIN) NO.6 SIZE S PIECES 84700
Page 124
SO lt.2 (16.6.19)
772 INTUBATION STYLET(MANDRIN)NO.14 SIZE L 4.3MM PIECES 84700

773 IV CANNULA G18 PIECES 14850
777 IV CANNULA G26 PIECES 44687.5
778 IV DRESSING 6X7CM (WINNER) PIECES 3245
779 KAIN MORI/KAIN KAFAN PIECES 47500
780 KASSA VERBAND 4Y X 10CM PIECES 6000
781 KASSA VERBAND 4Y X 5CM PIECES 2332
782 KASSA VERBAND 4Y X 8CM PIECES 3437.5
783 KERTAS PUYER PIECES 75
784 KONDOM CATH L PIECES 7500
785 KONDOM CATH M PIECES 16600
786 KONDOM CATH S PIECES 7500
787 LEUKOCREPE 10 CM X 4.5M(4)8240 PIECES 83710
788 LEUKOCREPE 15 CM X 4.5M(6)8245 PIECES 107470
789 LEUKOCREPE 7.5 CM X 4.5M(3)8238 PIECES 70620
790 LEUKOPLAST 5CM X 4.5M (2`) 1624H PIECES 23650
791 LEUKOPLAST 7.5CM x 4.5M (3`) 1625H PIECES 41800
792 MASKER JILBAB/KARET/TALI PIECES 484
793 MICROPORE 1 X 10 YDS TM15351 PIECES 25826.35
794 MICROPORE 1/2 X 10 YDS TM15350 PIECES 12913.18
795 MICROPORE 2 X 10 YDS TM15352 PIECES 51652.7
796 NASAL CANNULA ADULT PIECES 11000
797 NASAL CANNULA INFANT/NEONATE PIECES 9460
798 NASAL CANNULA PEDIATRIC PIECES 10450
799 NASOPHARYNGEAL AIRWAY NO 7 PORTEX(NPA) PIECES 192500
800 NEBULIZER MASK ADULT MICROMIST (A0201) PIECES 47352
801 NEBULIZER MASK PEDIATRIC MICROMIST PIECES 41800
802 NEEDLE 18 G 1-1/2` TERUMO PIECES 2475
805 NEEDLE 24 G 1` TERUMO PIECES 2475
806 NEEDLE 25 G 1` TERUMO PIECES 2475
807 NEEDLE 26 G 1/2` TERUMO PIECES 2475
808 NEEDLE 27 G 1/2` TERUMO PIECES 2475
809 NEEDLE MICROFINE 31 G PIECES 2801.7
810 NEEDLE NOVO TWIST 32G X 5MM PIECES 2310
811 NON REBREATHING MASK PEDIATRIC (NRM) PIECES 47300
812 NON REBREATHING MASK ADULT (NRM) PIECES 33660
813 OXYGEN TUBING (SO-1170) PIECES 12100
814 PAKET KASSA RI 2(5 KASSA 5X5) PIECES 11000
815 PAKET KASSA RI 3(10 KASSA 5X5) PIECES 15000
816 PISAU CUKUR PIECES 5060
817 POT PLASTIK 10 CC PIECES 470
Page 125
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822 RAPID RHINO NASAL PAC 5.5CM ANTERIOR RR 551 PIECES 405955
823 RAPID RHINO NASAL PAC 7.5 CM WITH BALLOON RRPIECES 405955
824 REBREATHING MASK ADULT PIECES 29480
825 REBREATHING MASK PED PIECES 29480
826 RECTAL TUBE NO 20 PIECES 22000
827 RECTAL TUBE NO.20 (BPJS) PIECES 6732
828 RECTAL TUBE NO.28 PIECES 22000
829 RING PESARIUM NO 65 PIECES 100000
833 ROLL TAMPON VK PIECES 12000
834 SANOSKIN FOAM 10X10 CM PIECES 115500
835 SANOSKIN MELLADERM PLUS TULLE 10X10 CM PIECES 79200
836 SECURITY SEAL PIECES 10725
837 SENDOK OBAT PIECES 275
838 SIMPLE MASK(OXYGEN MASK) ADULT (8110) PIECES 29700
839 SIMPLE MASK(OXYGEN MASK) PED 1122 PIECES 30250
840 SINGLE BLOOD BAG 250CC (PLEBOTOMY) PIECES 55000
846 SPALK TRIPLE LUGINA 10X13X50CM PIECES 163000
847 SPALK TRIPLE LUGINA 10X15X85CM PIECES 258000
848 STERI STRIP 1/2x4 R1547 PIECES 18832
849 STERI STRIP 25MM X 125MM R1548 PIECES 27852
850 STOMACH TUBE FR 10 JMS(NGT) PIECES 33000
851 STOMACH TUBE FR 12 TERUMO(NGT) PIECES 36960
854 STOMACH TUBE FR 16(NGT) SILICON STARDEC PIECES 71500
855 STOMACH TUBE FR 18 JMS(NGT) PIECES 35000
857 STOMACH TUBE/NGT FR 16 (BPJS) PIECES 7744
858 SUCTION BAG LINER 2L WHITE/GREEN PIECES 54560
859 SUCTION CATHETER CH 06 PIECES 8712
865 SYRINGE 10ML ONEMED PIECES 1331
866 SYRINGE 10ML TERUMO PIECES 8030
868 SYRINGE 1ML TUBERCULIN TERUMO PIECES 7040
Page 126
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871 SYRINGE 3ML ONEMED PIECES 859.1

877 SYRINGE CATHETER TIP 50ML ONEMED PIECES 10725
878 SYRINGE CATHETER TIP 50ML TERUMO PIECES 44000
879 TEGADERM 7X8.5CM TM1633 PIECES 13860
880 TEGADERM PED 5X5.7CM TM1610 PIECES 19635.01
881 TONGUE SPATEL KAYU PIECES 700
882 TRANSOFIX (4090500) PIECES 7590
883 UNDERPAD DEWASA 60X90CM PIECES 10450
884 URINE BAG PIECES 8000
885 VENTILATOR BREATHING CIRCUIT (PORTABLE) 5100 PIECES 425425
886 WING NEEDLE 23G 3/4 TERUMO PIECES 12320
887 HARMONIA AH 8 POT 32670
888 HARMONIA BIOLASTIN (BLS) POT 51000
889 HARMONIA EYE GEL POT 65340
890 HARMONIA LIGHTENING ESSENCE POT 98212
891 HARMONIA MOISTURIZER MAK POT 68970
892 HARMONIA SERUM VIT C+ANTI AGING POT 73810
893 HARMONIA SUNBLOCK CREAM SPF 35 POT 47190
895 POT PLASTIK 20 CC POT 550
896 POT PLASTIK 75 CC POT 1100
897 CATAFLAM FAST 50MG 9s SACHET 8513.26
898 FLUIMUCIL GRANUL 200MG 30s SACHET 6472
899 KALITAKE SACH 5GR 20s SACHET 17325
900 KALITAKE SACH 5GR(INHEALTH) 20s SACHET 8500
901 MONURIL GRANUL 3GR SACHET 187000
902 PHAROLIT ORANGE SACH SACHET 1356.67
903 SEQUEST SACHET SACHET 20625
904 SMECTA SACH 3GR 30s SACHET 3666.66
905 SUPL. GCM FORTE SACHET 30s SACHET 14300
906 SUPL. LACTO B SACH 1GR 40s SACHET 6490
907 SUPL. PROBIOKID SACHET 10s SACHET 13695
908 GELAFUSAL INFUS SOFTBAG 194906.4
909 GELAFUSAL INFUS(INHEALTH) SOFTBAG 154000
910 INFUS D10 (GLUCOSE 10%)500ML(INHEALTH) SOFTBAG 12870
911 INFUS D5 + 1/4 NS 500ML DP (N4) SOFTBAG 21230
912 INFUS D5 + 1/4 NS 500ML DP (N4) (INHEALTH) SOFTBAG 12550
913 INFUS D5(GLUCOSE 5%) 500ML DP SOFTBAG 21560
914 INFUS D5(GLUCOSE 5%) 500ML(INHEALTH) SOFTBAG 10820
916 INFUS FUTROLIT 500ML (INHEALTH) SOFTBAG 45002.82
917 INFUS FUTROLIT 500ML DP SOFTBAG 62810
918 INFUS INFUMAL 10% / MARTOS 10% 500 ML DP SOFTBAG 97570
919 INFUS NS 100 ML(NATRIUM KLORIDA) SOFTBAG 18042
920 INFUS NS 500ML (NATRIUM KLORIDA)(INHEALTH) SOFTBAG 20075
921 INFUS NS 500ML (NATRIUM KLORIDA)DP SOFTBAG 20570
Page 127
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922 INFUS RING AS/ASERING 500ML SOFTBAG 29710.38

923 INFUS RING AS/ASERING 500ML(INHEALTH) SOFTBAG 17569
924 INFUS RL (RINGER LACTATE) 500ML (INHEALTH) SOFTBAG 9900
925 INFUS RL (RINGER LACTATE) 500ML DP SOFTBAG 21065
926 INFUS RL (RINGER LACTATE) 500ML SP SOFTBAG 7320.85
927 INFUS RL (RINGER LACTATE) 500ML SP (BPJS) SOFTBAG 12639
928 INFUS TRIDEX 27A 500ML(INHEALTH) SOFTBAG 22832
929 INFUS TRIDEX 27A 500ML/KA EN 3A 500ML SOFTBAG 24502.5
930 INFUS TRIDEX 27B 500ML(INHEALTH) SOFTBAG 22550
931 INFUS TRIDEX 27B 500ML/ KA EN 3B SOFTBAG 28512
933 INFUS TRIDEX PLAIN/KA EN 1B 500ML (BPJS) SOFTBAG 27656.64
934 ANTIHEMOROID SUPP SUPPOSITORI 3300
935 BORAGINOL S SUPP SUPPOSITORI 13475
936 DULCOLAX SUPP ADULT 10MG SUPPOSITORI 22693
937 DULCOLAX SUPP ADULT 10MG(INHEALTH) SUPPOSITORI 16836.6
938 DULCOLAX SUPP INFANT 5MG (INHEALTH) SUPPOSITORI 14000
939 FAKTU SUPP SUPPOSITORI 8250
940 KALTROFEN SUPP SUPPOSITORI 13750
941 PROFECOM 100 MG SUPPOS SUPPOSITORI 13420
942 PROFENID SUPP 100MG SUPPOSITORI 15622.42
943 PROFENID SUPP 100MG(INHEALTH) SUPPOSITORI 15622.42
944 PRONALGES SUPP 100 MG SUPPOSITORI 14685
945 PRORIS SUPP 125MG SUPPOSITORI 5300.45
946 TRAMAL SUPP 10s SUPPOSITORI 17380
947 ULTRAPROCT N SUPP SUPPOSITORI 22500
948 LANTUS SOLOSTAR SYRINGE 207994.6
949 LANTUS SOLOSTAR INJ(INHEALTH) SYRINGE 142018.71
950 NOVOMIX FLEXPEN SYRINGE 176500.5
951 NOVOMIX FLEXPEN(INHEALTH) SYRINGE 142800
952 NOVORAPID FLEXPEN (BPJS) SYRINGE 87000
953 NOVORAPID FLEXPEN(ACTRAPID) SYRINGE 176500.5
954 NOVORAPID FLEXPEN(INHEALTH) SYRINGE 142800.55
955 REMOPAIN PREFILLED SYRINGE SYRINGE 46200
956 ACPULSIF TAB 5 MG 50s TABLET 3850
957 ACRAN TAB 150 MG 30s TABLET 5280
958 ADALAT OROS TAB 30MG 30s TABLET 8680.06
959 ADALAT OROS TAB 30MG(BPJS)@ TABLET 4379.99
960 ADALAT OROS TAB 30MG(INHEALTH) TABLET 4380
961 AERIUS TAB 5MG 30s TABLET 9186.1
962 ALLORIS TAB 100s TABLET 4922.5
963 AMINEFRON TAB TABLET 7150
964 AMTOCORT TAB 4 MG 30s TABLET 3146
965 ANALSIK CAPT TABLET 1595
966 AR-GOUT TAB 0.5MG TABLET 4125
967 ARCOXIA TAB 120MG 30s TABLET 17796.16
970 ASCARDIA TAB 80MG 100s TABLET 935
971 ASPAR K TAB 300MG TABLET 2474
Page 128
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972 ASPAR K TAB 300MG(INHEALTH) TABLET 1945

973 ASPILET TAB 80MG TABLET 583
974 ASPILET TAB 80MG(INHEALTH) TABLET 450
975 ATOFAR TAB 20 MG 30s TABLET 11550
976 AVELOX TAB 400MG TABLET 62415.32
977 AVELOX TAB 400MG(INHEALTH) TABLET 56173.79
978 AZOMAX TAB 500MG 10s TABLET 49300
979 AZTRIN TAB 500MG 6s TABLET 33000
980 BESTALIN TAB TABLET 4400
981 BETASERC TAB 24MG (INHEALTH) 20s TABLET 8492
982 BETASERC TAB 24MG 20s TABLET 11396.7
983 BICROLID CAPT 500 MG 30s TABLET 26367
984 BLOPRESS TAB 16MG 14s TABLET 16500
985 BLOPRESS TAB 8 MG 14s TABLET 12521.93
986 BRAXIDIN TAB 100s TABLET 1160.5
987 BRAXIDIN TAB(INHEALTH) TABLET 1100
988 BRILINTA TAB 90MG (BPJS) 56s TABLET 8323
989 BRILINTA TAB 90MG 56s TABLET 16336.16
990 BRILINTA TAB 90MG(INHEALTH) 56s TABLET 14000
991 BUSCOPAN PLUS TAB 100s TABLET 4443.45
992 BUSCOPAN TAB 10MG 100s TABLET 3241.15
993 BUSCOPAN TAB 10MG(INHEALTH) TABLET 2400.02
994 CALOS (CACO3) 500MG CHEW TAB 60s TABLET 916.66
995 CANDERIN TAB 16MG 30s TABLET 9900
996 CANDERIN TAB 16MG(INHEALTH) 30s TABLET 7425
997 CANDERIN TAB 8MG 30s TABLET 7150
998 CANDERIN TAB 8MG(INHEALTH) 30s TABLET 5005
999 CARDIO ASPIRIN TAB TABLET 1503.44
1000 CATAFLAM TAB 25MG 50s TABLET 3175.85
1001 CATAFLAM TAB 50MG 50s TABLET 6061.07
1002 CEDOCARD TAB 5MG 60s TABLET 1136.66
1003 CELESTAMINE TAB TABLET 3962.35
1004 CETINAL TAB 10MG 30s TABLET 5500
1005 CLARITIN TAB TABLET 7814
1006 CLIDIAZ TAB 30s TABLET 1650
1007 COMBANTRIN TAB 250MG 50s TABLET 6534
1008 CONCOR TAB 2.5MG (BPJS) TABLET 626
1009 CONCOR TAB 2.5MG 100s TABLET 6238.16
1010 CORTIDEX TAB 100s TABLET 308
1011 CPG TAB 75MG 30s TABLET 17966.66
1012 CRAVIT TAB 500 MG 10s TABLET 42900
1013 CRESTOR TAB 20MG 30s TABLET 23144.28
1014 CRIPSA TAB 2.5MG 30s TABLET 16687
1015 D-VIT FT TAB 30s TABLET 2750
1016 DESTAVELL TAB 5MG 30s TABLET 7260
1017 DIAMICRON MR TAB 60MG (BPJS)@ 30s TABLET 5769.23
1018 DIAMICRON MR TAB 60MG (INHEALTH) 30s TABLET 6237
1019 DIAMICRON MR TAB 60MG 30s TABLET 6237
1020 DIVASK 5MG TAB 30s TABLET 6600
Page 129
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1021 DOLO NEUROBION TAB TABLET 1635.48

1022 DRAMAMINE TAB 100s TABLET 1606
1023 DULCOLAX TAB 5MG TABLET 1400.58
1024 DULCOLAX TAB 5MG(INHEALTH) TABLET 950
1025 DUODART TAB 0.5MG TABLET 16500
1026 EFISOL C LOZENGES TAB TABLET 1311.75
1027 EPEXOL TAB 30MG 100s TABLET 891
1028 EPRINOC TAB 50MG TABLET 3679.5
1029 EPSONAL TABLET 100s TABLET 4345
1030 ERICAF TAB 1MG TABLET 6200
1031 ERICAF TAB 1MG(INHEALTH) TABLET 5626.43
1032 ESILGAN TAB 1 MG TABLET 4106.03
1033 ESILGAN TAB 2MG TABLET 6285.13
1034 ESTIN TAB 10MG TABLET 4620
1035 EUTHYROX TAB 50 MICROGRAM TABLET 1234.46
1036 EUTHYROX TAB 50 MICROGRAM(INHEALTH) TABLET 1009
1037 EZETROL TAB 10 MG 30s TABLET 18967.67
1038 EZOCON TAB 40MG 30s TABLET 18480
1039 FEBURIC TAB 80MG TABLET 22000
1040 FG TROCHES MEIJI TAB 120s TABLET 1164.77
1041 FLUIMUCIL EFF TAB 600MG 10s TABLET 14355
1042 FOLAVIT TAB 400MICROGRAM 100s TABLET 891
1043 FORDESIA TAB 30s TABLET 24128.5
1044 FORMYCO TAB 50s TABLET 5467
1045 FORRES TAB 50MG 50s TABLET 5500
1046 FORXIGA TAB 10MG 28s TABLET 16106.99
1047 FREGO TAB 10 MG 50s TABLET 8140
1048 FREGO TAB 5 MG 50s TABLET 6600
1049 FRISIUM TAB 10 MG TABLET 4560.04
1050 G.ACARBOSE TAB 50 MG TABLET 1185.8
1051 G.ACARBOSE TAB 50 MG (BPJS) TABLET 1185.8
1052 G.ACYCLOVIR TAB 200 MG (BPJS) TABLET 291.13
1053 G.ACYCLOVIR TAB 200MG TABLET 388.3
1054 G.ACYCLOVIR TAB 200MG (INHEALTH) TABLET 586.85
1055 G.ACYCLOVIR TAB 400 MG (BPJS) TABLET 713
1056 G.ACYCLOVIR TAB 400MG TABLET 693.62
1057 G.ACYCLOVIR TAB 400MG(INHEALTH) TABLET 572
1058 G.ALBENDAZOLE TAB 400MG TABLET 600
1059 G.ALLOPURINOL TAB 100 MG TABLET 275
1060 G.ALLOPURINOL TAB 100 MG (BPJS) TABLET 264
1061 G.ALLOPURINOL TAB 100 MG (INHEALTH) TABLET 220
1062 G.ALLOPURINOL TAB 300 MG TABLET 462
1063 G.ALLOPURINOL TAB 300 MG (BPJS) TABLET 462
1064 G.ALLOPURINOL TAB 300 MG(INHEALTH) TABLET 264.58
1065 G.ALPRAZOLAM TAB 0.25 MG TABLET 531.3
1066 G.ALPRAZOLAM TAB 0.5 MG TABLET 671
1067 G.ALPRAZOLAM TAB 1 MG TABLET 1034
1068 G.ALPRAZOLAM TAB 1 MG (BPJS)@ TABLET 1034
1069 G.AMBROXOL TAB 30 MG (BPJS) TABLET 231
Page 130
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1070 G.AMBROXOL TAB 30MG TABLET 330

1071 G.AMBROXOL TAB 30MG (INHEALTH) TABLET 211.2
1072 G.AMITRIPTYLINE TAB 25 MG (BPJS) TABLET 187
1073 G.AMITRIPTYLINE TAB 25MG TABLET 187
1074 G.AMITRIPTYLINE TAB 25MG(INHEALTH) TABLET 187
1075 G.AMLODIPINE TAB 10MG TABLET 2032
1076 G.AMLODIPINE TAB 10MG (INHEALTH) TABLET 297
1077 G.AMLODIPINE TAB 10MG(BPJS) TABLET 711.19
1078 G.AMLODIPINE TAB 5 MG (BPJS) TABLET 262
1079 G.AMLODIPINE TAB 5MG TABLET 476
1080 G.AMOXICILLIN CAPT 500MG TABLET 770
1081 G.AMOXICILLIN CAPT 500MG (BPJS) TABLET 539
1082 G.AMOXICILLIN CAPT 500MG (INHEALTH) TABLET 320
1083 G.ANTALGIN TAB 500MG(INHEALTH) TABLET 175
1084 G.ASAM MEFENAMAT TAB 500 MG (BPJS) TABLET 275
1085 G.ASAM TRANEKSAMAT TAB 500MG TABLET 1980
1086 G.ASAM TRANEKSAMAT TAB 500MG (INHEALTH) TABLET 1155
1087 G.ATORVASTATIN TAB 10MG TABLET 2933.34
1088 G.ATORVASTATIN TAB 20 MG TABLET 4400
1089 G.ATORVASTATIN TAB 20 MG (BPJS) TABLET 2886.66
1090 G.AZITHROMYCIN TAB 500 MG (BPJS) TABLET 7150
1091 G.AZITHROMYCIN TAB 500MG TABLET 9900
1092 G.BETAHISTIN TAB 6 MG TABLET 924
1093 G.BETAHISTIN TAB 6 MG (BPJS) TABLET 508.2
1094 G.BETAHISTIN TAB 6 MG (INHEALTH) TABLET 924
1095 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB TABLET 125
1096 G.BICARBONAS NAT TAB 500MG/BIC NAT TAB (INHEATABLET 200
1097 G.BISOPROLOL FUMARATE TAB 5MG TABLET 2321.67
1098 G.BISOPROLOL FUMARATE TAB 5MG (BPJS) TABLET 1210
1099 G.BISOPROLOL FUMARATE TAB 5MG (INHEALTH) TABLET 671
1100 G.CANDESARTAN TAB 16MG TABLET 7700
1101 G.CANDESARTAN TAB 16MG(BPJS)@ TABLET 4620
1102 G.CANDESARTAN TAB 8MG TABLET 5500
1103 G.CANDESARTAN TAB 8MG(BPJS)@ TABLET 3300
1104 G.CAPTOPRIL TAB 12,5MG (BPJS) TABLET 143
1105 G.CAPTOPRIL TAB 12.5MG TABLET 112.5
1106 G.CAPTOPRIL TAB 12.5MG(INHEALTH) TABLET 160
1107 G.CAPTOPRIL TAB 25MG TABLET 225.94
1108 G.CAPTOPRIL TAB 25MG (BPJS) TABLET 225.94
1109 G.CAPTOPRIL TAB 25MG(INHEALTH) TABLET 125.1
1110 G.CEFADROXIL CAP 500MG (INHEALTH) TABLET 605
1111 G.CETIRIZINE TAB 10 MG(BPJS) TABLET 250.8
1112 G.CETIRIZINE TAB 10 MG(INHEALTH) TABLET 184.01
1113 G.CHLORPHENON (CTM) TAB 4 MG TABLET 104.17
1114 G.CHLORPHENON (CTM) TAB 4 MG (BPJS) TABLET 104.17
1115 G.CILOSTAZOL TAB 100MG TABLET 10450
1117 G.CIPROFLOXACIN TAB 500 MG(BPJS) TABLET 666
1118 G.CIPROFLOXACIN TAB 500MG TABLET 770
1119 G.CIPROFLOXACIN TAB 500MG(INHEALTH) TABLET 450
Page 131
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1120 G.CLOBAZAM TAB 10MG TABLET 1045

1121 G.CLOBAZAM TAB 10MG(BPJS) TABLET 992.75
1122 G.CLOPIDOGREL TAB 75MG TABLET 4273
1123 G.CLOPIDOGREL TAB 75MG (BPJS) TABLET 4400
1124 G.CO AMOXICLAV TAB 625MG TABLET 5808.15
1125 G.DEXAMETHASONE TAB 0.5MG TABLET 184.25
1126 G.DEXAMETHASONE TAB 0.5MG(BPJS)@ TABLET 157
1127 G.DEXKETOPROFEN TAB 25MG TABLET 3300
1128 G.DIAZEPAM TAB 2MG TABLET 135.91
1129 G.DIGOXIN TAB 0.25MG TABLET 143
1130 G.DIGOXIN TAB 0.25MG (BPJS) TABLET 129
1131 G.DIMENHYDRINATE TAB 50MG TABLET 143
1132 G.DIMENHYDRINATE TAB 50MG (BPJS) TABLET 143
1133 G.DIMENHYDRINATE TAB 50MG (INHEALTH) TABLET 130
1134 G.DOMPERIDONE TAB 10 MG TABLET 484.34
1135 G.DOMPERIDONE TAB 10 MG (INHEALTH) TABLET 403.61
1136 G.DOMPERIDONE TAB 10MG(BPJS) TABLET 403.61
1137 G.DOXYCYCLINE CAP 100MG(BPJS) TABLET 450.53
1138 G.EPERISONE TAB 50MG TABLET 1694
1139 G.EPERISONE TAB 50MG (INHEALTH) TABLET 1309
1140 G.EPERISONE TAB 50MG(BPJS) TABLET 1540
1141 G.ETHAMBUTOL TAB 500MG TABLET 688.6
1142 G.ETHAMBUTOL TAB 500MG(BPJS) TABLET 837.52
1143 G.FLUNARIZINE TAB 10MG TABLET 2200
1144 G.FLUNARIZINE TAB 5MG TABLET 1375
1145 G.FLUNARIZINE TAB 5MG(BPJS) TABLET 1760
1146 G.FUROSEMIDE TAB 40MG TABLET 242
1147 G.FUROSEMIDE TAB 40MG(BPJS) TABLET 242
1148 G.FUROSEMIDE TAB 40MG(INHEALTH) TABLET 181.98
1149 G.GABAPENTINE CAP 300MG (INHEALTH)* TABLET 4851
1150 G.GLIMEPIRIDE TAB 1MG TABLET 913.53
1151 G.GLIMEPIRIDE TAB 1MG(BPJS) TABLET 363
1152 G.GLIMEPIRIDE TAB 1MG(INHEALTH) TABLET 240
1153 G.GLIMEPIRIDE TAB 2MG TABLET 1430
1157 G.GLIMEPIRIDE TAB 3MG (INHEALTH) TABLET 650
1162 G.GLIQUIDONE TAB 30 MG(BPJS) TABLET 1400
1163 G.GLIQUIDONE TAB 30MG TABLET 1450
1164 G.GRISEOFULVIN TAB 125MG TABLET 516.99
1165 G.GRISEOFULVIN TAB 125MG(BPJS) TABLET 297.17
1166 G.HALOPERIDOL TAB 5 MG TABLET 134.2
1167 G.HYDROCHLOROTHIAZIDE (HCT) TAB 25MG TABLET 127.6
1168 G.IBUPROFEN TAB 200 MG(BPJS) TABLET 158.4
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1169 G.IBUPROFEN TAB 200MG TABLET 176

1170 G.IBUPROFEN TAB 400 MG TABLET 528
1171 G.IBUPROFEN TAB 400 MG(BPJS) TABLET 411.84
1172 G.IRBESARTAN TAB 150MG TABLET 1964
1173 G.IRBESARTAN TAB 150MG (INHEALTH) TABLET 1589
1174 G.IRBESARTAN TAB 300MG TABLET 3811.5
1175 G.IRBESARTAN TAB 300MG (INHEALTH) TABLET 3179
1176 G.IRBESARTAN TAB 300MG(BPJS) TABLET 5133.34
1177 G.ISONIAZIDE (INH)TAB 100MG (INHEALTH) TABLET 200
1178 G.ISONIAZIDE (INH)TAB 100MG(BPJS) TABLET 300
1179 G.ISONIAZIDE (INH)TAB 300MG TABLET 350
1180 G.ISONIAZIDE (INH)TAB 300MG(BPJS) TABLET 190.3
1181 G.ISONIAZIDE (INH)TAB 300MG(INHEALTH) TABLET 200
1182 G.ISOSORBIDE DINITRATE(ISDN) TAB 5 MG(INHEALTHTABLET 165
1183 G.ISOSORBIDE DINITRATE(ISDN) TAB 5MG TABLET 121
1184 G.ISOSORBIDE DINITRATE(ISDN) TAB 5MG (BPJS) TABLET 121
1185 G.KALIUM/POTASSIUM DIKLOFENAK TAB 25MG TABLET 391
1186 G.KALIUM/POTASSIUM DIKLOFENAK TAB 25MG (BPJSTABLET 332
1187 G.KALIUM/POTASSIUM DIKLOFENAK TAB 50MG TABLET 708.03
1188 G.KALIUM/POTASSIUM DIKLOFENAK TAB 50MG (INHETABLET 270
1189 G.KETOCONAZOLE TAB 200MG TABLET 410.3
1190 G.KETOCONAZOLE TAB 200MG (BPJS) TABLET 389.49
1191 G.KETOCONAZOLE TAB 200MG(INHEALTH) TABLET 360
1192 G.KETOPROFEN TAB 100MG TABLET 1349.7
1193 G.KETOPROFEN TAB 100MG (INHEALTH) TABLET 850
1194 G.KETOPROFEN TAB 50MG TABLET 704
1195 G.KETOPROFEN TAB 50MG (INHEALTH) TABLET 457
1196 G.KETOROLAC TAB 10MG TABLET 3157
1197 G.LEVOFLOXACIN TAB 500MG TABLET 1430
1198 G.LEVOFLOXACIN TAB 500MG (BPJS) TABLET 1430
1199 G.LEVOFLOXACIN TAB 500MG (INHEALTH) TABLET 1153.68
1200 G.LORATADINE TAB 10MG TABLET 333.3
1201 G.LORATADINE TAB 10MG (BPJS) TABLET 326.63
1202 G.LORATADINE TAB 10MG (INHEALTH) TABLET 180
1203 G.LOSARTAN TAB 50MG TABLET 3333
1204 G.MELOXICAM TAB 15MG TABLET 770
1205 G.MELOXICAM TAB 15MG(INHEALTH) TABLET 540
1206 G.MELOXICAM TAB 7.5MG TABLET 691.9
1207 G.MELOXICAM TAB 7.5MG(INHEALTH) TABLET 362.97
1208 G.METAMIZOLE TAB 500MG/G.ANTALGIN TAB 500 MGTABLET 308.09
1209 G.METAMIZOLE TAB 500MG/G.ANTALGIN TAB 500MG TABLET 308.09
1210 G.METFORMIN TAB 500MG TABLET 275
1211 G.METFORMIN TAB 500MG (BPJS) TABLET 211
1212 G.METFORMIN TAB 500MG(INHEALTH) TABLET 150
1213 G.METFORMIN TAB 850MG TABLET 429
1214 G.METFORMIN TAB 850MG(INHEALTH) TABLET 300
1215 G.METHYLPREDNISOLONE TAB 16MG TABLET 1196.99
1216 G.METHYLPREDNISOLONE TAB 4MG TABLET 529.1
1217 G.METHYLPREDNISOLONE TAB 4MG (BPJS) TABLET 330.41
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1218 G.METHYLPREDNISOLONE TAB 4MG (INHEALTH) TABLET 250.02

1219 G.METHYLPREDNISOLONE TAB 8MG TABLET 702
1220 G.METHYLPREDNISOLONE TAB 8MG (BPJS) TABLET 462
1221 G.METHYLPREDNISOLONE TAB 8MG (INHEALTH) TABLET 470.01
1222 G.METRONIDAZOLE TAB 500MG TABLET 264
1223 G.METRONIDAZOLE TAB 500MG (BPJS) TABLET 286
1224 G.METRONIDAZOLE TAB 500MG(INHEALTH) TABLET 211
1225 G.NATRIUM DIKLOFENAK TAB 25MG TABLET 366.3
1226 G.NATRIUM DIKLOFENAK TAB 25MG (BPJS) TABLET 366.19
1227 G.NATRIUM DIKLOFENAK TAB 50MG TABLET 458
1228 G.NATRIUM DIKLOFENAK TAB 50MG (BPJS) TABLET 458.37
1229 G.NATRIUM DIKLOFENAK TAB 50MG (INHEALTH) TABLET 306.9
1230 G.NIFEDIPINE TAB 10MG TABLET 148.35
1231 G.NIFEDIPINE TAB 10MG (INHEALTH) TABLET 167
1232 G.OFLOXACIN TAB 400MG TABLET 616
1233 G.OFLOXACIN TAB 400MG(INHEALTH) TABLET 742
1234 G.ONDANSETRON TAB 4MG TABLET 1768
1235 G.ONDANSETRON TAB 4MG (BPJS) TABLET 1414
1236 G.ONDANSETRON TAB 4MG(INHEALTH) TABLET 847
1237 G.ONDANSETRON TAB 8MG TABLET 5500
1238 G.ONDANSETRON TAB 8MG (BPJS) TABLET 2530
1239 G.ONDANSETRON TAB 8MG(INHEALTH) TABLET 2530
1240 G.PANTOPRAZOLE TAB 20MG TABLET 8800
1241 G.PANTOPRAZOLE TAB 40MG TABLET 11000
1242 G.PANTOPRAZOLE TAB 40MG (INHEALTH) TABLET 8000.19
1243 G.PARACETAMOL TAB 500MG TABLET 286.94
1244 G.PARACETAMOL TAB 500MG (BPJS) TABLET 286.94
1245 G.PARACETAMOL TAB 500MG (INHEALTH) TABLET 195
1246 G.PHYTOMENADIONE/VITAMIN K TAB 10MG TABLET 758
1247 G.PHYTOMENADIONE/VITAMIN K TAB 10MG (BPJS) TABLET 1000.51
1248 G.PHYTOMENADIONE/VITAMIN K TAB 10MG(INHEALTTABLET 686
1249 G.PROPRANOLOL TAB 10 MG TABLET 140
1250 G.PROPRANOLOL TAB 10 MG (BPJS) TABLET 140
1251 G.PROPRANOLOL TAB 10 MG (INHEALTH) TABLET 140
1252 G.PYRAZINAMIDE TAB 500MG TABLET 715
1253 G.PYRAZINAMIDE TAB 500MG (BPJS) TABLET 536.25
1254 G.RAMIPRIL TAB 10 MG TABLET 1118.7
1255 G.RAMIPRIL TAB 5 MG TABLET 635
1256 G.RAMIPRIL TAB 5 MG (INHEALTH) TABLET 635
1257 G.RANITIDINE TAB 150MG TABLET 660
1258 G.RANITIDINE TAB 150MG (BPJS) TABLET 396
1259 G.RANITIDINE TAB 150MG (INHEALTH) TABLET 195
1260 G.REBAMIPIDE TAB 100MG TABLET 2090
1261 G.SALBUTAMOL TAB 2 MG TABLET 121
1262 G.SALBUTAMOL TAB 2 MG(INHEALTH) TABLET 86
1263 G.SALBUTAMOL TAB 2MG (BPJS) TABLET 88
1264 G.SALBUTAMOL TAB 4 MG TABLET 121
1265 G.SALBUTAMOL TAB 4 MG(INHEALTH) TABLET 120
1266 G.SALBUTAMOL TAB 4MG (BPJS) TABLET 109.25
Page 134
SO lt.2 (16.6.19)
1267 G.SIMVASTATIN TAB 10MG TABLET 660

1268 G.SIMVASTATIN TAB 10MG (BPJS) TABLET 369
1269 G.SIMVASTATIN TAB 10MG (INHEALTH) TABLET 332
1270 G.SIMVASTATIN TAB 20MG TABLET 1320
1271 G.SIMVASTATIN TAB 20MG (BPJS) TABLET 1320
1272 G.SIMVASTATIN TAB 20MG(INHEALTH) TABLET 473
1273 G.SPIRONOLACTON TAB 100 MG (INHEALTH) TABLET 1111
1274 G.SPIRONOLACTON TAB 100MG TABLET 1055
1275 G.SPIRONOLACTON TAB 100MG (BPJS) TABLET 1540
1276 G.SPIRONOLACTON TAB 25MG TABLET 440
1277 G.SPIRONOLACTON TAB 25MG (BPJS) TABLET 440
1278 G.SPIRONOLACTON TAB 25MG (INHEALTH) TABLET 365
1279 G.TRIAMCINOLONE TAB 4MG TABLET 797.5
1280 G.TRIAMCINOLONE TAB 4MG(INHEALTH) TABLET 597
1281 G.VITAMIN B COMPLEX TAB TABLET 143.99
1282 G.VITAMIN B COMPLEX TAB (BPJS) TABLET 143.99
1283 G.VITAMIN B COMPLEX TAB (INHEALTH) TABLET 122.97
1284 G.VITAMIN B12 TAB 25 MICROGRAM TABLET 90
1285 G.VITAMIN B12 TAB 25 MICROGRAM(INHEALTH) TABLET 90
1286 G.VITAMIN B12 TAB 50 MICROGRAM TABLET 88
1287 G.VITAMIN B12 TAB 50 MICROGRAM (INHEALTH) TABLET 88
1288 G.VITAMIN B6 TAB 10MG TABLET 148.5
1289 G.VITAMIN C TAB 100MG TABLET 121.44
1290 G.VITAMIN C TAB 50MG TABLET 125.84
1291 G.VITAMIN C TAB 50MG (BPJS) TABLET 273
1292 G.VITAMIN C TAB 50MG(INHEALTH) TABLET 116
1293 G.ZINC TAB 20MG TABLET 674.47
1294 G.ZINC TAB 20MG (BPJS) TABLET 674.47
1295 GLUCOPHAGE TAB 500MG 100s TABLET 1703.58
1296 GLUCOPHAGE XR TAB 500MG (INHEALTH) 120s TABLET 2005.05
1297 GLUCOPHAGE XR TAB 500MG 120s TABLET 2451.02
1298 GLUCOPHAGE XR TAB 750MG (INHEALTH) 120s TABLET 2091
1299 GLUCOPHAGE XR TAB 750MG 120s TABLET 2696.16
1300 GLURENORM TAB 30MG (INHEALTH) 100s TABLET 1398
1301 GLURENORM TAB 30MG 100s TABLET 4544.25
1302 GRANON TAB 1MG 10s TABLET 16500
1303 GRATIZIN TAB 10MG TABLET 5813.5
1304 HARNAL D CAP 0.2MG (BPJS) 28s TABLET 7788
1305 HARNAL D CAP 0.2MG 28s TABLET 14775.75
1306 HARNAL TAB (OCAS) 400 MICROGRAM (BPJS) 30s TABLET 5115
1307 HARNAL TAB (OCAS) 400 MICROGRAM 30s TABLET 15288.35
1308 HARNAL TAB (OCAS) 400 MICROGRAM(INHEALTH) 30TABLET 15288.35
1309 HERB. ARDIUM TAB 1000MG 30s TABLET 15400
1310 HERB. CURCUMA TAB 100s TABLET 973.5
1312 HERB. TEBOKAN SPESIAL TAB 80MG 30s TABLET 11715
1313 HEXILON TAB 16 MG 30s TABLET 7370
1316 HEXYMER TAB 2 MG (INHEALTH) 100s TABLET 385
Page 135
SO lt.2 (16.6.19)
1317 HEXYMER TAB 2 MG 100s TABLET 385

1318 HISTRINE FT 10 TAB 30s TABLET 6270
1319 HISTRINE FT 5 TAB 30s TABLET 4400
1320 IKALEP TAB 250MG 30s TABLET 4744
1321 INOXIN 400 TAB 150s TABLET 550
1322 INOXIN 400 TAB(INHEALTH) 150s TABLET 454.03
1323 INTERLAC CHEW TAB TABLET 9900
1324 IRBOSYD TAB TABLET 3850
1325 ISOPRINOSINE TAB 500MG 8s TABLET 13426.88
1326 ISPRINOL TAB 500MG 8s TABLET 10312.5
1327 JANUMET TAB 50 MG/1000 MG 28s TABLET 9146.53
1328 JANUMET TAB 50 MG/500 MG 28s TABLET 9146.53
1329 JANUVIA TAB 100 MG 28s TABLET 17035.9
1330 JANUVIA TAB 50 MG 28s TABLET 17035.9
1331 JARDIANCE TAB 10MG 30s TABLET 16111.07
1332 JARDIANCE TAB 25MG 30s TABLET 21000
1333 KALNEX TAB 500MG TABLET 3520
1334 KALTROFEN TAB 100 30s MG TABLET 4950
1335 KALTROFEN TAB 50MG 30s TABLET 2750
1336 KENACORT TAB 4 MG TABLET 4482.5
1337 KETESSE TAB 25MG 50s TABLET 8800
1338 KETOSTERIL TAB TABLET 7590
1339 KETRICIN TAB TABLET 3630
1340 KSR TAB TABLET 3164.06
1341 KSR TAB (BPJS)@ TABLET 1842.01
1342 KSR TAB(INHEALTH) TABLET 2839.99
1343 LANAKELOID TAB TABLET 9350
1344 LASIX TAB TABLET 5398.2
1345 LAZAFIN TAB 500MG 30s TABLET 6050
1346 LEVAZIDE TAB TABLET 5225
1347 LEVOCIN TAB 500 MG 18s TABLET 39578
1348 LEVOPAR TAB (BPJS) TABLET 4400
1349 LEXATRANS TAB 500MG TABLET 1386
1350 LEXATRANS TAB 500MG (INHEALTH) TABLET 900
1351 LIPANTHYL PENTA TAB 145 MG TABLET 22339
1352 LIPANTHYL SUPRA 160MG TAB TABLET 21761.15
1353 LIPITOR TAB 10MG 30s TABLET 19914.91
1354 LIPITOR TAB 20MG (INHEALTH) 90s TABLET 5250
1357 LIPITOR TAB 40MG(INHEALTH) 90s TABLET 5350
1358 LIZOR TAB TABLET 30690
1359 LODIA TAB 2 MG 60s TABLET 1072.5
1360 MADOPAR D TAB (BPJS) 30s TABLET 6292.3
1361 MADOPAR D TAB 30s TABLET 6292.3
1362 MALTOFER CHEW TAB (INHEALTH) 30s TABLET 2682
1363 MALTOFER CHEW TAB 30s TABLET 2915
1364 MAXPRINOL TAB 500MG 8s TABLET 11000
1365 MEIACT TAB 200 MG 20s TABLET 26400
Page 136
SO lt.2 (16.6.19)
1366 MERISLON TAB 12MG TABLET 7321.22

1367 MERISLON TAB 12MG (INHEALTH) TABLET 3148.11
1368 METRIX TAB 4 MG 30s TABLET 7810
1370 MEXPHARM TAB 15 MG 20s TABLET 8800
1371 MEXPHARM TAB 7.5 MG 20s TABLET 5500
1372 MINIASPI TABLET 80MG TABLET 429
1373 MINIASPI TABLET 80MG (BPJS) TABLET 429
1374 MINIASPI TABLET 80MG (INHEALTH) TABLET 165
1375 MOPRIN TAB 500MG 10s TABLET 7700
1376 MOTILIUM TAB 10MG TABLET 6055
1377 MUCOPECT TAB 30MG TABLET 3742.2
1378 MUCOSTA TAB TABLET 4948
1380 MXN TAB 400MG 10s TABLET 36300
1381 MYLANTA TAB TABLET 601.7
1382 MYONAL TAB 50MG 100s TABLET 7856.59
1383 N-ACE TAB 200MG 30s TABLET 3200
1384 NALETAL TAB 100MG 30s TABLET 10780
1385 NALETAL TAB 50MG 30s TABLET 7700
1386 NALGESTAN TAB TABLET 1636.8
1387 NARFOZ TAB 4MG 12s TABLET 15125
1388 NARFOZ TAB 8 MG 12s TABLET 27500
1389 NEBILET TAB 5MG 28s TABLET 6651.07
1390 NEO MERCAZOLE TAB 100s TABLET 1650
1391 NEOZEP FORTE TAB 100s TABLET 504
1392 NEURALGIN RX TAB TABLET 781
1393 NEUROFENAC PLUS TAB 100s TABLET 5713
1394 NEUROSANBE 5000 TABLET TABLET 2552
1395 NEVOX XR TAB 500MG 30s TABLET 2420
1396 NEW DIATABS TAB (INHEALTH) TABLET 475
1397 NEW DIATABS TAB 100s TABLET 557.15
1398 NEXIUM TAB 20MG 28s TABLET 18205
1399 NEXIUM TAB 40MG 28s TABLET 21809.23
1400 NORVASK TAB 10MG 30s TABLET 14984.35
1401 NORVASK TAB 5MG 30s TABLET 8361.21
1402 NORVASK TAB 5MG(INHEALTH) 100s TABLET 2150
1403 NOVALGIN TAB TABLET 1456.28
1404 OCUSON TAB TABLET 1430
1405 ORINOX TAB 120MG 30s TABLET 11000
1406 ORINOX TAB 90MG 30s TABLET 8250
1407 OSTGEN TAB 30s TABLET 8800
1409 PANADOL CAPT TABLET 813.12
1410 PANADOL COLD&FLU CAPT TABLET 1050.84
1411 PANADOL EXTRA CAPT TABLET 896.28
1412 PARATUSIN TAB TABLET 1162.15
1413 PARIET TAB 10 MG 14s TABLET 18561.48
1414 PARIET TAB 20 MG 14s TABLET 20935.6
1415 PEHADOXIN FORTE TAB 100s TABLET 660
1416 PLADOGREL TAB 75MG TABLET 13200
1417 PLASMINEX TAB 100s TABLET 2904
Page 137
SO lt.2 (16.6.19)
1418 PLAVIX TAB 75MG 28s TABLET 27200.21

1419 PLETAAL TAB 100 MG 30s TABLET 13442
1420 PLETAAL TAB 50 MG (INHEALTH) 100s TABLET 8890.67
1421 PLETAAL TAB 50 MG 100s TABLET 8890.67
1422 POLYSILANE TAB TABLET 962.5
1423 PONSTAN FCT TAB TABLET 2603
1424 PREMASTON TAB 30s TABLET 4216.66
1425 PRESEPT TAB 5GR 50s TABLET 9603
1426 PRIDESIA TAB 5 MG TABLET 2024
1427 PRIMOLUT N TAB (INHEALTH) 30s TABLET 3924
1428 PRIMOLUT N TAB 30s TABLET 7200
1429 PRIMPERAN TAB 10MG TABLET 1375
1430 PRO TB 2 TAB 28s TABLET 7246.25
1431 PRO TB 4 TAB 28s TABLET 5426.65
1432 PROFERTIL TAB 10s TABLET 17050
1433 PROFILAS TAB 50s TABLET 3960
1434 PROSOGAN FD TAB 30MG 28s TABLET 20060.26
1435 PROSPIDE TAB 100MG 100s TABLET 3300
1436 PROSTACOM TAB (INHEALTH) 30s TABLET 10083.33
1437 PROSTACOM TAB 30s TABLET 10083.33
1438 PROVERA TAB 10MG 30s TABLET 11514.65
1439 PURICEMIA TAB TABLET 3025
1440 QUIDEX TAB 500MG* TABLET 12100
1441 QUINOBIOTIC TAB 500MG TABLET 12870
1442 RANTIN TAB 150 MG TABLET 4730
1443 REBAMAX TAB 100MG 30s TABLET 3740
1444 RECOLFAR TAB (BPJS) 30s TABLET 5170
1445 RECOLFAR TAB (INHEALTH) 30s TABLET 5170
1446 RECOLFAR TAB 30s TABLET 5170
1447 RENADINAC TAB 50MG TABLET 605
1448 RENAMID TAB 2MG (INHEALTH) TABLET 155
1449 RENATOR 500MG TAB* TABLET 12100
1450 RETAPHYL SR TAB(INHEALTH) TABLET 1983
1451 RHINOFED TAB TABLET 1870
1452 RIBAVIRIN 200 MG TABLET (COPEGUS) TABLET 6548
1453 RICOVIR TAB 300MG TABLET 18205
1454 RIFABIOTIC TAB 600MG TABLET 3630
1455 RIFASTAR 4FDC TAB TABLET 5115
1456 RIFASTAR 4FDC TAB(INHEALTH) TABLET 4700
1457 RIKLONA TAB 2MG TABLET 7326
1458 RITEZ FT TAB 10MG 30s TABLET 5500
1459 RIZODAL TAB 1MG 20s TABLET 5390
1460 RYDIAN TAB 10 MG (CETIRIZINE) TABLET 4840
1461 SALOFALK TAB 500MG TABLET 13680
1462 SANEXON TAB 16 MG 30s TABLET 5940
1463 SANEXON TAB 4MG 100s TABLET 2376
1464 SANMOL FORTE TAB 650 MG TABLET 363
1465 SANMOL TAB 500MG TABLET 308
1466 SANPRIMA TAB TABLET 957
Page 138
SO lt.2 (16.6.19)
1467 SANTIBI PLUS TAB TABLET 715

1468 SANTIBI TAB 500MG TABLET 1072.5
1469 SEBIVO TAB (INHEALTH) 28s TABLET 48700
1470 SEBIVO TAB 28s TABLET 54305.63
1471 SERLOF TAB 50MG 30s TABLET 15400
1472 SEROQUEL TAB 100MG 60s TABLET 31000
1473 SHAROX TAB 500MG 20s TABLET 23100
1474 SIBELIUM TAB 10MG TABLET 14485
1475 SIBELIUM TAB 5MG TABLET 8690.78
1476 SIFROL ER 0.375MG (BPJS) 30s TABLET 8300
1477 SIFROL ER 0.375MG(INHEALTH) 30s TABLET 13780.78
1478 SIFROL TAB 0.125MG 30s TABLET 8996.3
1479 SIFROL TAB 0.25MG 30s TABLET 15940.84
1480 SIMARC-2 TAB 100s TABLET 1540
1481 SIMARC-2 TAB(INHEALTH) 100s TABLET 1156.54
1482 SIMPROFEN TAB 25MG 30s TABLET 6600
1483 SIRDALUD TAB 2MG TABLET 12200
1484 SIRPLUS TABLET TABLET 220
1485 SPIRASIN TAB 500MG TABLET 6402
1486 SPIROLA TAB 100MG 50s TABLET 5170
1487 SPIROLA TAB 25MG 50s TABLET 1870
1488 SPIROPENT TAB 20 MICROGRAM TABLET 6526
1489 SPORANOX TAB 28s TABLET 39632.33
1490 STALEVO 100/25/200 MG TAB 30s TABLET 19789
1491 STATOR TAB 20 MG 30s TABLET 17600
1492 STENIROL TAB 16MG 50s TABLET 8250
1495 STUGERON TAB 25MG TABLET 3187.01
1496 SULFITIS TAB 500MG 30s TABLET 4766.66
1497 SULFITIS TAB 500MG(INHEALTH) 30s TABLET 2860
1498 SUMAGESIC TAB TABLET 471.16
1499 SUPL G.CITICOLINE TAB 500 MG TABLET 7333.7
1500 SUPL. CALNIC PLUS TAB 30s TABLET 5060
1501 SUPL. CALNIC TAB 30s TABLET 4537.5
1502 SUPL. CAVIT D3 TAB TABLET 2068.14
1503 SUPL. CAVIT D3 TAB(INHEALTH) TABLET 1877.01
1504 SUPL. CYSTONE TAB TABLET 3302.11
1505 SUPL. EZYGARD FORTE TAB 30s TABLET 7040
1506 SUPL. G.FOLIC ACID TAB 1MG TABLET 157.3
1507 SUPL. G.FOLIC ACID TAB 1MG(BPJS) TABLET 157.08
1508 SUPL. GLUCOSAMIN TAB 500MG TABLET 1843
1509 SUPL. HEZANDRA TAB 30s TABLET 4400
1510 SUPL. IMBOOST FORCE TAB TABLET 6453.33
1511 SUPL. IMBOOST TAB TABLET 3410
1512 SUPL. INBUMIN TAB 30s TABLET 6416.66
1513 SUPL. LYCOXY TAB 30MG 30s TABLET 5500
1514 SUPL. MALTOFER FOL CHEW TAB (INHEALTH) 30s TABLET 3116.67
1515 SUPL. MALTOFER FOL CHEW TAB 30s TABLET 3116.66
Page 139
SO lt.2 (16.6.19)
1516 SUPL. PROZA TAB 30s TABLET 11000

1517 SUPL. RENALOF CAPS TABLET 12210
1518 SUPL. RILLUS TAB CHEWABLE 30s TABLET 10000
1519 SUPL. STARFOLAT TAB 400MCG (INHEALTH) 100s TABLET 176
1520 SUPL. THERAGRAN M TAB TABLET 4529.8
1521 SYSMUCO TAB 30s TABLET 4400
1522 TANTUM LOZ 12s TABLET 2888
1523 TEGRETOL CR TAB 200MG TABLET 4811.4
1524 TEGRETOL TAB 200MG TABLET 4146.12
1525 TELFAST HD TAB 180MG 10s TABLET 9343.95
1526 TELFAST OD TAB 120MG 100s TABLET 9119.31
1527 TELFAST OD TAB 120MG(INHEALTH) 100s TABLET 5250
1528 TENSIVASK TAB 10MG 50s TABLET 10450
1529 THROMBO ASPILETS TAB 80MG TABLET 963.9
1530 THROMBO ASPILETS TAB 80MG (INHEALTH) TABLET 560
1531 THYROZOL TAB 10MG TABLET 1962
1532 THYROZOL TAB 10MG(INHEALTH) TABLET 1607
1533 THYROZOL TAB 5MG TABLET 1263.2
1534 THYROZOL TAB 5MG(INHEALTH) TABLET 1034
1535 TORASIC TAB 10MG TABLET 5500
1536 TORASIC TAB 10MG (INHEALTH) TABLET 2000
1537 TRAJENTA (LINAGLIPTIN) TAB 5MG (INHEALTH) 30s TABLET 8873
1538 TRAJENTA (LINAGLIPTIN) TAB 5MG 30s TABLET 17348.43
1539 TRAJENTA DUO 2.5MG/1000MG FCT TAB 30s TABLET 10069.33
1542 TREMENZA TAB TABLET 1523.5
1543 TREMENZA TAB (INHEALTH) TABLET 1523.5
1544 TRENTAL FCT 400MG TAB TABLET 11561.42
1545 TRICHODAZOL TAB 500MG TABLET 1782
1546 TRILAC TAB 4MG 30s TABLET 5000
1547 TROVENSIS TAB 8MG 10s TABLET 18480
1548 TRUVAZ TAB 20MG 30s TABLET 16133.33
1549 UNALIUM TAB 10MG TABLET 8800
1550 URDAHEX CAP(INHEALTH) 30s TABLET 4767
1551 URISPAS TAB 200MG 30s TABLET 5591.66
1552 UROGETIX CAPT 100MG TABLET 6201.8
1553 UROGETIX CAPT 100MG(INHEALTH) TABLET 4750
1554 VALISANBE TAB 2MG TABLET 242
1555 VALISANBE TAB 5MG TABLET 407
1556 VALISANBE TAB 5MG (INHEALTH) TABLET 407
1557 VBLOC TAB 6.25MG 30s TABLET 2933.34
1558 VESICARE TAB 10 MG 30s TABLET 20661.67
1559 VESICARE TAB 5 MG (INHEALTH) 30s TABLET 14002.4
1560 VESICARE TAB 5 MG 30s TABLET 18645
1561 VESTEIN CAP 20s TABLET 4840
1562 VIRIDIS TAB 500 MG 10s TABLET 7150
1563 VIT. NEURODEX TAB TABLET 605
1564 VIT. NEUROSANBE TAB TABLET 1193.5
1565 VIT. NEUROSANBE TAB (INHEALTH) TABLET 1193.5
1566 VOLTAREN SR TAB 75 MG 50s TABLET 9135
Page 140
SO lt.2 (16.6.19)
1567 VOMCERAN TAB 4MG 10s TABLET 16500

1568 VOMCERAN TAB 8MG 10s TABLET 21780
1569 VOMETA FLASH TAB 10MG 50s TABLET 4070
1570 VOMISTOP FT TAB 30s TABLET 4125
1571 VOMIZOLE TAB 40MG 10s TABLET 18425
1572 VOSEDON TAB TABLET 2491.5
1573 XANAX TAB 0.5 MG TABLET 4147.92
1574 XANAX TAB 1 MG TABLET 6814.4
1575 XARELTO TAB 10MG(INHEALTH) 10s TABLET 29792.08
1576 XARELTO TAB 15MG 28s TABLET 33102.3
1577 XEPAZYM CAP 50s TABLET 2750
1578 XIETY TAB 10MG TABLET 4125
1579 ZALDIAR TAB 10s TABLET 11880
1580 ZEMYC TAB 150MG 3s TABLET 63800
1581 ZITANID TAB 30s TABLET 6050
1582 ZITHRAX TAB 500 MG 6s TABLET 60000
1583 ZITHROMAX TAB 500MG 3s TABLET 69417
1584 ZYLORIC TAB 100MG TABLET 2432.29
1585 ZYLORIC TAB 300 MG TABLET 5080.46
1586 ZYPRAZ TAB 0.25MG TABLET 1573
1587 ZYPRAZ TAB 0.5MG TABLET 2942.5
1588 ZYPRAZ TAB 1MG TABLET 4605
1589 ACUATIM CREAM 10GR TUBE 110533.5
1590 ALOCLAIR PLUS GEL 8ML TUBE 84700
1591 ATOPICLAIR CREAM 40ML TUBE 176660
1592 BACTODERM CREAM 2% 5GR TUBE 45100
1593 BACTODERM CREAM 2% 5GRAM(INHEALTH) TUBE 25500
1594 BENOSON CREAM 5GR TUBE 15000
1595 BENOSON G CREAM 10GR TUBE 66000
1596 BENOSON M CREAM 5GR TUBE 60500
1597 BENOSON N CREAM 5GR TUBE 18499.8
1598 BENZOLAC CL CREAM 10GR TUBE 32010
1599 BETASON CREAM 5GR TUBE 9619.5
1600 BIOPLACENTON GEL 15 GR TUBE 17050
1601 BURNAZIN CREAM 35GR TUBE 58850
1602 BURNAZIN CREAM 35GR(INHEALTH) TUBE 47600
1603 CARMED 10% CREAM 40GR TUBE 31900
1604 CARMED 20% CREAM 40GR TUBE 41030
1605 CATHEJELL WITH LIDOCAIN TUBE 64900
1606 CINOLON CREAM 10GR TUBE 17600
1607 CINOLON N CREAM 10GR TUBE 19800
1608 COUNTERPAIN CREAM 30 GR TUBE 36190
1609 COUNTERPAIN PXM 25 GR TUBE 85360
1610 DAIVOBET GEL 15GR TUBE 264000
1611 DAIVOBET OINT 15 G TUBE 264000
1612 DAIVOBET OINT 30 GR (INHEALTH) TUBE 343145
1613 DAIVONEX OINT 30G TUBE 264000
1614 DAKTARIN CREAM 5GR TUBE 21186
1615 DECUBAL CREAM 20 GRAM TUBE 23958
Page 141
SO lt.2 (16.6.19)
1616 DERMANIDE CREAM 10GRAM(INHEALTH) TUBE 15400

1617 DERMATIX ULTRA 15 GR TUBE 250800
1618 DERMOVEL 0.1% CREAM 10GR TUBE 71500
1619 DERMOVEL 0.1% CREAM 10GR (INHEALTH) TUBE 34500
1620 DESOLEX CREAM 10GR TUBE 25080
1621 DIPROGENTA CREAM 10 GR TUBE 94050
1622 DIPROGENTA OINT 5GR TUBE 68090
1623 DIPROSONE OV CREAM 10GR TUBE 99775.5
1624 DIPROSONE OV OINT 5GR TUBE 53677
1625 DUMIN RECTAL TUBE 125MG/2.5ML TUBE 15510
1626 DUMIN RECTAL TUBE 250MG/4ML TUBE 21670
1627 ELOCON CREAM 10GR TUBE 107140
1628 ELOCON OINT 10GR TUBE 107140
1629 ELOX 0,1% CREAM 5GR TUBE 48400
1630 ESPERSON CREAM 15 GR TUBE 137649.6
1631 EVALEN GEL 0.1% 10GR TUBE 44000
1632 FAKTU OINT 20 GR TUBE 108240
1633 FLAMAR EMULGEL 20 GR TUBE 17600
1634 FLAMAR EMULGEL 20GR (INHEALTH) TUBE 17600
1635 FORMYCO CREAM 10GR TUBE 19800
1636 FUCILEX CREAM 2% 5GR TUBE 11000
1637 FUCILEX CREAM 2% 5GRAM(BPJS) TUBE 8800
1638 FUCILEX CREAM 2% 5GRAM(INHEALTH) TUBE 6600
1639 FULADIC CREAM 5GR TUBE 58300
1640 G.ACYCLOVIR 5% CREAM 5GR TUBE 4342.8
1641 G.BETAMETASON 0,1 % CREAM 5GR (BPJS) TUBE 2559.7
1642 G.BETAMETASON 0.1% CREAM 5GR TUBE 2640
1643 G.BETAMETASON 0.1% CREAM 5GR (INHEALTH) TUBE 1999.8
1644 G.DESOXIMETASONE CREAM 0.25% 15GR TUBE 19142.2
1646 G.DESOXIMETASONE OINT 0.25% 15GR TUBE 21272
1647 G.DESOXIMETASONE OINT 0.25% 15GR (INHEALTH) TUBE 19144
1648 G.GENTAMYCIN OINT 0.1% 5GR TUBE 3651
1649 G.HYDROCORTISON 1% CREAM 5GR TUBE 6600
1650 G.HYDROCORTISON 1% CREAM 5GR (BPJS) TUBE 4400
1651 G.HYDROCORTISON 2.5% CREAM (BPJS) TUBE 5500
1652 G.HYDROCORTISON 2.5% CREAM 5GR TUBE 8800
1653 G.KETOCONAZOLE CREAM 2% 10GR TUBE 5610
1654 G.KETOCONAZOLE CREAM 2% 10GR (BPJS) TUBE 5610
1655 G.KETOCONAZOLE CREAM 2% 10GR (INHEALTH) TUBE 3899.01
1656 G.MICONAZOLE CREAM 2 % 10GR (INHEALTH) TUBE 3414.4
1657 G.MICONAZOLE CREAM 2 % 10GR TUBE 3575
1658 G.MOMETASONE CREAM 10GR TUBE 22275
1659 G.MOMETASONE CREAM 10GR (BPJS) TUBE 22275
1660 GLYCORE 8 CREAM TUBE 25300
1661 HARMONIA ACNE SPOT TUBE 62920
1662 HEMOLOK GEL 15GR TUBE 76450
1663 HERB. MEBO OINT 20GR TUBE 87450
1664 INERSON 0.25% OINT 15GR(INHEALTH) TUBE 32200
1665 KALTROFEN GEL 2.5% 30 GR TUBE 60500
Page 142
SO lt.2 (16.6.19)
1666 KENACORT A CREAM 10 GR TUBE 81400

1667 KENALOG IN ORABASE 5 GR TUBE 54450
1668 KETRICIN ORABASE 0.1% 5GR TUBE 49500
1669 KLODERMA CREAM 10GR TUBE 34787.5
1670 KLODERMA OINTMENT 10GR TUBE 34787.5
1671 MEDERMA CREAM 20GR(PROAKTIF GEL) TUBE 187000
1672 MEDI-KLIN GEL 15G TUBE 25190
1673 MEDIFLEX CREAM 75GR TUBE 192500
1674 MEDIQUIN 5% CREAM 15G TUBE 33000
1675 MELANOX ES 15GR TUBE 65890
1676 MELANOX FORTE 4% TUBE 34650
1677 MICROLAX ENEMA TUBE 20625
1678 MOFACORT 0.1% CREAM 10GR TUBE 73205
1679 MOFACORT 0.1% OINTMENT 10GR TUBE 73205
1680 MOISDERM 20% 20GRAM(INHEALTH) TUBE 28999.99
1681 MYCO Z OINT 10 GR TUBE 74250
1682 NEBACETIN OINT 5GR TUBE 18700
1683 NIACEF GEL 15GR TUBE 31570
1684 NOROID SOOTHING CREAM 80ML TUBE 121000
1685 NOVELL SMOOTHING CREAM TUBE 242000
1686 OSTEOR C CREAM 60GR TUBE 132000
1687 PARASOL CREAM 20GR TUBE 40865
1688 PARASOL CREAM 33 SPF TUBE 56430
1689 PIBAKSIN OINT 10GR TUBE 44000
1690 PIBAKSIN OINT 10GR (INHEALTH) TUBE 44000
1691 PIROFEL GEL 20GR TUBE 18920
1692 PIROTOP CREAM 10GR TUBE 65560
1693 PRODIVA VAGINAL GEL TUBE 220000
1694 SAGALON CREAM 10GR TUBE 40315
1695 SAGESTAM CREAM 10GR TUBE 13200
1696 SCABIMITE CREAM 10 GR TUBE 44000
1697 SCABIMITE CREAM 10 GR(INHEALTH) TUBE 44000
1698 SEBCLAIR CREAM 30ML TUBE 131450
1699 SOFT U DERM 40 GR TUBE 36300
1700 STESOLID RECTAL TUBE 10MG/2.5ML TUBE 39204
1701 STESOLID RECTAL TUBE 5MG/2.5ML TUBE 26136
1702 TERMISIL CREAM 10GR TUBE 53130
1703 THROMBOPOB GEL 20GR TUBE 54450
1704 ULTRAPROCT N CREAM 10 GR TUBE 133000
1705 VITACID 0.05% CREAM 20GR TUBE 37180
1706 VITACID 0.1% CREAM 20 GR TUBE 48290
1707 VOLTAREN EMULGEL 1% 50GR TUBE 163296.1
1708 ZOLORAL 2 % CREAM TUBE 22000
1709 ZOLORAL 2 % CREAM(KETOCONAZOL)(INHEALTH) TUBE 3500
1710 FARSORBID INJ VIAL 66000
1711 FARSORBID INJ (INHEALTH) VIAL 333355
1712 FIBRION 1.500.000 IU (INHEALTH) VIAL 3971000
1713 G.CEFTRIAXONE INJ 1GR VIAL 38500
1714 G.CEFTRIAXONE INJ 1GR(BPJS) VIAL 4708.55
Page 143
SO lt.2 (16.6.19)
1715 G.DIPHENHYDRAMIN INJ 150MG/15ML VIAL 7700

1716 G.DOBUTAMINE INJ 250MG/5ML VIAL 77000
1717 G.DOBUTAMINE INJ 250MG/5ML (BPJS) VIAL 27342.7
1718 G.DOBUTAMINE INJ 250MG/5ML (INHEALTH) VIAL 26526
1719 G.METHYLPREDNISOLONE INJ 125MG VIAL 49500
1720 G.METHYLPREDNISOLONE INJ 125MG (BPJS) VIAL 32711
1721 G.METHYLPREDNISOLONE INJ 125MG(INHEALTH) VIAL 24640
1722 G.NOREPINEPHRINE BITARTRATE INJ 4MG/4ML VIAL 66000
1723 G.OMEPRAZOLE INJ 40MG VIAL 88000
1724 G.OMEPRAZOLE INJ 40MG (BPJS) VIAL 27500
1725 G.PANTOPRAZOLE INJ 40MG VIAL 88000
1726 INOTROP INJ 250MG/5ML VIAL 108900
1727 NEXIUM INJ 40MG VIAL 205106
1728 NEXIUM INJ 40MG (INHEALTH) VIAL 100000
1729 PPD 2 TU 1.5 ML VIAL 772475
1730 PROXIUM INJ 40MG VIAL 176000
1731 PUMPISEL INJ VIAL 158840
1732 PUMPISEL INJ (INHEALTH) VIAL 64000
1733 PUMPITOR INJ VIAL 160930
1734 SEMAX SOL 0.1% 3 ML VIAL 1782000
1735 UDOPA INJ 40MG/ML (INHEALTH) VIAL 14127
1736 VAKSIN TETANUS TOXOIDT 5ML VIAL 93500
1737 VAKSIN VERORAB 0.5M (BPJS) VIAL 170137
1738 VAKSIN VERORAB 0.5ML VIAL 212799.4
1739 VIT. CERNEVIT INJ VIAL 190300
Total: 63150385.68
Page 144
SO lt.2 (16.6.19)
Stok CutOff Stok Fisik Stok Selisih Nominal SeHarga SO Keterangan

1720 1 -1719 -85950 50 salah input
1037 1 -1036 -51800 50 salah input
203 119 -84 -298200.8 422451.19 kurang input
57 17 -40 -21000 8925 Lantai 1 belum RO
36 7 -29 -232000 56000 salah input
22 0 -22 -286000 0 belum terhitung
25 20 -5 -242000 968000
2 0 -2 -28050 0
1 0 -1 -19800 0
1 0 -1 -28512 0 belum terinput
135 134 -1 -10450 1400300
59 58 -1 -13310 771980
0 3 3 14300.01 14300.01
7 14 7 70070 140140 belum RO
9 18 9 90090 180180 belum RO
11 22 11 334262.5 668525 belum RO
0 12 12 32676 32676 belum RO
17 34 17 1122000 2244000 belum RO
-89 89 178 1629401 814700.66 salah input
3 3 0 0 60500.01
1 1 0 0 311850
1 1 0 0 113300
1 1 0 0 88825
1 1 0 0 17710
0 0 0 0 0
104 104 0 0 693576
42 42 0 0 13398
4 4 0 0 1064.8
4 4 0 0 16500
0 0 0 0 0
8 8 0 0 70400
9 9 0 0 89100
2 2 0 0 343200
13 13 0 0 5990.4
1 1 0 0 113300
0 0 0 0 0
2 2 0 0 9822
7 7 0 0 53900
2 2 0 0 6600
50 50 0 0 42000
1 1 0 0 27225
12 12 0 0 78004.56
0 0 0 0 0
8 8 0 0 103840
4 4 0 0 75240
0 0 0 0 0
2 2 0 0 192
100 100 0 0 40755
Page 145
SO lt.2 (16.6.19)
0 0 0 0 0
30 30 0 0 19050
20 20 0 0 344568.4
0 0 0 0 0
0 0 0 0 0
3 3 0 0 18000
58 58 0 0 69600
31 31 0 0 8252.2
6 6 0 0 158400
0 0 0 0 0
0 0 0 0 0
58 58 0 0 18502
0 0 0 0 0
3 3 0 0 28500
52 52 0 0 34034
1 1 0 0 15491.67
30 30 0 0 32910
72 72 0 0 63360
6 6 0 0 121440
2 2 0 0 53240
4 4 0 0 106480
0 0 0 0 0
5 5 0 0 19800
36 36 0 0 788400
3 3 0 0 56265
2 2 0 0 106846.66
1 1 0 0 60793
2 2 0 0 133540
4 4 0 0 257400
44 44 0 0 32428
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 0 0 179438.6
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 94600
1 1 0 0 133466.66
0 0 0 0 0
10 10 0 0 123200
0 0 0 0 0
13 13 0 0 386100
17 17 0 0 13744.5
1 1 0 0 37396.7
1 1 0 0 60793.33
Page 146
SO lt.2 (16.6.19)
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
8 8 0 0 357280
4 4 0 0 308000
6 6 0 0 13200
9 9 0 0 14355
11 11 0 0 395004.5
2 2 0 0 140981
2 2 0 0 67800
0 0 0 0 0
0 0 0 0 0
7 7 0 0 606375
0 0 0 0 0
53 53 0 0 959883.53
22 22 0 0 100100
27 27 0 0 285036.3
7 7 0 0 280530.25
12 12 0 0 480909
16 16 0 0 107184
0 0 0 0 0
0 0 0 0 0
5 5 0 0 192500
2 2 0 0 108108
3 3 0 0 145200
1 1 0 0 4180000
10 10 0 0 210540
11 11 0 0 124388
27 27 0 0 175415.76
2 2 0 0 12993.76
2 2 0 0 11264.26
5 5 0 0 34650
12 12 0 0 48000
3 3 0 0 12540
8 8 0 0 176666.64
5 5 0 0 110416.65
5 5 0 0 85000
41 41 0 0 586300
14 14 0 0 33633.6
0 0 0 0 0
5 5 0 0 137500
3 3 0 0 74250
2 2 0 0 44000
9 9 0 0 85500
10 10 0 0 95000
10 10 0 0 95002.3
81 81 0 0 286902
45 45 0 0 153450
35 35 0 0 561330
Page 147
SO lt.2 (16.6.19)
28 28 0 0 148191.12
21 21 0 0 134715
15 15 0 0 26400
0 0 0 0 0
5 5 0 0 6600
6 6 0 0 52800
6 6 0 0 528000
0 0 0 0 0
3 3 0 0 257400
0 0 0 0 0
14 14 0 0 107800
24 24 0 0 122400
25 25 0 0 82500
18 18 0 0 332640
21 21 0 0 107100.21
22 22 0 0 121000
8 8 0 0 448040
25 25 0 0 1120102.5
2 2 0 0 33000
19 19 0 0 90566.73
2 2 0 0 9533.34
6 6 0 0 123156
19 19 0 0 133760
34 34 0 0 83776
10 10 0 0 22000
6 6 0 0 41481
4 4 0 0 17925.6
3 3 0 0 23046
4 4 0 0 215600
5 5 0 0 635250
0 0 0 0 0
9 9 0 0 138600
3 3 0 0 155100
15 15 0 0 268052.4
1 1 0 0 198553.19
0 0 0 0 0
1 1 0 0 12523.5
10 10 0 0 215416.6
3 3 0 0 102149.85
14 14 0 0 144200.28
12 12 0 0 109200
2 2 0 0 189200
2 2 0 0 189200
1 1 0 0 94600
3 3 0 0 214500
9 9 0 0 540540
0 0 0 0 0
3 3 0 0 58443
3 3 0 0 34101
Page 148
SO lt.2 (16.6.19)
3 3 0 0 21000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
52 52 0 0 1244841
21 21 0 0 405332.34
0 0 0 0 0
0 0 0 0 0
8 8 0 0 313984
7 7 0 0 731500
2 2 0 0 19976
13 13 0 0 715000
13 13 0 0 328900
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
15 15 0 0 544500
9 9 0 0 663894
4 4 0 0 102740
11 11 0 0 207273
4 4 0 0 38400
7 7 0 0 72667.98
34 34 0 0 185878
0 0 0 0 0
11 11 0 0 665500
2 2 0 0 92400
2 2 0 0 114400
1 1 0 0 90750
0 0 0 0 0
1 1 0 0 34210
0 0 0 0 0
2 2 0 0 165000
4 4 0 0 204600
4 4 0 0 1227600
0 0 0 0 0
1 1 0 0 135828
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 0 0 31413.76
10 10 0 0 108570
7 7 0 0 133595
14 14 0 0 59290
3 3 0 0 97350
0 0 0 0 0
Page 149
SO lt.2 (16.6.19)
4 4 0 0 352000
2 2 0 0 91960
3 3 0 0 238590
5 5 0 0 544500
2 2 0 0 132310.2
2 2 0 0 135300
1 1 0 0 42680
2 2 0 0 113960
1 1 0 0 56980
2 2 0 0 151140
0 0 0 0 0
1 1 0 0 15862
2 2 0 0 77220
3 3 0 0 237600
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 6 0 0 169620
2 2 0 0 114400
2 2 0 0 168300
0 0 0 0 0
2 2 0 0 59400
4 4 0 0 73920
4 4 0 0 209880
0 0 0 0 0
0 0 0 0 0
3 3 0 0 224400
0 0 0 0 0
0 0 0 0 0
1 1 0 0 83344
0 0 0 0 0
0 0 0 0 0
5 5 0 0 33000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 11489.5
2 2 0 0 22979
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 16500
0 0 0 0 0
0 0 0 0 0
5 5 0 0 151250
4 4 0 0 59400
2 2 0 0 23600
Page 150
SO lt.2 (16.6.19)
1 1 0 0 10440.1
1 1 0 0 10439
1 1 0 0 8500
2 2 0 0 52800
1 1 0 0 22440
5 5 0 0 77000
0 0 0 0 0
0 0 0 0 0
1 1 0 0 11000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 8250
1 1 0 0 8500
0 0 0 0 0
10 10 0 0 55000
0 0 0 0 0
0 0 0 0 0
15 15 0 0 240459
1 1 0 0 145015.2
7 7 0 0 589638
1 1 0 0 32000
17 17 0 0 678810
11 11 0 0 505780
6 6 0 0 349800
0 0 0 0 0
4 4 0 0 221760
1 1 0 0 79750
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 23 0 0 409860
0 0 0 0 0
0 0 0 0 0
2 2 0 0 26097.5
4 4 0 0 99440
5 5 0 0 114160
5 5 0 0 62621.35
2 2 0 0 171600
3 3 0 0 148500
3 3 0 0 324845.4
3 3 0 0 247500
0 0 0 0 0
8 8 0 0 387200
3 3 0 0 159000
Page 151
SO lt.2 (16.6.19)
3 3 0 0 85800
0 0 0 0 0
2 2 0 0 82500
3 3 0 0 123750
2 2 0 0 250000
1 1 0 0 209446.6
4 4 0 0 127600
0 0 0 0 0
3 3 0 0 162690
3 3 0 0 193875
1 1 0 0 67705
1 1 0 0 56650
3 3 0 0 349800
0 0 0 0 0
4 4 0 0 242000
6 6 0 0 541200
0 0 0 0 0
0 0 0 0 0
4 4 0 0 308000
3 3 0 0 148701.3
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 5400
3 3 0 0 57750
0 0 0 0 0
2 2 0 0 70866.4
1 1 0 0 10010
7 7 0 0 60060
6 6 0 0 19338
3 3 0 0 23100
13 13 0 0 130130
10 10 0 0 151800
4 4 0 0 51920
38 38 0 0 114000
2 2 0 0 132000
4 4 0 0 220000
1 1 0 0 29700
3 3 0 0 31350
2 2 0 0 63800
0 0 0 0 0
4 4 0 0 102080
8 8 0 0 202400
3 3 0 0 111000
1 1 0 0 71500
0 0 0 0 0
3 3 0 0 280500
Page 152
SO lt.2 (16.6.19)
3 3 0 0 89100
4 4 0 0 101200
4 4 0 0 242000
0 0 0 0 0
0 0 0 0 0
3 3 0 0 82500
5 5 0 0 181500
1 1 0 0 49500
0 0 0 0 0
0 0 0 0 0
3 3 0 0 61380
2 2 0 0 40920
3 3 0 0 45870
3 3 0 0 45870
4 4 0 0 67320
10 10 0 0 655600
20 20 0 0 780032.8
4 4 0 0 50160
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
5 5 0 0 447700
3 3 0 0 108900
0 0 0 0 0
0 0 0 0 0
1 1 0 0 46200
2 2 0 0 187000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
3 3 0 0 227700
3 3 0 0 825000
1 1 0 0 43890
4 4 0 0 161920
5 5 0 0 183700
3 3 0 0 453750
4 4 0 0 85800
1 1 0 0 21450
3 3 0 0 108900
3 3 0 0 132000
0 0 0 0 0
0 0 0 0 0
3 3 0 0 191400
0 0 0 0 0
2 2 0 0 86900
1 1 0 0 43450
0 0 0 0 0
5 5 0 0 206250
Page 153
SO lt.2 (16.6.19)
2 2 0 0 60500
13 13 0 0 42900
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1 1 0 0 487919.3
1 1 0 0 305760.4
0 0 0 0 0
63 63 0 0 917532
70 70 0 0 257565
41 41 0 0 529925
16 16 0 0 98560
34 34 0 0 96866
79 79 0 0 21725
4 4 0 0 1100
6 6 0 0 59400
10 10 0 0 14250
2 2 0 0 2400
0 0 0 0 0
0 0 0 0 0
75 75 0 0 783750
75 75 0 0 1196250
0 0 0 0 0
5 5 0 0 73333.3
60 60 0 0 85800
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
32 32 0 0 68464
13 13 0 0 90571
74 74 0 0 610500
194 194 0 0 426800
122 122 0 0 939400
116 116 0 0 1084600
93 93 0 0 1023000
60 60 0 0 273900
156 156 0 0 1029600
95 95 0 0 836000
10 10 0 0 67630
7 7 0 0 38500
79 79 0 0 260700
36 36 0 0 34452
67 67 0 0 95810
34 34 0 0 1309000
97 97 0 0 545237
Page 154
SO lt.2 (16.6.19)
108 108 0 0 368280

62 62 0 0 494450
145 145 0 0 1414234.3
135 135 0 0 1365056.55
68 68 0 0 335580
0 0 0 0 0
70 70 0 0 64166.9
177 177 0 0 3504600
80 80 0 0 870800
95 95 0 0 2299000
100 100 0 0 3850000
137 137 0 0 1507030.14
146 146 0 0 2258640.44
75 75 0 0 284625
25 25 0 0 481250
48 48 0 0 1584000
2 2 0 0 59400
20 20 0 0 1496000
110 110 0 0 663483.7
86 86 0 0 94600
94 94 0 0 113740
77 77 0 0 93170
117 117 0 0 280167.03
123 123 0 0 220900.62
102 102 0 0 85486.2
211 211 0 0 1160500
229 229 0 0 923632.57
36 36 0 0 13860
0 0 0 0 0
0 0 0 0 0
33 33 0 0 50820
60 60 0 0 78360
60 60 0 0 82526.4
5 5 0 0 1455.05
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
37 37 0 0 162800
0 0 0 0 0
10 10 0 0 18500
0 0 0 0 0
45 45 0 0 891000
4 4 0 0 22000
60 60 0 0 291060
0 0 0 0 0
0 0 0 0 0
73 73 0 0 321200
Page 155
SO lt.2 (16.6.19)
56 56 0 0 204512
197 197 0 0 319455.2
107 107 0 0 95431.16
97 97 0 0 54417
152 152 0 0 133760
177 177 0 0 136290
72 72 0 0 29399.04
65 65 0 0 26540.8
89 89 0 0 29072.74
79 79 0 0 47795
31 31 0 0 15004
45 45 0 0 27225
65 65 0 0 357500
50 50 0 0 93500
122 122 0 0 228140
20 20 0 0 35392.6
114 114 0 0 96415.5
50 50 0 0 28303
87 87 0 0 401940
109 109 0 0 1678600
73 73 0 0 803000
61 61 0 0 335500
7 7 0 0 17325
205 205 0 0 284130
0 0 0 0 0
1 1 0 0 12571.43
61 61 0 0 476410
14 14 0 0 36960
49 49 0 0 93100
410 410 0 0 20500
546 546 0 0 27300
1 1 0 0 77
52 52 0 0 843700
120 120 0 0 1542420
92 92 0 0 126500
49 49 0 0 485100
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
27 27 0 0 237600
62 62 0 0 110484
267 267 0 0 1082909.28
24 24 0 0 372768
2 2 0 0 18000
0 0 0 0 0
0 0 0 0 0
79 79 0 0 1303500
9 9 0 0 21178.62
90 90 0 0 216179.1
Page 156
SO lt.2 (16.6.19)
0 0 0 0 0
0 0 0 0 0
31 31 0 0 315425
0 0 0 0 0
43 43 0 0 551833.62
60 60 0 0 887172
50 50 0 0 739310
0 0 0 0 0
0 0 0 0 0
75 75 0 0 990000
90 90 0 0 341550
151 151 0 0 1164361
45 45 0 0 742500
79 79 0 0 901897.97
100 100 0 0 1452000
145 145 0 0 757625
130 130 0 0 679216.2
0 0 0 0 0
30 30 0 0 168960
17 17 0 0 368390
112 112 0 0 2375296
107 107 0 0 3277945
0 0 0 0 0
21 21 0 0 145530
145 145 0 0 1674750
66 66 0 0 871200
39 39 0 0 228800.13
0 0 0 0 0
70 70 0 0 436333.8
46 46 0 0 441906.36
59 59 0 0 441320
77 77 0 0 762300
82 82 0 0 1082400
60 60 0 0 285999.6
0 0 0 0 0
0 0 0 0 0
43 43 0 0 53199.6
136 136 0 0 149600
24 24 0 0 208560
65 65 0 0 382525
63 63 0 0 658350
80 80 0 0 806666.4
90 90 0 0 792000
53 53 0 0 166950
14 14 0 0 48972
226 226 0 0 1180850
7 7 0 0 19250
0 0 0 0 0
4 4 0 0 154000
Page 157
SO lt.2 (16.6.19)
1 1 0 0 6930
1 1 0 0 93500
0 0 0 0 0
1 1 0 0 18364.5
0 0 0 0 0
1 1 0 0 215050
6 6 0 0 311370
4 4 0 0 270564
1 1 0 0 90062
9 9 0 0 370260
3 3 0 0 244200
2 2 0 0 154000
25 25 0 0 605000
28 28 0 0 575960
1 1 0 0 20900
8 8 0 0 149600
0 0 0 0 0
2 2 0 0 88220
1 1 0 0 33000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
58 58 0 0 403343.6
98 98 0 0 539000
4 4 0 0 145200
45 45 0 0 312939
63 63 0 0 346500
0 0 0 0 0
0 0 0 0 0
2 2 0 0 121220
3 3 0 0 326205
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
4 4 0 0 141240
2 2 0 0 228905.6
280 280 0 0 280000
0 0 0 0 0
0 0 0 0 0
4 4 0 0 436
100 100 0 0 10000
8 8 0 0 308796.4
0 0 0 0 0
1 1 0 0 2546
0 0 0 0 0
8 8 0 0 264000
3 3 0 0 247500
0 0 0 0 0
Page 158
SO lt.2 (16.6.19)
7 7 0 0 3465
258 258 0 0 32250
54 54 0 0 17550.54
5 5 0 0 75900
5 5 0 0 88085.8
8 8 0 0 124960
1 1 0 0 9108
8 8 0 0 46800
0 0 0 0 0
19 19 0 0 416100
22 22 0 0 481800
7 7 0 0 86240
9 9 0 0 470250
1 1 0 0 455262
0 0 0 0 0
1 1 0 0 455262
517 517 0 0 81324.1
1 1 0 0 25300
2 2 0 0 50600
2 2 0 0 50000
2 2 0 0 50000
0 0 0 0 0
0 0 0 0 0
2 2 0 0 21681
1 1 0 0 143641.66
0 0 0 0 0
1 1 0 0 52013.5
1 1 0 0 60214
3 3 0 0 258060
1 1 0 0 70551.25
3 3 0 0 180290.01
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
2 2 0 0 202796
0 0 0 0 0
1 1 0 0 133897.5
0 0 0 0 0
1 1 0 0 132330
1 1 0 0 92631
1 1 0 0 121605
1 1 0 0 139883.33
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
6 6 0 0 21384
7 7 0 0 27720
Page 159
SO lt.2 (16.6.19)
10 10 0 0 77000
5 5 0 0 140250
9 9 0 0 23760
0 0 0 0 0
11 11 0 0 20570
0 0 0 0 0
6 6 0 0 231000
10 10 0 0 82500
50 50 0 0 269500
4 4 0 0 300000
3 3 0 0 313500
3 3 0 0 313500
3 3 0 0 313500
37 37 0 0 1480166.5
2 2 0 0 84700
1 1 0 0 20790
0 0 0 0 0
0 0 0 0 0
3 3 0 0 660000
0 0 0 0 0
2 2 0 0 47300
2 2 0 0 37510
4 4 0 0 83600
2 2 0 0 37510
0 0 0 0 0
3 3 0 0 165000
2 2 0 0 319000
3 3 0 0 195000
3 3 0 0 405000
0 0 0 0 0
2 2 0 0 451000
2 2 0 0 150000
2 2 0 0 154000
4 4 0 0 299200
2 2 0 0 150000
4 4 0 0 52000
3 3 0 0 39000
6 6 0 0 78000
5 5 0 0 65000
6 6 0 0 78000
536 536 0 0 383240
5 5 0 0 66000
2 2 0 0 57200
4 4 0 0 52800
0 0 0 0 0
5 5 0 0 104500
30 30 0 0 990000
3 3 0 0 450000
4 4 0 0 338800
Page 160
SO lt.2 (16.6.19)
1 1 0 0 84700
0 0 0 0 0
43 43 0 0 638550
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SO lt.2 (16.6.19)
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SO lt.2 (16.6.19)
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SO lt.2 (16.6.19)
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SO lt.2 (16.6.19)
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SO lt.2 (16.6.19)
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1 1 0 0 26526
5 5 0 0 247500
0 0 0 0 0
3 3 0 0 73920
4 4 0 0 264000
11 11 0 0 968000
9 9 0 0 247500
31 31 0 0 2728000
0 0 0 0 0
12 12 0 0 2461272
2 2 0 0 200000
0 0 0 0 0
0 0 0 0 0
21 21 0 0 3335640
11 11 0 0 704000
0 0 0 0 0
0 0 0 0 0
3 3 0 0 42381
3 3 0 0 280500
0 0 0 0 0
1 1 0 0 212799.4
3 3 0 0 570900
61756 59052 -2704 1975727 386131631
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Sheet1

LAPORAN STOCK OPNAME

41 04369 G.ACARBOSE TAB 100 MG

90 02532 CATAPRES INJ 150 MICROGRAM/ML(INHEALTH)

139 01563 G.ONDANSETRON INJ 4MG/2ML

188 04680 SANTAGESIK INJ 1GR/2ML 5s

237 01591 CLARITIN SYRUP 60 ML

286 03246 G.IBUPROFEN SYRUP 100MG/5ML (INHEALTH)

335 01287 MUCOPECT 30MG/5ML ADULT SYRUP 60 ML

384 02652 SALICYL TALK (INHEALTH)

433 00742 SYMBICORT 160/ 4.5 UG 60 DOSIS

482 00140 CEFSPAN CAP 100 MG 30s

531 01969 G.PHENYTOIN CAP 100 MG

580 00145 PRADAXA CAP 110MG

629 01089 GELOFUSIN INFUS 500ML

678 02303 FLAGYSTATIN OVULA

727 A0085 BOTOL COKLAT 50 CC

776 A0428 IV CANNULA G24

825 A0761 REBREATHING MASK PED

874 A0900 SYRINGE 50ML TERUMO

923 02585 INFUS RING AS/ASERING 500ML(INHEALTH)

972 02316 ASPAR K TAB 300MG(INHEALTH)

1021 01269 DOLO NEUROBION TAB

1070 00820 G.AMBROXOL TAB 30MG

1119 02101 G.CIPROFLOXACIN TAB 500MG(INHEALTH)

1168 03668 G.IBUPROFEN TAB 200 MG(BPJS)

1217 03710 G.METHYLPREDNISOLONE TAB 4MG (BPJS)

1266 03736 G.SALBUTAMOL TAB 4MG (BPJS)

1315 00415 HEXILON TAB 8 MG 30s

1364 OB18070001 MAXPRINOL TAB 500MG 8s

1413 00586 PARIET TAB 10 MG 14s

1462 03174 SANEXON TAB 16 MG 30s

1511 00583 SUPL. IMBOOST TAB

1560 01708 VESICARE TAB 5 MG 30s

1609 00185 COUNTERPAIN PXM 25 GR

1658 03814 G.MOMETASONE CREAM 10GR

1707 01761 VOLTAREN EMULGEL 1% 50GR

CO19060001 DiSetujuiOleh ERWIN

TABLET 1635.48 101 101 0

TABLET 330 159 159 0

TABLET 330.41 113 113 0

No Nama Satuan CostDasar

31 G.METHISOPRINOL TAB 500MG 03703 5500

80 BENANG PROLENE 7-0 W8702 (TP/ETHICON) (BPJS) A1957 218487.5

129 G.KETOROLAC INJ 3%(BPJS) AMPUL 5292.54

178 PRIMPERAN INJ 10MG/2ML (INHEALTH) AMPUL 7000

227 CEFAROX DRY SYRUP 100MG/5ML BOTTLE 88000

276 G.CETIRIZINE SYRUP 5MG/5ML 60ML BOTTLE 10440.1

326 LASAL SYRUP 100ML BOTTLE 28600

375 PRORIS FORTE SYRUP 50 ML BOTTLE 29700

424 ZINKID SYRUP 100ML BOTTLE 30250

473 AMOXSAN CAP 500MG CAPSUL 3410

522 G.ITRACONAZOLE CAP 100MG (INHEALTH) CAPSUL 3652

573 NITROKAF RETARD 2,5 MG CAP (INHEALTH) CAPSUL 2200

622 ALKOHOL 70% 100 ML FLASH 6930

674 CEPEZET TAB 100MG OB18090015 495

723 BLOOD SET BPJS PIECES 7700

772 INTUBATION STYLET(MANDRIN)NO.14 SIZE L 4.3MM PIECES 84700

821 POT PLASTIK 50 CC PIECES 715

871 SYRINGE 3ML ONEMED PIECES 859.1

922 INFUS RING AS/ASERING 500ML SOFTBAG 29710.38

972 ASPAR K TAB 300MG(INHEALTH) TABLET 1945

1021 DOLO NEUROBION TAB TABLET 1635.48

1070 G.AMBROXOL TAB 30MG TABLET 330