NO Komposisi Merk Pabrik Kemasan Harga

NO KOMPOSISI MERK PABRIK KEMASAN HARGA
ACT (Artesunate tablet 50 mg + Amodiaquine

1 anhydrida tablet 200 mg) n/a PT. Kimia Farma 1 blister@24 tablet 1,375
2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera PT. SmithKline Beecham Phamaceuticals

Dus, 3 Blister @ 10 kapsul 28,875
3 Air untuk irigasi lar infus 1000 ml WIDA WI UNICAP PT. Widatra Bhakti Btl @ 1000 ml 7,875
4 Akarbose tablet/kaplet 100 mg n/a PT. Dexa Medica Dus, 10 strip @10tablet 990
5 Akarbose tablet/kaplet 50 mg n/a PT. Dexa Medica Dus, 10 strip @10tablet 780
6 Albendazol suspensi 200 mg/5 ml n/a PT. Indofarma Dus, 10 dus @ 1 botol @ 10 ml 4,041
7 Albendazol tablet/kapsul/kaplet 400 mg n/a PT. Kimia Farma ktk 5 x 6 tablet 350
Albumin serum normal (human albumin)
8 injeksi 20%, 100 ml Zenalb PT. Ikapharmindo Vial 100 ml 787,500
9 injeksi 20%, 50 ml Zenalb PT. Ikapharmindo Vial 50 ml 362,250
10 injeksi 25%, 100 ml Albuminar 25 Dus, botol @ 100 ml
PT. Ferron Par Pharmaceuticals 1,600,000
11 injeksi 25%, 20 ml PLASBUMIN 25% 20 ML PT. Dipa Pharmalab botol @ 20 ml 337,722
12 injeksi 25%, 50 ml Octalbin 25% PT. Dankos Farma botol @ 50 ml 775,000
13 injeksi 5% 250 ml PLASBUMIN 5% 250 ML PT. Dipa Pharmalab botol @ 250 ml 945,000
14 injeksi 5% 50 ml PLASBUMIN 5% 50 ML PT. Dipa Pharmalab botol @ 50 ml 297,150
15 Alopurinol tablet/kapsul/kaplet 100 mg n/a PT. Pertiwi Agung Box, 10 strips @ 10 tablets 88
16 Alopurinol tablet/kapsul/kaplet 300 mg n/a PT. Bernofarm Dus, 10 blister @ 10 tablet 215
17 Alprazolam tablet/kapsul/kaplet 0,25 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet 410
18 Alprazolam tablet/kapsul/kaplet 0,5 mg n/a PT. Otto Pharmaceuticals 1 box 10 Strip X 10 tablet 180
19 Alprazolam tablet/kapsul/kaplet 1 mg n/a PT. Kimia Farma Ktk 10x10 tablet 233
Dus, 1 vial@50mg + 1 vial
20 Alteplase injeksi 50 mg/vial Actilyse PT. Boehringer Ingelheim pelarut @ 50ml 3,800,000
21 Amfoterisin B salep mata 1% Fungicide PT. Cendo Industri Farmasi tube 3.5 gr 18,500
22 Amikasin injeksi 250 mg/ml Glybotic 250 mg /ml PT. Sanbe Farma Vial 2 ml 50,500
23 Aminofilin injeksi 24 mg/ml n/a PT. Lucas Djaja dus 30 ampul @10 ml 4,013
24 Aminofilin tablet scored 200 mg n/a PT. Erela Botol @100 Tablet 82
25 Aminofilin tablet/kapsul/kaplet 150 mg n/a PT. Erela Btl @ 100 tablet 82
26 Amiodaron injeksi 150 mg/3 ml Cordarone PT. Aventis Pharma Dus, 6 ampul @ 3 ml 12,480
27 Amiodaron tablet/kaplet 200 mg Cordarone PT. Aventis Pharma Dus, 3 blister @ 10 tablet 1,300
28 Amitriptilin tablet salut 25 mg (HCl) n/a PT. Indofarma Dus, 10 strip @ 10 tss 117
29 Amlodipin tablet 10 mg n/a PT. Pertiwi Agung Box, 3 strips @ 10 tablets 341
30 Amlodipin tablet 5 mg n/a PT. Pertiwi Agung Box, 3 strips @ 10 tablets 192
31 Amoksisilin kapsul/kaplet 250 mg n/a PT. Indofarma Dus, 10 blister @ 12 kapsul 210
Amoksisilin kapsul/kaplet/tablet scored 500
32 mg n/a PT. Mersifarma Tirmaku Mercusana
KOTAK @ 10 x 10 TAB 270
33 Amoksisilin sirup kering forte 250 mg/5 ml n/a PT. Holi Pharma Dus, Botol 60 ml 4,212
34 Amoksisilin sirup kering 125 mg/ 5 ml n/a PT. Novapharin btl @ 60 ml 2,500
35 Ampisilin serbuk injeksi i.v. 1000 mg/vial n/a PT. Bernofarm Dus, 10 vial @ 1 g 5,355
Analog insulin long acting inj 100 UI/ml,
vial/cartridge disposible/penfill cartridge Lantus Solostar 100IU/ml
36 (Insulin glargine 100 IU/ml) 5pens x3ml PT. Aventis Pharma dus, 5 solostar pen @ 3ml 85,000
Analog insulin mix acting inj 100 UI/ml,
Analog insulin mix acting inj 100 UI/ml Injeksi 100 IU/ml, Flexpen
(Premix 30% Insulin Aspart + 70% disposible 3 ml (1 box isi 5
37 Protaminated Insulin Aspart (Analogue)) Novomix Flexpen PT. Ferron Par Pharmaceuticals
flexpen disposible) 106,000
Analog insulin mix insulininj 100 UI/ml,
vial/cartridge disposible/penfill cartridge (25%
insulin lispro, 75% insulin lispro protamine
38 suspension, (rDNA)) Humalog Mix 25 PT. Bayer Indonesia Penfill cartridge 102,375
Analog insulin rapid acting inj 100 UI/ml,
vial/cartridge disposible/penfill cartridge
39 (Insulin Aspart (Analogue)) Novorapid Vial PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 200,000
Analog insulin rapid acting inj 100 UI/ml, Injeksi 100 IU/ml, Flexpen
vial/cartridge disposible/penfill cartridge disposible 3 ml (1 box isi 5
40 (Insulin Aspart (Analogue)) Novorapid Flexpen PT. Ferron Par Pharmaceuticals
flexpen disposible) 85,345
Analog insulin rapid actinginj 100 UI/ml,
vial/cartridge disposible/penfill cartridge Apidra Solostar 100IU/ml
41 (Insulin glulisine 100 IU/ml) 5pens x3ml PT. Aventis Pharma dus, 5 solostar pen @ 3ml 83,125
Analog insulin rapid actinginj 100 UI/ml,
vial/cartridge disposible/penfill cartridge
42 (Insulin lispro (rDNA origin)) Humalog PT. Bayer Indonesia Penfill cartridge 83,125
43 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg PT. AstraZeneca indonesiaDus, 2 blister @ 14 Tablet 32,000

Antasida DOEN I tablet kunyah, kombinasi :
Aluminium Hidroksida 200 mg Magnesium
44 Hidroksida 200 mg n/a PT. Erela Dus, 10 Strip @ 10 Tablet 74
Antasida DOEN II suspensi, kombinasi :
Aluminium Hidroksida 200 mg/5 ml
45 Magnesium Hidroksida 200 mg/5 ml n/a PT. Lucas Djaja btl 60 ml 2,200
Anti Bakteri DOEN salep kombinasi:
46 Basitrasin 500 IU/g Polimiksin 10.000 IU/g n/a PT. Indofarma Dus, 25 tube @ 5 g 2,641
Antimalaria DOEN kombinasi : Pirimetamin
47 25 mg Sulfadoksin 500 mg n/a PT. Kimia Farma ktk 10 x 10 tablet 544
Antimigren: Ergotamin Tartrat 1 mg + Kofein
48 50 mg n/a PT. Kimia Farma Btl 100 tablet 142
Antiparkinson DOEN tablet kombinasi :
49 Benserazid 25 mg Levodopa 100 mg Levopar Tablet PT. Meprofarm Dus, 5 strip @ 10 tablet 1,575
50 Artemether injeksi 80 mg/ml Artem PT. Kimia Farma Dus 6 amp @ 1ml 23,100
51 Asam Asetilsalisilat (asetosal) tablet 100 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's 122
Asam Asetilsalisilat (asetosal)
52 tablet/kaplet/kapsul 80 mg Miniaspi 80 PT. Mersifarma Tirmaku Mercusana
KOTAK @ 10 x 10 TAB 155
53 Asam Askorbat (Vitamin C) tablet 50 mg n/a PT. Kimia Farma Dus 10 strip x 10 tab 100
Asam Askorbat (Vitamin C)
54 tablet/kapsul/kaplet 250 mg n/a PT. Kimia Farma ktk 10x10 tablet 159
55 Asam Folat tablet/kapsul/kaplet 0,4 mg Starfolat PT. Dexa Medica Dus, 10 strip @10 tablet 93
56 Asam Folat tablet/kapsul/kaplet 1 mg n/a PT. Marin Liza Farmasi Botol @ 100 tablet 50
57 Asam Ibandronat injeksi 6mg/6ml Bondronat PT. Boehringer Ingelheim Boks, 1 ampul 2,209,000
58 Asam Mefenamat kapsul/kaplet 500 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kaptab ss 116
59 Asam pipemidat kapsul 400 mg Urotractin 400 mg PT. Sanbe Farma Strip 1,815
60 Asam traneksamat injeksi 50 mg/ml n/a PT. Bernofarm Dus, 10 ampul @ 5 ml 3,100
61 Asam zoledronat injeksi 4mg/5mL ZOMETA PT. Novartis Indonesia Dus, 1 vial plastik @ 5ml 900,000
62 Asiklovir salep mata 3% Temiral Eye Oint PT. Sanbe Farma Tube 3,5 gram 24,750
63 Asiklovir tablet/kapsul/kaplet 200 mg n/a PT. Kimia Farma ktk 10x10 tablet 239
64 Asiklovir tablet/kapsul/kaplet 400 mg n/a PT. Kimia Farma ktk 10x10 tablet 345
65 Asparaginase serbuk injeksi 10.000 UI/vial Leunase PT. Widatra Bhakti 10.000 UI/Vial 1,039,500
66 Atapulgit tablet 600 mg Pularex PT. Zenith Pharmaceuticals Dus 5 strip @ 10 tablet 210
67 Atenolol tablet/kapsul/kaplet 100 mg Betablok PT Kalbe Farma strip 700
68 Atrakurium injeksi 25 mg/2,5 ml Tracrium PT. Glaxo Wellcome Indonesia

Dus, 5 ampul @ 2.5 ml 20,000
69 Atropin Sulfat tablet 0,5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet 77
70 Atropin Sulfat tetes mata 0,5% Cendo Tropin 0,5% PT. Cendo Industri Farmasi Botol 5ml 13,500
71 Atropin Sulfat tetes mata 1% Cendo Tropin 1% PT. Cendo Industri Farmasi Botol 5ml 13,500
72 Azitromisin sir kering 200 mg/ 5 mL n/a PT. Soho Industri Pharmasi botol @ 60 ml 34,500
73 Azitromisin tablet 500 mg n/a PT. Kimia Farma ktk 2x10 tablet 4,500
74 Azitromisin tablet 250 mg n/a PT. Soho Industri Pharmasi Strip 3,500
75 Bedak salisil serbuk 2% n/a PT. Rama Emerald Multi SuksesDus @ 50 gram 1,250
76 Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a PT. Phapros, Tbk Ds 10 vial x 1,2 Jt IU 10,290
77 Benzatin Benzil Penisilin 2,4 juta IU/vial n/a PT. Phapros, Tbk 10 vial @ 2.400.000 IU 14,070
78 Beractant injeksi / suspensi 25 mg/mL Survanta PT. Abbott Indonesia Vial 3,200,000
79 Beraprost sodium tablet 20 mcg Dorner 20 µg PT. Combiphar Box/ 3 blister @ 10 Tablet 3,600
80 Betametason krim 0,1% (sebagai Valerat) n/a PT. Kimia Farma Tube 5 gr 1,520
81 Betametason tetes mata 1 mg/ml Betam Ophtal ED PT. Sanbe Farma botol @ 5 ml 25,106
Bevasizumab injeksi 25 mg/ml (Skema Risk
Sharing sesuai Kepmenkes RI Nomor
82 HK.02.02/Menkes/223/2014) Avastin PT. Boehringer Ingelheim Dus, 1 vial @ 4 ml 4,803,697
83 Bikalutamid tablet salut 150 mg Casodex 150 mg PT. AstraZeneca indonesiaDus, 2 blister @ 14 Tablet 72,400
84 Bikalutamid tablet salut 50 mg Casodex 50 mg PT. AstraZeneca indonesiaDus, 2 blister @ 14 Tablet 45,000
85 Bisakodil suppositoria 10 mg Stolax supp PT. Sanbe Farma Supp 6,045
86 Bisakodil suppositoria 5 mg Dulcolax Supp Infant PT. Boehringer Ingelheim 1 Box @ 6's 4,990
87 Bisoprolol tablet 2,5 mg Concor 2.5 PT. Merck Tbk Dus 10 blister @ 10 tablet 746
88 Bisoprolol tablet 5 mg n/a PT. Pratapa Nirmala Box 3 X 10 tab 669
89 Bleomisin serbuk injeksi 15 mg/ampul BLEOCIN PT Kalbe Farma Vial 320,000
90 Bromokriptin tablet 2,5 mg Cripsa tab PT. Caprifarmindo Box 3 x 10'S 247,089
91 Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler PT. AstraZeneca indonesia
Dus, 1 Turbuhaler @ 100 dosis 93,000
92 Budesonid inhaler 200 mcg/puff, 200 dosis Obucort Swinghaler PT Otsuka Indonesia Unit, 200 dosis 106,000
Budesonid respules / cairan inhaler
93 0,25mg/mL Pulmicort Respules PT. AstraZeneca indonesia
Dus, 4 pak @ 5 respules @ 2 ml 8,900
Budesonid-formoterol (fixed combination) Symbicort Turbuhaler
94 inhaler 160/4,5 mcg 160/4.5 mcg PT. AstraZeneca indonesia
Budesonid-formoterol (fixed combination)
95 inhaler 80/4,5 mcg Symbicort 80/4.5 mcg PT. AstraZeneca indonesia
96 Bupivakain injeksi 0,50% (HCl) + glukosa 8% n/a PT. Dexa Medica Dus, 5 ampul @ 4 ml 26,880
97 Bupivakain injeksi 0,50% (P.V) Marcain Cairan Suntik PT. AstraZeneca indonesia
Dus, 5 polyamp duofit@ 20 ml 32,000
98 Dabigatran eteksilat kapsul 75 mg Pradaxa PT. Boehringer Ingelheim Dus, 3 blister @ 10 kapsul 12,936
99 Dabigatran eteksilat kapsul 110 mg Pradaxa PT. Boehringer Ingelheim Dus, 3 blister @ 10 kapsul 12,936
100 Dakarbazin serbuk injeksi 200 mg/vial DBL Dacarbazine PT. Tempo Scan Pacific vial @ 20 ml 307,000
101 Daunorubisin serbuk injeksi 20 mg/vial DAUNOCIN PT. Novell Pharmaeutical Laboratoriesvial 288,750
102 Deferasiroks tablet disp/ eff 250 mg Exjade 250 mg Tab PT. Novartis Indonesia Dus, 4 blister @ 7 tablet 80,000
103 Deferasiroks tablet disp/ eff 500 mg Exjade 500 mg Tab PT. Novartis Indonesia Dus, 4 blister @ 7 tablet 155,000
104 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution PT. Sydna Farma Dus, Botol @ 500ml 2,600,000
105 Deferipron tablet 500 mg Ferriprox tablet PT. Sydna Farma Dus, Botol @ 100 tablet 25,300
106 Deferoksamin Mesilat serbuk injeksi 500 mg Desferal PT. Novartis Indonesia Dus, 10 vial @ 500mg 112,000
107 Deksametason injeksi i.v./i.m. 5 mg/ml n/a PT. Indofarma Dus, 100 ampul @ 1 ml 1,659
108 Deksametason tablet 0,5 mg n/a PT. Promedrahardjo Farmasi

Dus,
Industri
10 Strip@10 Tablet 64
109 Desogestrel tablet 75 mcg Cerazette PT. Merck Sharp Dohme Pharma
Dus, 1 Tbk
Blister @ 28 tablet 70,000
110 Desoksimetason krim 0,25% DEXIGEN PT. Ifars Pharmaceutical Laboratories

Dus, tube @ 5 g 6,150
111 Desoksimetason krim 0,25% n/a PT. Dexa Medica Kotak, tube @ 15 gram 9,983
112 Diazepam larutan rektal 5 mg/2,5 mL STESOLID PT. Actavis Indonesia Dus, 5 alubag @ 1 tube @ 2,5ml 12,159
113 Diazepam larutan rektal 10 mg/2,5 mL STESOLID PT. Actavis Indonesia Dus, 5 alubag @ 1 tube @ 2,5ml 17,604
114 Diazepam tablet 2 mg n/a PT. Kimia Farma Btl 100 45
115 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a PT. Lucas Djaja ampul @ 1 ml 1,107
116 Digoksin injeksi 0,25 mg/ml Fargoxin inj PT. Pratapa Nirmala Box @ 5 ampul 2 mL 23,150
117 Digoksin tablet 0,25 mg n/a PT. Yarindo Farmatama Box 10 X 10 Tab 100
118 Diltiazem HCl tablet 30 mg n/a PT. Kimia Farma Ktk 10X10 TAB 134
Herbesser Powder
119 Diltiazem infus injeksi 50 mg Injection 50mg PT. Tanabe Indonesia 10 vial @ 50mg 134,050
120 Diltiazem injeksi 25 mg/5 mL Farmabes Injeksi 25 mg PT. Pratapa Nirmala Vial 5 mL 49,000
121 Diltiazem Kapsul SR 100 mg Herbesser CD 100 PT. Tanabe Indonesia 3 blister @ 10 kapsul 3,850
122 Diltiazem Kapsul SR 200 mg Herbesser CD 200 PT. Tanabe Indonesia 3 blister @ 10 kapsul 4,216
123 Dimenhidrinat tablet 50 mg n/a PT. Kimia Farma Btl 100 tablet 104
124 Dinatrium edetat tetes mata 0,35% E.D.T.A PT. Cendo Industri Farmasi botol 15 ml 37,500
125 Dinatrium klodronat infus kons 60 mg/mL ml PT. Bayer Indonesia ampul 124,955
126 Dobutamin injeksi 50 mg/mL DOBURAN PT. Dipa Pharmalab ampul @ 5 ml 28,035
127 Doksazosin mesilat tablet 1 mg Cardura 1mg PT. Pfizer Indonesia Dus, 5 blister @10's tab 3,480
128 Doksazosin mesilat tablet 2 mg Cardura 2mg PT. Pfizer Indonesia Dus, 5 blister @10's tab 5,480
129 Doksisiklin tablet/kapsul/kaplet 100 mg n/a PT. Yarindo Farmatama Box @ 10 strip 10 kapsul 285
130 Doksorubisin serbuk injeksi i.v. 10 mg/vial Doxorubicin Actavis 10 mg PT. Actavis Indonesia Dus, 1 vial @ 10 mg 60,375
131 Doksorubisin serbuk injeksi i.v. 50 mg/vial Naprodox Inj. 50 Mg PT. Kimia Farma Dus 1 vial @ 50 mg 300,300
132 Domperidon suspensi/sirup 5 mg/5 ml n/a PT. Novapharin btl @ 60 ml 3,410
133 Domperidon tablet 10 mg n/a PT. Novapharin dus 10 X 10'S 170
134 Domperidon tetes 5 mg/mL n/a PT. Bernofarm Dus, botol @ 10 ml 16,350
135 Dopamin injeksi 40 mg/ml UDOPA PT. Dipa Pharmalab ampul @ 5 ml 10,332
Dus, 1 vial @0,5 ml+ 1 vial
136 Dosetaksel injeksi 20 mg/0,5 ml n/a PT. Sanbe Farma pelarut @1,5 ml 970,200
DTPA (diethylene triamine pentaacetic acid)

137 2,06-2,5 mg pentetate calcium trisodium/mL Renalscan KaeF PT. Kimia Farma Dus @ 5 vial 455,000
138 Dutasterid kaps lunak 0,5 mg Avodart PT. SmithKline BeechamDus,

Phamaceuticals
Botol Plastik @ 30 Tablet 7,455
139 Efavirens tablet salut 600 mg n/a PT. Kimia Farma Botol 30 tab 6,375
140 Efedrin Inj 50 mg/ml n/a PT. Bernofarm Ampul @ 1 ml 13,790
141 Eksemestan tablet 25 mg Aromasin PT. Pfizer Indonesia Dus, 2 blister @ 15 tablet 42,600
142 Enoksaparin sodium inj 20 mg/0,2 mL Lovenox 2000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe @ 0,2 ml 42,780
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
145 mg/ml n/a PT. Phapros, Tbk Dus @ 30 Ampul 8,505
146 Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe PT Kalbe Farma Vial @ 25 ml 600,000
147 Epirubisin serb injeksi 10 mg/5 ml n/a PT. Sanbe Farma Dus, 1 vial @5 ml 128,000
Ergokalsiferol (vitamin D3/D2) kapsul 50.000
148 UI D-Vit FT PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet 680
Ergokalsiferol (vitamin D3/D2) suspensi
149 10.000 UI/ml D-Vit Syrup PT. Gracia Pharmindo Dus, Botol Plastik @ 100 mL 8,000
150 Eritromisin kapsul/kaplet 250 mg n/a PT. Kimia Farma ktk 10 x 10 kapsul 497
151 Eritromisin kapsul/kaplet 500 mg n/a PT. Indofarma Dus, 10 blister @ 10 kss 976
152 Eritromisin sirup kering 200 mg/ 5 ml n/a PT. Phyto Kemo Agung Farma Botol @60 ml 7,893
153 Eritropoetin-alfa inj 10000 UI/mL Hemapo 10.000 IU PT Kalbe Farma vial/ampul (Prefilled Syringe) 278,000
Dus, 6 prefilled syrenge @ 0.5
154 Eritropoetin-alfa inj 2000 UI/mL Eprex 2000 PT. Soho Industri Pharmasi ml 140,569
155 Eritropoetin-alfa inj 3000 UI/mL Hemapo 3000 PT Kalbe Farma Prefilled Syringe @ 1ml 128,000
156 Eritropoetin-beta inj 2000 UI/0,3 mL Recormon PT. Boehringer Ingelheim Boks, 6 ampul 139,500
157 Etambutol tablet 250 mg (HCl) n/a PT. Kimia Farma ktk 20 x 10 tablet 314
158 Etambutol tablet salut 500 mg (HCl) n/a PT. Indofarma Dus, 10 strip @ 10 tss 473
159 Etanol 70% cairan n/a PT. Novapharin btl @ 100 ml 2,575
160 Etinilestradiol tablet 0,05 mg Lynoral PT. Merck Sharp Dohme Pharma
Dus, botol
Tbk @ 100 tablet 1,360
Dus, 1 blister @ 1 subdermal
161 Etonogestrel implan 68 mcg Implanon PT. Merck Sharp Dohme Pharma Tbk implant 128,779
162 Etoposid injeksi 20 mg/ml Etopul PT. Novell Pharmaeutical Laboratories

ampul @ 5ml 100,900
163 Eugenol cairan n/a PT. Kimia Farma Botol 10 ml 17,500
164 Everolimus tab 0,25 mg Certican 0,25 mg Tab PT. Novartis Indonesia Dus, 6 blister @ 10 tablet 11,813
165 Everolimus tab 0,5 mg Certican 0,5 mg Tab PT. Novartis Indonesia Dus, 6 blister @ 10 tablet 23,250
Faktor koagulasi II 14-35 UI, faktor koagulasi
VII 7-20 UI, faktor koagulasi IX 25 UI, faktor
166 koagulasi X 14-35 UI Cofact 500 IU/20 ml PT. Graha Farma Dual, vial 500 IU 4,400,000
Faktor VIIa (rekombinan) serb inj 1 mg/vial + KOTAK @ 1 VIAL SERBUK
167 pelarut untuk injeksi Novoseven PT. Ferron Par Pharmaceuticals
OBAT & INFUSION KIT 9,200,000
168 Faktor VIII (konsentrat) serb inj 230 -340 UI Haemoctin PT. Kimia Farma vial 1,189,650
Faktor VIII (konsentrat) serb inj 250 UI/vial +
169 pelarut 5 mL 8Y PT. Ikapharmindo Vial 10 mll 1,047,900
170 Faktor VIII (konsentrat) serb inj 480 - 600 UI KOATE DVI 500 IU PT. Dipa Pharmalab vial 2,257,500
Faktor VIII (konsentrat) serb inj 500 UI/vial +
171 pelarut 5 mL 8Y PT. Ikapharmindo Vial 10 mll 1,524,600
172 Fenitoin injeksi 50 mg/ml n/a PT. Mersifarma Tirmaku Mercusana

KOTAK @ 10 ampul 20,850
173 Fenitoin kapsul/kaplet 100 mg n/a PT. Ikapharmindo Botol @ 100 140
174 Fenitoin Na Inj 100 mg/2 ml n/a PT. Mersifarma Tirmaku Mercusana
175 Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a PT. Phapros, Tbk Dus @ 30 Ampul 1,890
176 Fenofibrat kaps 100 mg n/a PT. Hexpharm Jaya Laboratories

Dus, 3 strip @ 10 kapsul 1,075
177 Fenofibrat kaps 300 mg n/a PT. Hexpharm Jaya Laboratories

Dus, 3 strip @ 10 kapsul 1,375
Fenoksimetil penisilin (penisilin V) tablet 250
178 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's 304
Fenoksimetil penisilin (penisilin V) tab 125
179 mg Fenocin PT. Actavis Indonesia Dus 45 x 12 tab 235
Fenoksimetil penisilin (penisilin V)tablet 500
180 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's 535
181 Fenoterol HBr ih 100 mcg/puff Berotec MDI PT. Boehringer Ingelheim Box, canister 10mL 72,900
182 Fenoterol HBr inh solution 0,1% Berotec Solution PT. Boehringer Ingelheim Dus, Canister 200 dosis 117,500
Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10
183 ml n/a PT. Kimia Farma Dus 5 ampul@ 10ml 134,400
184 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 2 ml n/a PT. Kimia Farma Dus 5 ampul@ 2ml 35,610
185 Fentanil patch 12,5 mcg/jam Durogesic 12,5 MU Matrix PT. Kimia Farma Dus @ 5 patch 81,375
186 Fentanil patch 25 mcg/jam Durogesic 25 MU Matrix PT. Kimia Farma Dus@ 5 patch 160,650
187 Fentanil patch 50 mcg/jam Durogesic 50 MU Matrix PT. Kimia Farma Dus@ 5 patch 299,250
188 Filgrastim inj 300 mcg/mL Zarzio PT. Sandoz Indonesia pfs @ 0,5 ml 400,000
189 Finasterid tab 5 mg Prostacom PT. Combiphar Box, isi 3 Strip @ 10 tab 2,950
190 Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a PT. Marin Liza Farmasi Botol @ 100 tablet salut gula 666
Fitomenadion (Vitamin K1) injeksi i.m. 2
191 mg/ml n/a PT. Phapros, Tbk dus @ 30 ampul 3,582
192 Fludarabin inj 50 mg Fludara IV LYO PT. Aventis Pharma Dus, 5 vial @ 50 mg 1,248,319
Dus, 4 blister @ 5 tablet salut
193 Fludarabin tab 10 mg Fludara Oral PT. Aventis Pharma selaput 275,000
194 Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi PT. Mersifarma Tirmaku Mercusana
Dus, 5 ampul @ 1ml 55,000
195 Flukonazol tablet/kaplet/kapsul 50 mg Diflucan 50mg PT. Pfizer Indonesia Blister 4,862
196 Flukonazol tablet/kapsul 150 mg n/a PT. Kimia Farma ktk 1 x 10 kapsul 23,100
197 Fluoksetin tablet 10 mg Foransi 10 PT. Gracia Pharmindo strip 439
198 Fluoksetin tablet 20 mg NOPRES PT. Dexa Medica DUS, 30 TABLET 454
199 Fluorometolon tetes mata 0,1 % Ocuflam ED PT. Sanbe Farma botol @ 5 ml 30,493
200 Fluorourasil inj 250 mg/mL Curacil PT Kalbe Farma vial @ 1 ml 25,725
201 Fluorourasil inj 500 mg/ 5 mL Curacil PT Kalbe Farma vial @ 10 ml 35,500
202 Flusinolon asetonid krim 0,025% SYNARCUS PT. Ifars Pharmaceutical Laboratories
Dus, Tube 5 g 2,500
203 Flutikason furoat intranasal spray Avamys PT. Glaxo Wellcome Indonesia
Dus, Botol 120 Dosis Spay 98,000
Dus, 2 flow wrap@ 5 nebules @
204 Flutikason propionat nebules 0,5 mg Flixotide Nbules PT. Glaxo Wellcome Indonesia 1 dosis (2ml) 13,563
205 Fondaparinuks inj 2,5 mg/0,5 mL Arixtra PT. Glaxo Wellcome Indonesia Dus, 2 pfs 0.5 ml 253,750
206 Fraksi protein plasma lar inf 5% Plasmanate PT. Dipa Pharmalab dus, vial @ 250 ml 972,000
207 Furosemid injeksi i.v./i.m. 10 mg/ml n/a PT. Indofarma Dus, 25 ampul @ 2 ml 1,920
208 Furosemid tablet 40 mg n/a PT. Sampharindo Perdana Dus, 10 strip @ 10 tablet 80
209 Gadobutrol macrocyclic 5 mg Gadovist 5 mg PT. Bayer Indonesia Prefilled Syringe 275,000
210 Gadobutrol macrocyclic 7,5 mg Gadovist 7,5 mg PT. Bayer Indonesia Prefilled Syringe 412,500
Gadoksetat disodium 0,25 mmol gadoxetate
211 disodium/mL Primovist PT. Bayer Indonesia Prefilled Syringe 2,570,000
212 Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene PT. Boehringer Ingelheim Boks, 1 ampul 399,500
Garam Oralit I serbuk, kombinasi : Natrium

klorida 0,52 g kalium klorida 0,30 g Trinatrium
213 sitrat dihidrat 0,58 g Glukosa Anhidrat 2,70 g n/a PT. Phapros, Tbk Dus @ 100 Sachet 303
214 Gefitinib tab 250 mg Iressa 250 mg PT. AstraZeneca indonesia Dus, 1 blister @ 10 tablet 295,000
215 Gemfibrozil kapsul/kaplet 300 mg n/a PT. Indofarma Dus, 10 blister @ 12 kapsul 303
216 Gemfibrozil tablet 600 mg n/a PT. Indofarma Dus, 10 blister @ 10 kaptab 713
217 Gemsitabin inj 1000 mg/vial Gemzar 1000 mg PT. Bayer Indonesia vial 1,113,850
218 Gemsitabin inj 200 mg/vial n/a PT. Sanbe Farma Dus, 1 vial @200 mg 330,000
219 Gentamisin injeksi 40 mg/ ml n/a PT. Indofarma Dus, 5 ampul @ 2 ml 3,569
220 Gentamisin salep mata 0,3% Genoint Salep Mata PT. Erela Tube @ 3,5 gr 2,660
221 Gentamisin tetes mata 0,3% n/a PT. Indofarma Dus, botol plastik 5 ml 3,353
222 Glibenklamid tablet 5 mg n/a PT. Indofarma Dus, 10 blister @ 10 kaptab 58
223 Gliklazid tab 80 mg Glicab PT. Tempo Scan Pacific Strip 238
Dus, 6 strip @ 10 tablet lepas
224 Gliklazid tab 30 mg Diamicron MR 30 PT. Pradja Pharin lambat 638
225 Gliklazid tablet lepas lambat 60 Mg Diamicron MR 60 PT. Darya Varia Box, 30 Tablet 5,500
226 Glikuidon tab 30 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet 997
227 Glimepiride tablet 1 mg n/a PT. Kimia Farma ktk 5x10 tablet 265
231 Glipizid tablet/kaplet/kapsul 10 mg Glucotrol 10 mg PT. Pfizer Indonesia Dus, botol@TAB 10MG 30 3,207
232 Glipizid tablet/kaplet/kapsul 5 mg Glucotrol 5 mg PT. Pfizer Indonesia Dus, botol@TAB 10MG 31 3,000
233 Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard PT. Kimia Farma Dus 10x10 1,493
234 Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte PT. Kimia Farma Dus 10x10 2,171
235 Gliseril trinitrat tab sublingual 0,5 mg Nitral PT. Actavis Indonesia Btl @ 30 tablet 1,575
236 Gliserin lar 50% Gliserin lar 50% PT. Lucas Djaja Glycerin 100 ml 5,600
237 Glukosa larutan infus 10 % steril n/a PT. Widatra Bhakti botol @ 500 ml 5,985
238 Glukosa larutan infus 5 % steril n/a PT. Widatra Bhakti botol @ 500 ml 5,460
239 Goserelin asetat inj 10,8 mg/vial Zoladex 10,8 mg PT. AstraZeneca indonesiaDus, 1 syringe @ 10.8 mg 2,300,000
240 Goserelin asetat inj 3,6 mg Zoladex 3,6 mg PT. AstraZeneca indonesia Dus, 1 syringe @ 3.6 mg 840,000
241 Griseofulvin tablet 125 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet 230
242 Haloperidol inj 50 mg/mL Haldol Decanoas PT. Soho Industri Pharmasi Dus 5 Ampul@1mL 87,500
243 Haloperidol injeksi i.m 5 mg/ml Lodomer Injeksi PT. Mersifarma Tirmaku Mercusana
244 Haloperidol tablet 0,5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet 61
245 Haloperidol tablet 5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet 100
246 Haloperidol tablet 1,5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet 72
247 Haloperidol tablet 2 mg Lodomer 2 PT. Mersifarma Tirmaku Mercusana

KOTAK @ 10 x 10 TAB 130
248 Haloperidol tts 2 mg/mL LODOMER DROPS PT. Mersifarma Tirmaku Mercusana
BOTOL @ 15 ML 16,995
249 Halotan Inhalasi Halothane PT. Dexa Medica Botol 673,500
250 Heparin injeksi i.v./s.k. 5000 UI/ml Inviclot PT. Pratapa Nirmala vial 45,100
251 Hepatitis B imunoglobulin (human) Hyperhep B PT. Dipa Pharmalab Dus, 1 syringe @ 0.5 mL 1,328,000
252 Hidrokortison krim 1% n/a PT. Marin Liza Farmasi tube @ 5 ml 2,699
253 Hidrokortison krim 2,5 % n/a PT. Kimia Farma Tube 5 gr 2,798
254 Hidroksi Urea tablet/kaplet/kapsul 500 mg HYDROXYUREA MEDAC PT. Dipa Pharmalab vial 5,670
255 Hiosin butilbromid injeksi 20 mg/ml n/a PT. Otto Pharmaceuticals box 5ampul @1 ml 4,725
256 Homatropin tetes mata 2% Homatro 2% PT. Cendo Industri Farmasi Botol 5ml 18,000
Human insulin intermediate acting inj 100
UI/ml, vial (Human Insulin (Intermediate-
257 Acting)) Insulatard Vial PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 138,000
258 UI/ml, vial (Insulin human Basal) Humulin N Vial PT. Bayer Indonesia Dus, vial 10 ml 138,000
UI/ml, vial/cartridge disposible/penfill
259 cartridge n/a PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000
Human insulin intermediate acting inj 100 Injeksi 100 IU/ml, penfill
UI/ml,penfill cartridge (Human Insulin disposible 3 ml (1 box isi 5 penfill
260 (Intermediate-Acting)) Insulatard Penfill PT. Ferron Par Pharmaceuticals disposible) 76,125

261 UI/ml,penfill cartridge (Insulin human Basal) Humulin N Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @ 3ml 76,125

262 UI/ml,penfill cartridge (Insulin human Basal) Sansulin N PT. Sanbe Farma penfillcartridge @ 3ml 75,000
Human insulin mix insulin inj 100 UI/ml, Injeksi 100 IU/ml, penfill
penfill cartridge (Human Insulin (Premix: 30% disposible 3 ml (1 box isi 5 penfill
263 Soluble + 70 % NPH Insulin)) Mixtard Penfill PT. Ferron Par Pharmaceuticals disposible) 76,125
Human insulin mix insulin inj 100 UI/ml,
264 penfill cartridge (Insulin human Comb) Humulin 30/70 Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @ 3ml 76,125
Human insulin mix insulin inj 100 UI/ml, vial
(Human Insulin (Premix: 30% Soluble + 70 %
265 NPH Insulin)) Mixtard Vial PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 138,000
Human insulin mix insulin inj 100 UI/ml, vial
266 (Insulin human Comb) Humulin 30/70 Vial PT. Bayer Indonesia Dus, vial 10 ml 138,000
Human insulin short acting inj 100 UI/ml, Injeksi 100 IU/ml, penfill
penfill cartridge (Human Insulin (Short disposible 3 ml (1 box isi 5 penfill
267 Acting)) Actrapid Penfill PT. Ferron Par Pharmaceuticals disposible) 76,125
Human insulin short acting inj 100 UI/ml,
268 penfill cartridge (Insulin human Rapd) Sansulin R PT. Sanbe Farma penfill cartridge @ 3ml 75,000
269 penfill cartridge (Insulin human Rapd) Humulin R Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @ 3ml 76,125
Human insulin short acting inj 100 UI/ml, vial
270 (Human Insulin (Short Acting)) Actrapid Vial PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 138,000
Human insulin short acting inj 100 UI/ml, vial
271 (Insulin human Rapd) Humulin R Vial PT. Bayer Indonesia Dus, vial 10 ml 138,000
272 vial/cartridge disposible/penfill cartridge n/a PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000
Human tetanus imunoglobulinn injeksi i.m.
273 250 UI Tetagam PT. Dexa Medica Prefilled syringe 170,000
274 Ibuprofen sirup 100 mg/5 ml n/a PT. Indofarma Dus, botol 60 ml 3,674
275 Ibuprofen suspensi 200 mg/5 ml n/a PT. Indofarma Dus, botol 60 ml 4,724
276 Ibuprofen tablet 200 mg n/a PT. Yarindo Farmatama botol @ 100 tablet 116
277 Ibuprofen tablet 400 mg n/a PT. Novapharin dus 10 X 10'S 153
278 Ifosfamid serbuk injeksi 1000 mg/vial Holoxan injeksi 1000 PT. Mugi Laboratories Dus, 1 vial @ 1 g 1,329,163
Imanitib Mesilat tablet salut selaput 100 mg

(Skema Risk Sharing sesuai Kepmenkes RI Dus, 6 blister @ 10 tablet salut
279 Nomor HK.02.02/Menkes/223/2014) Glivec PT. Novartis Indonesia selaput 211,000
280 Imidapril tab 10 mg Tanapress 10mg PT. Tanabe Indonesia 3 blister @ 10 tablet 4,104
281 Imidapril tab 5 mg Tanapress 5mg PT. Tanabe Indonesia 3 blister @ 10 tablet 2,226
Iopamidol 200-300 mg Iodium/mL (300mg @
282 vial 100ml) Iopamiro PT. Dipa Pharmalab Dus, botol @ 100 ml 350,000
283 vial 30ml) Iopamiro PT. Dipa Pharmalab Dus, vial @ 30 ml 122,000
285 vial 100ml) Iopamiro PT. Dipa Pharmalab Dus, botol @ 100 ml 369,000
Iopromide 300-370 mg Iodium/mL (300 mg /
288 100 ml) Ultravist 300/100 mg PT. Bayer Indonesia Botol 245,000
292 Ipratropium bromida inhalasi 20 mcg/semprot Atrovent HFA PT. Boehringer Ingelheim Box, canister 10mL 80,000
Atrovent solution for
293 Ipratropium bromida nebulizer 0,025% inhalation 0.025% PT. Boehringer Ingelheim Box, bottle 20mL 90,000
294 Irbesartan tab 150 mg n/a PT. Indofarma Dus, 5 blister @ 10 kss 1,496
295 Irbesartan tab 300 mg n/a PT. Indofarma Dus, 5 blister @ 10 kss 2,593
296 Irinotekan inf 20 mg/ml n/a PT. Sanbe Farma Dus, 1 vial @2 ml 510,000
297 Isofluran inhalasi Terrell PT. Pratapa Nirmala Botol 100 mL 270,000
298 Isoniazid tablet/kapsul/kaplet 100 mg n/a PT. Phyto Kemo Agung Farma Botol 100 tablet 68
299 Isoniazid tablet/kapsul/kaplet 300 mg n/a PT. Phyto Kemo Agung Farma Botol 100 tablet 166
300 Isosorbid Dinitrat injeksi i.v 10 mg/10 ml Farsorbid inj PT. Pratapa Nirmala vial 34,980
301 Isosorbid Dinitrat tablet sublingual 5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet 93
302 Isosorbid dinitrat tablet/kaplet/kapsul 10 mg Isonat PT. Kimia Farma Dus, 5 strip @ 10 tablet 195
303 Kalium aspartat tab 300 mg Kalipar PT. Tempo Scan Pacific Strip 708
304 Kalium Klorida tablet 600 mg KSR PT. Merck Tbk Dus, 10 strip @ 10 tablet 1,580
305 Kalsium Folinat (Leukovorin Ca) inj 50 mg/ml DBL Leucovorin PT. Tempo Scan Pacific Vial 50 mg/5 ml 82,000
306 Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Kalsium glukonat PT. Ethica Industri Farmasi Ampul 7,800
Kalsium Laktat (Kalk) tablet/kapsul/kaplet
307 500 mg n/a PT. Afifarma Dus,10 Strip @ 10 tablet 73
308 Kalsium polistirena sulfonat ktg 5 g KALQUEST kantong 5 g

PT. Novell Pharmaeutical Laboratories 8,333
309 Kanamisin inj 1000 mg/ vial n/a PT. Hexpharm Jaya Laboratories vial 4,900
310 Kandesartan tab 16 mg n/a PT. Dexa Medica Dus, 3 Blister @ 10 tablet 5,145
311 Kandesartan tab 8 mg n/a PT. Dexa Medica Dus, 3 Blister @ 10 tablet 3,255
312 Kapesitabin tab 500 mg Xeloda PT. Boehringer Ingelheim Boks, 120 tablet 27,500
313 Kaptopril tablet 50 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet 141
314 Kaptopril tablet scored 25 mg n/a PT. Errita Pharma Dus, 10 strip @10 tablet 89
315 Kaptopril tablet scored12,5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet 62
Tegretol Syrup
316 Karbamazepin sirup 100 mg/5 ml 100mg/5ml, 120ml PT. Novartis Indonesia Dus, botol @ 120 ml 44,770
317 Karbamazepin tablet 200 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet 257
318 Karbimazol tab 5 mg Neo-Mercazole PT. Nicholas Laboratories Indonesia

Dus,botol 100 tablet 875
Karbogliserin tetes telinga
319 Karbogliserin tetes telinga 10% 10% PT. Lucas Djaja Fenol 100 mg / 1 ml 2,144
320 Karboplatin 150 mg / 15 ml DBL Carboplatin 150 mg PT. Tempo Scan Pacific vial @ 15 ml 191,000
321 Karboplatin 450 mg / 45 ml DBL Carboplatin 450 mg PT. Tempo Scan Pacific vial @ 45 ml 410,000
322 Karvediol tablet/kaplet/kapsul 6,25 mg V - BLOC PT Kalbe Farma strip 1,428
323 Ketamin injeksi i.v. 100 mg/ml KTM PT. Guardian Pharmatama Vial @ 10 ml 110,000
324 Ketamin injeksi i.v. 50 mg/ml Ketamin Hameln PT. Combiphar Box, isi 1 vial @ 10 ml 62,500
325 Ketokonazol krim 2% n/a PT. Hexpharm Jaya Laboratories tube 5 gr 2,993
326 Ketokonazol krim 2% n/a PT. Novell Pharmaeutical Laboratories

Box isi 1 Tube @ 15 g 4,930
327 Ketokonazol krim 2% n/a PT. Kimia Farma tube 10 gr 2,569
328 Ketokonazol scalp sol 2% Zoloral SS PT. Ikapharmindo Botol 80 ml 29,400
329 Ketokonazol tablet 200 mg n/a PT. Novapharin dus 10 X 5'S 310
330 Ketoprofen supositoria 100 mg Protofen Supp PT. Kimia Farma dus 2 's @ 10 supp 2,722
331 Ketorolac injeksi 30 mg/ml n/a PT. Phapros, Tbk Dus @ 12 Ampul 2,539
Dus, 3 Strip @ 10 Kaplet salut

332 Klaritromisin tab 500 mg ORIXAL PT. Ifars Pharmaceutical Laboratories
selaput 3,350
333 Klindamisin kapsul/kaplet 150 mg n/a PT. Indofarma Dus, 5 blister @ 10 kapsul 379
334 Klindamisin kapsul/kaplet 300 mg n/a PT. Bernofarm Dus, 3 strip @ 10 kapsul 570
335 Klobazam tab 10 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet 900
336 Klonidin injeksi i.v 0,15 mg/ml (HCL) (150) Catapres Injeksi PT. Boehringer Ingelheim Box, 10 ampoules @ 1mL 30,600
337 Klonidin tablet 0,15 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet 214
338 Klopidogrel tab 75 mg n/a PT. Kimia Farma Ktk 3X10 tablet 3,500
339 Kloramfenikol salep mata 1 % n/a PT. Kimia Farma Tube 5 gr 1,600
340 Kloramfenikol serb inj 1000 mg/mL Colsancetine Injeksi PT. Sanbe Farma vial 7,260
341 Kloramfenikol suspensi 125 mg/ 5 ml n/a PT. Bernofarm Botol @ 60 ml 3,865
342 Klorpromazin tablet salut 100 mg (HCl) n/a PT. Kimia Farma ktk 10x10 tablet 149
343 Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a PT. Phapros, Tbk Dus @ 30 Ampul 1,155
344 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a PT. Phapros, Tbk Dus @ 30 Ampul 1,103
345 Klorpromazin tablet salut 25 mg (HCl) n/a PT. Phapros, Tbk 10 X 10 71
346 Klozapin 100 mg n/a PT. Mersifarma Tirmaku Mercusana

KOTAK @ 5 x 10 TAB 5,000
347 Klozapin 25 mg n/a PT. Mersifarma Tirmaku Mercusana

KOTAK @ 5 x 10 TAB 1,550
348 Kodein tablet 10 mg n/a PT. Kimia Farma ktk 10x10 tablet 525
349 Kodein tablet 15 mg n/a PT. Kimia Farma ktk 10x10 tablet 893
350 Kodein tablet 20 mg n/a PT. Kimia Farma ktk 10x10 tablet 1,155
Kolekalsiferol (vitamin D3) kapsul lunak 0,25
351 mcg Ostriol PT. Pratapa Nirmala Btl @ 30 kapsul 2,600
352 Koloid HES BM 130 000 lar inf 6% Voluven PT. Fresenius Kabi Combiphar
Botol Plastik @ 500 ml 33,000
Kombinasi : Ipratropium bromida inhalasi 0,5
353 mg Salbutamol 2,5 mg Combivent UDV PT. Boehringer Ingelheim 1 dus @ 20 vial 5,990
Kombinasi injeksi depot : Medroksi
progesteron asetat 25 mg Estradiol sipionat 5
354 mg n/a PT. Triyasa Nagamas Farma Vial 5,618
Kombinasi suspensi : Parafin + gliserin +

355 fenolftalein Laxadine Emulsi 60 ml PT. Galenium Pharmasia Laboratories
Botol @ 60 ml 12,450
Kombinasi tablet salut : Besi (II) sulfat 7H2O
356 200 mg Asam folat 0,25 mg n/a PT. Erela Dus, 100 Sachet @ 30 Tablet 43
Kombinasi tetes mata 2,5 mg/mL: Natrium
357 klorida 8,664 mg; Kalium klorida 1,32 mg Cendo Lyteers PT. Cendo Industri Farmasi botol 15 ml 15,750
Kombinasi: Artemether 20 mg; Lumefantrin
358 120 mg Coartem PT. Novartis Indonesia Dus, 4 blister @ 6 tablet 3,220
Kombinasi: Levodopa 100 mg; Karbidopa 25 Dus, botol plastik @ 30 tablet
359 mg; Entekapon 200 mg Stalevo PT. Novartis Indonesia salut selaput 8,900
Kombinasi: Lopinavir 200 mg; Ritonavir
360 (LPV/r) 50 mg Aluvia PT. Abbott Indonesia botol @ 120 tablet 6,100
Kombinasi: Salmeterol 25 mcg; Flutikason
361 propionat 50 mcg Seretide Inhaler 50 mcg PT. Glaxo Wellcome Indonesia
Dus, Botol 120 Dosis 95,200
362 propionat 100 mcg Seretide Diskus 100 mcg PT. Glaxo Wellcome Indonesia
Dus, foil strip @ 60 dosis 105,871
363 propionat 250 mcg Seretide Diskus 250 mcg PT. Glaxo Wellcome Indonesia
Dus, foil strip @ 60 dosis 119,000
Kontrasepsi pil oral, kombinasi :*
Levonorgestrel 150 mcg Etinilestradiol 30
364 mcg n/a PT. Kimia Farma Dus, 100 blister @ 28 tablet 2,193
Kotrimoksazol DOEN I (dewasa) kombinasi :

365 Sulfametoksazol 400 mg Trimetoprim 80 mg n/a Dus,
PT. Promedrahardjo Farmasi 10 Strip@10 Tablet
Industri 145
Kotrimoksazol Suspensi komb:
Sulfametoksazol 200 mg + Trimetoprim 40
366 mg / 5 ml n/a PT. Sampharindo Perdana Botol, 60 ml 2,222
367 Kuinin (Kina) tablet 200 mg n/a PT. Kimia Farma ktk 60 tablet 704
368 Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a PT. Kimia Farma ktk 100 amp @ 2 ml 6,510
369 Kuinin tablet 222 mg (H2SO4.7H2O) n/a PT. Kimia Farma ktk 10 x 10 tablet 567
370 Lamivudin tablet/kaplet/kapsu 100 mg Heplav PT. Kimia Farma Botol 30 tab 2,100
371 Lamivudine tablet 150 mg n/a PT. Kimia Farma Botol 60 tablet 1,470
372 Lansoprazol inj 30 mg/ml Prosogan Inj. PT. Takeda Indonesia Serbuk vial 82,042
373 Lanzoprazol kapsul/kaplet 30 mg n/a PT. Indofarma Dus, 2 strip @ 10 kapsul 473
374 Lapatinib tab 250 mg Tykerb PT. SmithKline Beecham Phamaceuticals

Dus, 7 Blister @ 10 tablet 70,560
Larutan mengandung Asam Amino (Asam
375 Amino 10%) Kalbamin PT. Finusolprima Farma Internasional
botol 500 ml 56,300
Amino 100 g, Total N 15,7 g, Na+ 2 mEq,
376 Asetat 120 mEq) Amiparen PT Otsuka Indonesia Softbag 500 ML 56,300
377 Amino 27 g, Sorbitol 50 g, Cl- 52 mEq) Pan-amin G PT Otsuka Indonesia Softbag 500 ML 39,375
Amino 30 g, Glukosa 7,3 % dan elektrolit) Double Chamber Softbag 1000
378 1000 ml Aminofluid PT Otsuka Indonesia ML 115,500
Amino 30 g, Glukosa 7,3 % dan elektrolit) Double Chamber Softbag 500
379 500 ml Aminofluid PT Otsuka Indonesia ML 64,680
Amino 5% dengan BCAA 45%, L-Ornithine L
Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol
380 50 gr/L) Aminofusin Hepar PT Kalbe Farma botol 500 mL 75,350
381 Amino 6%, mengandung Taurine 0,24 gr/l) Aminosteril Infant 6% PT. Fresenius Kabi CombipharBotol Gelas 100 ml 36,667

Amino 7%, Komposisi: Asam Amino esensial:
382 Asam Amino non esensial = 60 : 40) Nephrosteril PT. Fresenius Kabi CombipharBotol Gelas 250 ml 50,820

Amino 72.05 g, Total N 11.53 g, AAE/AANE
383 ratio 2.6, Na+ 2 mEq, Asetat 46 mEq) Kidmin PT Otsuka Indonesia Softbag 200 ML 46,000
Amino 79.9 g, Total N 12.2 g, Na+ 14 mEq,
384 Cl 94 mEq) Aminoleban PT Otsuka Indonesia Softbag 500 ML 65,000
385 amino 8%) Aminosteril N-Hepa PT. Fresenius Kabi CombipharBotol Gelas 500 ml 82,418
386 Amino esensial 7%+Xylitol 10 g/L) Eas Pfrimer PT. Finusolprima Farma Internasional
botol 250 ml 51,260
Larutan mengandung Asam Amino (BCAA 25

gr/L, L-Ornithine L Aspartate 10 gr/L, Xylitol
387 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L) Comafusin Hepar PT. Finusolprima Farma Internasional
botol 500 ml 64,900
Larutan mengandung Asam Amino

(Kombinasi Asam aminno 50 g/L, Sorbitol 50
g/L, Xylitol 50 g/L, Asam Askorbat (Vit C) 0.4
g/L, Inositol 0.5 g/L, Nikotinamida
(Niasinamida) 0.06 g/L, Piridoksin HCl (Vit
B6) 0.04 g/L, Riboflavin Natrium Fosfat 2.5
388 mg/L, elektrolit) Aminofusin L600 PT Kalbe Farma botol 500 mL 42,000
(Kombinasi Asam amino 50 g/L, vitamin dan
389 elektrolit) Aminofusin Paed PT Kalbe Farma botol 250 mL 46,000
(Kombinasi Asam Amino: 34gr, Glukosa:
97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000
390 kkal, Akses peripheral)) Kabiven 1440 ml PT. Fresenius Kabi Combiphar
Bag (3 Chamber) 1440 ml 295,240
(Kombinasi Asam Amino: 45gr, Glukosa:
130gr, Lipid: 68gr dan Elektrolit (Kalori =
391 1400 kkal, Akses peripheral)) Kabiven 1920 ml PT. Fresenius Kabi Combiphar
Bag (3 Chamber) 1920 ml 343,842
(Kombinasi Glukosa dan elektrolit 150 gr + Bag Double chamber (Dua
392 Asam Amino 48 gr dgn akses sentral) Combiflex Plus (790 kcal) PT. Phapros, Tbk compartement), 1000 mL 322,000
(Kombinasi Glukosa dan elektrolit 80 gr + Bag Double chamber (Dua
393 Asam Amino 40 gr ) Combiflex peri (480 kcal) PT. Phapros, Tbk compartement), 1000 mL 218,700
Larutan mengandung Elektrolit (Kalium
394 Klorida) Otsu - KCl 7,46% PT Otsuka Indonesia Ampoel 25 ML 2,153
Larutan mengandung Elektrolit (Larutan
395 Ringer Laktat) Wida RL PT. Widatra Bhakti Botol 1000 ml 8,000
Larutan mengandung Elektrolit (Na 130 mEq,
396 Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Asering PT Otsuka Indonesia Plastic Bottle 500 ML 9,000
Larutan mengandung Elektrolit (NaCl 1.125
397 gr, Dekstrosa 18.75 gr) KA EN 1B PT Otsuka Indonesia Plastic Bottle 500 ML 9,000
Larutan mengandung Elektrolit (Sodium
Lactate sol (50%) 113 gr/L, Potassium
Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L,
398 elektrolit) Totilac PT Kalbe Farma flexybag 250 mL 87,000
Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
Potassium 4.0 mmol/l, Calcium 2.5 mmol/l,
Magnesium 1.0 mmol/l, Chloride 118 mmol/l, LDPE (Low Density Poly
399 Acetate 24 mmol/l, Malate 5.0 mmol/l) Ringerfundin 500 mL PT. Phapros, Tbk Ethilene), botol plastik 12,650
Larutan mengandung Karbohidrat (Fructose
120 g, glucose 66 g, Xylitol 60 g/ L +
400 elektrolit) Triofusin 1000 PT Kalbe Farma botol 500 mL 50,500
Larutan mengandung Karbohidrat (Fructose

401 60 g, glucose 33 g, Xylitol 30 g/ L) Triofusin 500 PT Kalbe Farma Flexy bag 500 mL 42,350
Larutan mengandung Karbohidrat (Maltose
402 100 gr) Martos PT Otsuka Indonesia Plastic Bottle 500 ML 30,625
Larutan mengandung Karbohidrat + Elektrolit

(25.00g maltose, 3.00 g sodium chloride,
0.15 g potassium chloride, 0.10 g calcium
403 chloride dihydrate dan 1.55 g sodium lactate) Potacol inj PT Otsuka Indonesia Plastic Bottle 500 ML 55,500

404 (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) Tutofusin OPS PT Kalbe Farma botol 500 mL 37,500
(Asam amino 28 gr/L, Glukosa 100 gr/L,
405 elektrolit) Clinimix N9G20E PT Kalbe Farma Botol Plastik 1000 mL 210,000
(Asam amino 28 gr/L, Glukosa 75 gr/L,
406 elektrolit) Clinimix N9G15E PT Kalbe Farma Botol Plastik 1000 mL 199,000

407 (Fructose 60 g, glucose 33 g, Xylitol 30 g/ L) Triofusin E1000 PT Kalbe Farma botol 500 mL 56,000
(Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g,
Natrium Laktat 3,1 g, air untuk injeksi ad
408 1000 ml) Wida HSD PT. Widatra Bhakti Botol 500 ml 9,500
(Glukosa 55 g ; Natrium Chloride 9 g, air
409 untuk injeksi ad 1000 ml) Wida D5-NS PT. Widatra Bhakti Botol 500 ml 6,800
410 (Glukosa: 25,0 g; NaCl: 4,5 g) WIDA 2A PT. Widatra Bhakti Botol 500 ml 7,263
411 (Glukosa: 55.0 g; NaCl: 2.25 g) WIDA D5-1/4NS PT. Widatra Bhakti Botol 500 ml 8,085
412 (Glukosa: 55.0 g; NaCl: 4.5 g) WIDA D5-1/2NS PT. Widatra Bhakti Botol 500 ml 8,085

(Larutan nutrisi kombinasi infus per L: Na.
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ,
413 Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g) Futrolit PT. Sanbe Farma softbag 500ml 35,750
414 (Larutan Ringer & Glukosa 5%) Wida RD PT. Widatra Bhakti Botol 500 ml 6,930

415 (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) KA ENMG 3 PT Otsuka Indonesia Plastic Bottle 500 ML 9,625
(Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr,
416 Dekstrosa 27 gr) KA EN 3B PT Otsuka Indonesia Plastic Bottle 500 ML 10,000
(Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr
417 Dekstrosa 27 gr) KA EN 3A PT Otsuka Indonesia Plastic Bottle 500 ML 10,000
Larutan mengandung Lipid ( Infus Lipid Lipofundin MCT/LCT 1% 20%, Botol Kaca @100 ml,
418 Emulsi MCT/LCT 20% 100 ml) 100 PT. Phapros, Tbk single bottle 105,500
Larutan mengandung Lipid (Emulsi lemak
419 20%) Intralipid PT. Fresenius Kabi CombipharBotol Gelas 100 ml 60,500
Larutan mengandung Lipid (Infus Lipid Lipofundin MCT/LCT 1% 20%, Botol Kaca @250 ml,
420 Emulsi MCT/LCT 20% 250 ml) 250 PT. Phapros, Tbk single bottle 210,000
Larutan mengandung Lipid (Kombinasi

Glukosa dan elektrolit 180 gr + Asam Amino Nutriflex Lipid Special Bag, 3 chamber ( 3
421 71.8 gr + Lipid 50 gr dgn akses sentral) 1250 PT. Phapros, Tbk kompartemen), 1250 ml 591,000
Glukosa dan elektrolit 80 gr + Asam Amino Bag, 3 chamber ( 3
422 40 gr + Lipid MCT/LCT 50 gr) Nutriflex Lipid Peri 1250 PT. Phapros, Tbk kompartemen), 1250 ml 511,000

Glukosa dan elektrolit 90 gr + Asam Amino Bag, 3 chamber ( 3
423 35.9 gr + Lipid 25 gr dgn akses sentral) Nutriflex Lipid Special 625 PT. Phapros, Tbk kompartemen), 625 ml 358,000
424 Latanoprost tetes mata 0,01% Cendo Glaopen PT. Cendo Industri Farmasi strip 5 x 0.6 ml 72,000
425 Latanoprost tts mata 0,005% btl@2,5ml Xalatan 0,005% PT. Pfizer Indonesia dus, Botol @ 2,5 ml 127,000
Granocyte 34 1vl HSA Dus, 1 vial @ 263 mcg + 1
426 Lenograstim inj 263 mcg/mL Free PT. Aventis Pharma prefilled syringe pelarut @ 1 ml 550,000
427 Letrozol tablet/kaplet/kapsul 2,5 mg FEMARA PT. Novartis Indonesia Dus, 3 blister @ 10 tablet 17,500
428 Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg PT. Takeda Indonesia Vial 700,000
429 Leuprorelin asetat inj depot 11,25 mg Tapros 3M PT. Takeda Indonesia Vial 2,700,000
430 Leuprorelin asetat inj depot 3,75 mg TAPROS 3.75 MG PT. Takeda Indonesia Vial 550,000
431 Levofloksasin inf 5 mg/mL n/a PT. Novell Pharmaeutical Laboratories

Botol @ 100 ml 41,905
432 Levofloksasin tablet 500 mg n/a PT. Promedrahardjo FarmasiDus,

Industri
5 Strip@10 Tablet 554
433 Levofloksasin tts mata 0,5% Optiflox PT. Erela Btl @ 5 ml 13,365
434 Levotiroksin tablet/kaplet/kapsul 100 mcg Euthyrox 100 PT. Merck Tbk Dus 4 blister @ 25 tablet 850
435 Lidokain injeksi 2% (HCL) n/a PT. Bernofarm Dus, 100 ampul @ 2 ml 879
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
436 80.000 - 2ml n/a PT. Indofarma Dus, 30 ampul @ 2 ml 1,431
437 Lidokain jeli 2% Xylocaine Jelly 2% PT. AstraZeneca indonesia Dus, 10 syringe @ 10 g 40,000
Xylocaine Spray 10 mg /
438 Lidokain semprot 10% dosis PT. AstraZeneca indonesia
Dus,Botol @ 50 ml (500 dosis) 149,100
439 Lisinopril tablet 10 mg n/a PT. Novell Pharmaeutical Laboratories

Box ,3 Strip @ 10 tablet 630
440 Lisinopril tablet 5 mg n/a PT. Novell Pharmaeutical Laboratories

441 Litium karbonat tablet 200 mg Frimania 200 PT. Mersifarma Tirmaku Mercusana
KOTAK @ 10 x 10 TAB 1,050
442 Litium karbonat tablet 400 mg Frimania 400 PT. Mersifarma Tirmaku Mercusana
KOTAK @ 10 x 10 TAB 1,850
443 Loperamid tablet 2 mg n/a PT. Ifars Pharmaceutical Laboratories

Dus, 10 Strip @ 10 Tablet 92
444 Loratadin tablet 10 mg n/a PT. Promedrahardjo FarmasiDus, 5 Strip@10 Tablet

Industri 162
445 Lorazepam tablet 0,5 mg MERLOPAM 0,5 mg KOTAK @ 10 x 10 TAB

PT. Mersifarma Tirmaku Mercusana 705
446 Lorazepam tablet 2 mg Merlopam 2 PT. Mersifarma Tirmaku Mercusana

KOTAK @ 10 x 10 TAB 1,381
Low molecule feri sucrose inj amp 100 mg/5

447 mL DIALIFER PT. Novell Pharmaeutical Laboratories
ampul 54,600
448 Manitol n/a PT. Finusolprima Farma Internasional

botol 500 ml 62,000
449 Maprotilin HCl tab 25 mg Ludios PT. Soho Industri Pharmasi Strip 1,200
450 Maprotilin HCl tab 50 mg Sandepril 50 PT. Mersifarma Tirmaku Mercusana

KOTAK @ 5 x 10 TAB 3,374
MDP (methylene diphosphonate) 1 mg
451 methylene diphosphonic acid/mL Bonescan KaeF PT. Kimia Farma Dus @ 5 vial 473,000
452 Mebendazol tablet 500 mg Vermox 500 PT. Taisho Pharmaceutical Indonesia
Dus,24 Catch
Tbk @ 1 tablet 7,497
Medroksi Progesteron Asetat
453 tablet/kaplet/kapsul 100 mg Provera 100mg PT. Pfizer Indonesia Dus, 10 blister @10 tablet 6,125
454 Melfalan tablet 2 mg Alkeran Box, Tablet 2 mg/25's

PT. Glaxo Wellcome Indonesia 12,210
455 Meropenem inj 1 g n/a PT. Bernofarm Dus, 1 vial @ 1 g 57,000
456 Meropenem serb inj 500 mg/vial n/a PT. Bernofarm Dus, 1 vial @ 0,5 g 47,460
457 Mesna inj 100 mg/mL Uromitexan injeksi. PT. Mugi Laboratories Dus, 15 Ampul 74,998
458 Metadon sir 50mg/5ml n/a PT. Kimia Farma Botol 1000 ml 266,805
459 Metformin HCl tablet 500 mg n/a PT. Bernofarm Dus, 10 blister @ 10 tablet 115
460 Metformin HCl tablet 850 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kaptab 215
Dus, 10 Strip @ 10 tablet salut
461 Metildopa tablet salut 250 mg DOPAMET PT. Actavis Indonesia selaput 840
Metilergometrin Maleat (Metilergometrin)
462 tablet salut 0,125 mg n/a PT. Kimia Farma ktk 10 x 10 tablet salut 162
463 Metilergometrin Maleat injeksi 0,200 mg-1 ml n/a PT. Ethica Industri Farmasi ampul @ 1 ml 2,750
Dus, botol plastik @ 30 kapsul
464 Metilfenidat kapsul LA 20 mg Ritalin LA PT. Novartis Indonesia pelepasan lambat 6,537
465 Metilfenidat tablet SR 10 mg RITALIN PT. Novartis Indonesia Dus, 2 blister @ 15 tablet 1,950
466 Metilprednisolon inj 125 mg/2 mL n/a PT. Bernofarm Dus, 1 vial @ 125 mg 22,490
467 Metilprednisolon inj 500 mg/8 mL n/a PT. Bernofarm Dus, 1 vial @ 500 mg 92,990
468 Metilprednisolon tablet 16 mg n/a PT. Mahakam Beta Farma Strip 681
469 Metilprednisolon tablet 4 mg n/a PT. Natura Laboratoria Prima

Dus, 10 Blister @ 10 Tablet 210
470 Metilprednisolon tablet 8 mg n/a PT. Dexa Medica Dus, 10 Blister @ 10 tablet 375
471 Metoklopramid drop botol 10 mL GAVISTAL drops PT. Meprofarm Dus, Botol 10 ml 5,500
472 Metoklopramide sirup 5 mg/ 5 ml LEXAPRAM SIRUP PT. Molex Ayus BOTOL 60 ML 2,800
473 Metoklopramide tablet 10 mg n/a PT. Kimia Farma Ktk 10X10 TAB 105
474 Metoklopramide tablet 5 mg n/a PT. Kimia Farma ktk 10 x 10 tablet 108
475 Metotreksat serb inj 50 mg/2 mL Methotrexate PT. Sanbe Farma Vial @ 2 mL 35,000
476 Metotreksat serbuk injeksi i.v/i.m./i.t. 5 mg EBEWE PT. Sandoz Indonesia Box 10 ampul @ 1 ml 22,176
METHOTREXATE
477 Metotreksat tablet/kaplet/kapsul 2,5 mg EBEWE 2.5 MG PT. Sandoz Indonesia Box, bottle @ 50 tab 1,764
478 Metronidazol infus 500 mg/100 ml n/a PT. Natura Laboratoria PrimaDus, 1 Botol @ 100 ml 10,250
479 Metronidazol ovula 500 mg Vagizol PT. Kimia Farma dus 1 's @ 5 ovula 4,043
480 Metronidazol supositoria 500 mg Flagyl PT. Aventis Pharma Dus, 2 blister @ 5 suppositoria 3,220
501 Nadroparin inj 9500 Axa/mL syringe 0,3 mL Fraxiparine 0.3 ml PT. Glaxo Wellcome Indonesia
Dus, 5 blister @ 2 pfs 0.3 ml 56,851
502 Nadroparin inj 9500 Axa/mL, syringe 0,4 mL Fraxiparine 0.4 ml PT. Glaxo Wellcome Indonesia
503 Nadroparin inj 9500 Axa/mL, syringe 0,6 mL Fraxiparine 0.6 ml PT. Glaxo Wellcome Indonesia
504 Nalokson injeksi 0,4 mg/ml Nokoba PT. Pratapa Nirmala Dus, 5 Ampul @ 2ml 64,680
505 Natrium Bikarbonat injeksi i.v 8,4% Meylon PT Otsuka Indonesia Ampoel 25 ML 6,510
506 Natrium Diklofenak tablet 50 mg n/a PT. Phapros, Tbk Dus @ 5 X 10 's 185
507 Natrium fosfat lar oral 45 mL Fleet Phosphosoda PT. Combiphar Botol, 45 ml 33,900
508 Natrium fusidat salep 20 mg/g Fucilex Ointment PT. Molex Ayus Tube 5 gr 6,555
509 Neostigmin injeksi 0,5 mg/ml Neostigmin Hameln inj PT. Pharma Health Care Box, isi 5 ampul @ 1 ml 9,700
510 Nevirapin tablet 200 mg n/a PT. Kimia Farma btl 60 tablet 2,940
511 Nifedipin tab 20 mg, slow release; oros Adalat Oros 20 mg PT. Bayer Indonesia blister 2,999
512 Nifedipin tab 30 mg, oros Adalat Oros 30 mg PT. Bayer Indonesia blister 3,500
513 Nifedipin tablet/kapsul 10 mg n/a PT. Dexa Medica selaput 110
Nilotinib kapsul 200 mg (Skema Risk Sharing
sesuai Kepmenkes RI Nomor
514 HK.02.02/Menkes/223/2014) Tasigna PT. Novartis Indonesia Dus, 2 blister @ 14 kapsul 380,875
515 Nistatin tablet salut 500.000 IU/ g n/a PT. Phapros, Tbk Dus @ 10 X 10 's 672
516 Nistatin vaginal tablet 100.000 IU/ g n/a PT. Phapros, Tbk Dus @ 10 X 10 's 504
517 Norepinefrin injeksi 1 mg/ml Levosol PT. Kimia Farma Dus 5 amp @ 8 ml 53,900
518 Noretisteron tablet 5 mg Primolut N PT. Bayer Indonesia blister 2,618
519 Obat Antituberkulosis FDC Kategori 1 n/a PT. Indofarma Paket 377,990
520 Obat Antituberkulosis FDC Kategori 2 n/a PT. Phapros, Tbk Paket 1,259,900
521 Obat Antituberkulosis FDC Kategori Anak n/a PT. Phapros, Tbk Paket 225,650
522 Obat Antituberkulosis FDC Sisipan n/a PT. Indofarma Paket@84 tablet 168,000
Dus, 1 dus @ 60 blister @ 8
tablet tahap intensif kategori 1 +
1 Dus @ 54 blister @ 3 tablet
523 Obat Antituberkulosis Kategori 1 dewasa n/a PT. Indofarma tahap lanjutan kategori 1 302,605
Dus, 60 sachet tahap intensif @

(1 tablet Isoniazid, 2 kapsul
Rifampicin, 2 tablet
Pyrazinamide) + 120 sachet
tahap lanjutan @ (1 tablet
524 Obat Antituberkulosis Kategori anak n/a PT. Indofarma Isoniazid, 2 kapsul Rifampicin) 180,595
525 Octreotide Acetate0,05 - 6 mg/mL SANDOSTATIN PT. Novartis Indonesia Dus, 5 ampul @ 1ml 82,500
526 Ofloksasin tets telinga 3% Tarivid Otic Solution PT Kalbe Farma Btl @ 5 ml 50,000
527 Ofloxacin tablet 200 mg n/a PT. Novell Pharmaeutical Laboratories

528 Ofloxacin tablet 400 mg n/a PT. Novell Pharmaeutical Laboratories

529 Oksaliplatin serbuk injeksi 100 mg / vial ELOXATIN PT. Aventis Pharma Dus, 1 vial @ 20 ml 1,100,000
530 Oksaliplatin serbuk injeksi 50 mg / vial ELOXATIN PT. Aventis Pharma Dus, 1 vial @ 10 ml 550,000
531 Oksimetazolin tetes hidung 0,025% Ilaidin Drops PT. Merck Tbk botol @ 10 ml 28,928
532 Oksitosin injeksi 10 IU/ml Oxytocin "S" PT. Ethica Industri Farmasi ampul @ 1 ml 2,310
Dus, vial @ 355m + 1 prefilled
syringe pelarut @ 2,5 ml + 2
533 Oktreotid 10 mg Sandostatin LAR PT. Novartis Indonesia jarum suntik 2,950,000
534 Olanzapin inj 10 mg/vial Zyprexa IM PT. Bayer Indonesia Vial 120,000
535 Olanzapin kapl salut 5 mg Olandoz 5 PT. Sandoz Indonesia 3 X 10 fcc 6,773
536 Olanzapin tab 10 mg Olandoz 10 PT. Sandoz Indonesia 3 X 10 fcc 11,760
537 Olopatadin tts mata 0,1% Patanol PT. Tempo Scan Pacific botol, tetes mata 5 ml 68,000
538 Omeprazol injeksi 40 mg/ 10 ml n/a PT. Natura Laboratoria Prima Dus, 1 Vial @ 40 mg 38,000
539 Omeprazol kapsul/kaplet 20 mg n/a PT. Novapharin dus 10 X 3'S 216
540 ondansetron inj 4 mg/ 2 mL n/a PT. Indofarma Dus, 5 Ampul @ 2ml 2,400
541 Ondansetron tab 4 mg n/a PT. Yarindo Farmatama Box 3 X 10 Tab 759
542 Ondansetron tablet 8 mg n/a PT. Yarindo Farmatama Box 3 X 10 Tab 1,261
Transfer Set: Set; Ultaclam:
Paket CAPD Awal (Komposisi: 1 unit Transfer Kantong Plastik; Tenckoff
Set, 2 unit Ultaclam, 1 unit Tenckoff Catheter, Catheter: Box; Titanium Adaptor:
543 Titanium Adaptor) n/a PT Kalbe Farma Kantong Plastik 1,902,240
Paket CAPD Pergantian Transfer Set per 6
544 bulan n/a PT Kalbe Farma Set 219,540
Dianeal Low Calcium with
1,5% Dextrose; Larutan
Dialisa 2.5%: Dianeal Low
Calcium with 2,5%
Paket CAPD Rutin 120 ( 4x ganti cairan Dextrose; Larutan Dialisa Larutan Dialisa 1.5 %: 2.000 ml;
perhari dengan komposisi Larutan Dialisa 1.5 4.25%: Dianeal Low Larutan Dialisa 2.5 %: 2.000 ml;
%, Larutan Dialisa 2.5 %, Larutan Dialisa Calcium with 4.25% Larutan Dialisa 4.25 %: 2.000
545 4.25 %, Minicap) Dextrose PT Kalbe Farma ml; Minicap: Kantong Plastik 5,522,580
546 Paklitaksel inj 100 mg/vial ML PT. Actavis Indonesia Vial 6mg/ml (100mg/16.67ml) 1,135,000
547 Paklitaksel inj 300 mg/vial ML PT. Actavis Indonesia Vial 6mg/ml (260mg/43.33ml) 3,100,000
548 Paklitaksel injeksi 30 mg/vial SINDAXEL 30 MG/5 ML PT. Actavis Indonesia Vial 6mg/ml (30mg/5ml) 320,000
Parasetamol drop 100 mg/ml btl @15ml
549 (60mg/0,6ml) n/a PT. Indofarma Dus, 15 botol 5,460
550 Parasetamol sirup 120 mg / 5 ml n/a PT. Afifarma botol 60 ml 1,496
Dus, 10 Strip@10 Kaplet Salut
551 Parasetamol tablet 500 mg n/a PT. Promedrahardjo Farmasi IndustriSelaput 84
552 Parasetamol tetes 60 mg/0,6 mL FASIDOL PT. Ifars Pharmaceutical Laboratories
Dus, botol @ 15 ml 7,000
Pegylated interferon alfa-2a inj 135 mcg/0,5
553 ml Pegasys PT. Boehringer Ingelheim Boks, 1 pfs 1,077,815
Pegylated interferon alfa-2a inj 180 mcg/0,5
554 ml Pegasys PT. Boehringer Ingelheim Boks, 1 pfs 1,248,220
Dus, 1 vial 100 mcg + 1 ampul
pelarut 0,7 ml + 1 syringe + 2
555 Pegylated Interferon alfa-2b serb inj 100 mcg Pegintron Vial 100 Mcg PT. Merck Sharp Dohme Pharma Tbkjarum 973,500
Dus, 1 prefilled syringe (serbuk
injeksi 120mcg + pelarut 0.5 ml)
556 Pegylated Interferon alfa-2b serb inj 120 mcg Pegintron Pen 120 Mcg PT. Merck Sharp Dohme Pharma Tbk+ 1 jarum 1,135,000
557 Pegylated Interferon alfa-2b serb inj 50 mcg Pegintron PT. Merck Sharp Dohme Pharma Tbkjarum 915,000
558 Pegylated Interferon alfa-2b serb inj 80 mcg Pegintron Vial 80 Mcg PT. Merck Sharp Dohme Pharma Tbkjarum 915,810
559 Perak sulfadiazin krim 1% BURNAZIN 35 GR PT. Darya Varia tube @ 35 gram 24,150
Dus, botol plastik @ 30 tablet
560 Perindoprilarginin tab 5 mg Bioprexum 5 mg PT. Pradja Pharin salut selaput 2,420
561 Permetrin krim 5% Scabimite Cream 10 PT. Galenium Pharmasia Laboratories

Tube @ 10 g 11,475
Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml
562 (HCl) n/a PT. Kimia Farma Ktk 10 ampx2ml 15,225
563 Pioglitazon tab 15 mg Actos PT. Takeda Indonesia dus 2 blister@ 7 Tablet 3,600
564 Pioglitazon tab 30 mg Gliabetes 30 mg PT. Sanbe Farma Strip 5,225
565 Pirantel suspensi 125 mg/5 ml n/a PT. Holi Pharma Botol 60 ml 8,728
566 Pirantel tablet score (base) 125 mg n/a PT. Holi Pharma Dus, 25 Blister @ 4 tablet 308
567 Pirazinamid tablet 500 mg n/a PT. Holi Pharma Dus 10 strip @ 10 tablet 220
568 Piridoksin (vitamin B6) inj 100 mg/mL n/a PT. Ikapharmindo Ampul 1 ml 1,050
569 Polikresulen cairan Aptil PT. Pratapa Nirmala Dus, Botol @ 10ml 17,993
570 Povidon Iodida larutan 10% 1000 ml n/a PT. Afifarma botol @ 1000 ml 38,594
573 Povidon Iodida larutan 10% 60 ml n/a PT. Kimia Farma btl 60 ml 6,298
574 Pramipeksol tab ER 0,375 mg Sifrol ER 0,375mg PT. Boehringer IngelheimDus, 3 alu blister @ 10 tablet 7,200
575 Pramipeksol tab ER 0,750 mg Sifrol ER 0,750mg PT. Boehringer IngelheimDus, 3 alu blister @ 10 tablet 11,268
576 Pravastatin tablet 20 mg n/a PT. Novell Pharmaeutical Laboratories

Box ,5 Strip @ 10 tablet 2,400
577 Prednison tablet/kapsul/kaplet 5 mg n/a PT. Holi Pharma Dus, 10 strip @ 10 tablet 119
578 Probenesid tablet/kapsul/kaplet 500 mg Probenid PT. Dexa Medica Dus, 10 strip @ 10 tablet 1,730
Prokain Benzilpenisilin serbuk injeksi 3 juta
579 IU/vial n/a PT. Bernofarm Vial @ 3 juta IU 7,550
580 Propanolol tablet 10 mg ( HCl ) n/a PT. Holi Pharma Dus, 10 strip @ 10 tablet 79
581 Propiltiourasil tablet/kapsul/kaplet 100 mg n/a PT. Indofarma Botol @ 100 Tablet 335
582 Propofol injeksi i.v., bolus 1% Fresofol 1% MCT/LCT PT. Fresenius Kabi Combiphar Ampul 16,236
583 Propranolol tablet 40 mg (HCl) n/a PT. Holi Pharma Dus, 10 strip @ 10 tablet 110
584 Quetiapin tab 200 mg Seroquel XR 200 mg PT. AstraZeneca indonesia Dus, 1 blister @ 10 tablet 17,391
Cardace 2.5mg 6x10 s
587 Ramipril tablet 2,5 mg tablet PT. Pharma Health Care Dus, 6 blister @ 10 tablet 995
588 Ramipril tablet 5 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 kaptab 600
589 Ramipril tablet/kaplet/kapsul 10 mg n/a PT. Novell Pharmaeutical Laboratories

Dus, 10 strip @ 10 tablet 1,064
590 Ranitidin injeksi 25 mg/ml n/a PT. Natura Laboratoria PrimaDus, 10 Ampul @ 2 ml 1,190
591 Ranitidin tablet 150 mg n/a PT. Dexa Medica selaput 126
592 Retinol (Vitamin A) 100.000 IU n/a PT. Kimia Farma Botol 50 kapsul lunak 273
593 Retinol (Vitamin A) 200.000 IU kapsul lunak n/a PT. Kimia Farma Botol 50 Kapsul 482
594 Rifampisin tablet/kapsul/kaplet 300 mg n/a PT. Indofarma Dus, 10 Strip @ 10 Kapsul 640
595 Rifampisin tablet salut 450 mg n/a PT. Indofarma Dus, 10 Strip @ 10 Kapsul 829
596 Ringer Laktat larutan infus n/a PT. Widatra Bhakti botol 500 ml 5,460
597 Risperidon tablet 1 mg n/a PT. Dexa Medica Dus, 5 Blister @ 10 tablet 1,400
598 Risperidon tablet 2 mg n/a PT. Mersifarma Tirmaku Mercusana

KOTAK @ 5 x 10 TAB 1,038
599 Risperidon tablet 3 mg n/a PT. Dexa Medica Dus, 5 Blister @ 10 tablet 2,000
Rituksimab injeksi 10 mg/ml (Skema Risk
600 HK.02.02/Menkes/223/2014) Mabthera PT. Boehringer Ingelheim Dus, 1 vial @ 10 ml 3,164,805
601 Rivaroksaban tab 10 mg Xarelto 10 mg PT. Bayer Indonesia Blister 23,500
Dus, 7 blister @ 4 Tablet lepas
604 Ropinirol Tablet Salut 2 mg Requip PD 24 Hour 2 mg PT. Glaxo Wellcome Indonesia Lambat 5,510
607 Salbutamol cairan ih 0,1% Ventolin Nebules Dus, 4x5 Botol Plastik@2.5 ml
608 Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler Dus, botol 200 dosis
609 Salbutamol serb inh 200 mcg/kaps Ventolin Rotacaps PT. Glaxo Wellcome Indonesia
Dus, 10 Blister @ 10 Kapsul 452
Salbutamol serb inh 200 mcg/kaps +
610 rotahaler Ventolin Rotahaler PT. Glaxo Wellcome Indonesia Dus, 1 Rotahaler 6,160
611 Salbutamol tablet 2 mg (sebagai Sulfat) n/a PT. Yarindo Farmatama strip @ 10 tablet 62
612 Salbutamol tablet 4 mg (sebagai Sulfat) n/a PT. Kimia Farma ktk 10 x 10 tablet 89
Salep 2-4 , Kombinasi : Asam Salisilat 2% +
613 Belerang endap 4% n/a PT. Marin Liza Farmasi Pot @ 30 gram 2,100
614 Sefadroksil sirup kering 125 mg/5ml n/a PT. Holi Pharma Dus, Botol 60 ml 5,064
615 Sefadroksil kapsul/kaplet 250 mg n/a PT. Hexpharm Jaya Laboratories strip 539
616 Sefadroksil kapsul/kaplet 500 mg n/a PT. Bernofarm Dus, 10 strip @ 10 kapsul 519
617 Sefadroksil sir kering 250 mg/5 mL n/a PT. Holi Pharma Dus, Botol 60 ml 6,149
618 Sefaleksin kapsul/kaplet 500 mg n/a PT. Ifars Pharmaceutical Laboratories

Dus, 5 Strip @ 10 Kapsul 1,100
619 Sefazolin serbuk injeksi 1 g/vial n/a PT. Dexa Medica Dus, 2 Vial @ 1 gram 17,325
620 Sefepim inj 1 g n/a PT. Novell Pharmaeutical Laboratoriesvial 45,048

621 Sefiksim kapsul/kaplet 100 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kapsul 869
622 Sefiksim sirup kering 100 mg/ 5 ml n/a Dus, Botol 30 ml

PT. Ifars Pharmaceutical Laboratories 9,000
623 Sefoperazon inj 1 g n/a PT. Holi Pharma Dus, 2 vial @ 1 g 13,330
624 Sefotaksim injeksi 0,5 g n/a PT. Hexpharm Jaya Laboratories vial 4,900
625 Sefotaksim injeksi 1 g n/a PT. Natura Laboratoria Prima Dus, 10 Vial @ 1 g 3,150
626 Sefpodoksim proksetil tab 100 mg Banadoz 100 PT. Sandoz Indonesia Dus, 3 blister @ 10 tablet 3,700
627 Seftazidim injeksi 1 g n/a PT. Hexpharm Jaya Laboratories

Dus, 2 vial @ 1 g 17,913
628 Seftriakson serbuk injeksi 1 g/vial n/a PT. Natura Laboratoria Prima Dus, 10 Vial @ 1 g 3,500
Dus, 1 Blister @ 10 Tablet salut
629 Sefuroksim tablet/kapsul/kaplet 250 mg Zinnat 250 mg PT. Glaxo Wellcome Indonesia selaput 4,990
Dus, 1 Blister @ 10 Tablet salut
630 Sefuroksim tab 500 mg Zinnat 500 PT. Glaxo Wellcome Indonesia selaput 7,200
631 Sertralin tab 50 mg Fatral PT. Pratapa Nirmala strip @ 10 tab 3,520
632 Setirizin sirup 5 mg/5 ml n/a PT. Indofarma Botol @ 60 ml 8,399
633 Setirizin tablet 10 mg n/a PT. Pertiwi Agung Box, 10 strips @ 10 capsules 186
Setuksimab infus 5 mg/ml (Skema Risk
634 HK.02.02/Menkes/223/2014) Erbitux PT. Merck Tbk Dus, 1 vial @ 20 ml 3,650,000
635 Sevofluran ih, btl Sojourn PT. Pratapa Nirmala tabung/botol 1,320,000
Sianokobalamin (vitamin B12) injeksi 500
636 mcg n/a PT. Lucas Djaja 100 ampul @ 1 ml 1,132
Sianokobalamin (vitamin B12)
637 tablet/kapsul/kaplet 50 mcg n/a PT. Afifarma Dus, 10 Strip @ 10 tablet 60
638 Siklofosfamid serbuk injeksi i.v. 1000 mg Cyclovid 1000 mg PT. Novell Pharmaeutical Laboratoriesvial 268,800
639 Siklofosfamid serbuk injeksi i.v. 200 mg Cyclovid 200 mg PT. Novell Pharmaeutical Laboratoriesvial 86,100
640 Siklofosfamid serbuk injeksi i.v. 500 mg CYCLOVID 500 PT. Novell Pharmaeutical LaboratoriesVial 126,000
Sandimmun Neoral
641 Siklosporin kaps 100 mg 100mg Kap PT. Novartis Indonesia Dus, 10 blister @ 5 kapsul lunak 43,000
Sandimmun Neoral 25mg
642 Siklosporin kapsul lunak 25 mg Kap PT. Novartis Indonesia Dus, 10 blister @ 5 kapsul lunak 12,000
643 Silostazol tablet/kapsul/kaplet 100 mg Citaz PT. Dankos Farma strip 7,000
644 Simvastatin scored tablet 10 mg n/a PT. Pertiwi Agung Box,3 strips @ 10 tablets 174
Dus, 3 Strip @ 10 Kaplet salut
645 Simvastatin tablet 20 mg n/a PT. Natura Laboratoria Prima selaput 394
646 Siprofloksasin infus 2% n/a PT. Dexa Medica Vial 200 ml 15,000
647 Siprofloksasin tablet 500 mg (sebagai HCl) n/a PT. Bernofarm Dus, 10 blister @ 10 tab ss 260
648 Sisplatin serbuk injeksi 10 mg Cisplatin PT Kalbe Farma vial 23,000
649 Sisplatin serbuk injeksi 50 mg Cisplatin PT Kalbe Farma vial 97,000
650 Sitarabin serbuk injeksi i.m./i.v./s.k. 1gr/10ml DBL Cytarabun PT. Tempo Scan Pacific dus, 1 vial @ 10 ml 575,000
651 Spiramisin tablet 500 mg n/a PT. Indofarma Dus, 5 strip @ 10 tablet 1,574
652 Spironolakton tablet 25 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet 320
653 Stavudin tablet/kapsul/kaplet 30 mg n/a PT. Kimia Farma Botol @ 60 tablet 977
654 Streptokinase injeksi 1,5 juta UI/vial Streptase PT. Dexa Medica Vial 3,290,000
655 Streptomisin serbuk injeksi i.v 1000 mg/ml n/a PT. Phapros, Tbk Dus @ 56 Vial 3,832
Sufentanyl Injeksi
656 Sufentanil injeksi iv, epidural 5 mcg/ml iv.Epidural 5 mcg / ml PT. Kimia Farma dus 5 amp @ dus 10 133,350
657 Sukralfat susp 500 mg/5 mL Ulsafate PT. Combiphar Botol, 100 ml 13,850
658 Sukralfat tab 500 mg ULSIDEX PT. Dexa Medica DUS, 10 STRIP @ 10 TAB 466
Pounch @ 5 blister @ 10
659 Takrolimus kaps 0.5 mg Prograf PT. Combiphar capsule 11,725
Dus, 1 pouch @5 blister@10
660 Takrolimus kaps 1 mg Prograf PT. Combiphar kaps 21,500
661 Tamsulosin tab 0,2 mg Harnal D PT. Combiphar Box @ 2 blister @ 14 tablet 5,800
Harnal ® D 0.2 mg Disp.
662 Tamsulosin tab 0,2 mg Tablet PT. Combiphar Box/ 2 blister @ 14 tablet 5,800
663 Tamsulosin tab SR 0,4 mg Tablet PT. Combiphar Box/ 3 blister @ 10 Tablet 6,800
664 Telbivudin tab 600 mg Sebivo 600 mg Tab PT. Novartis Indonesia Dus, 2 blister @ 14 tablet 28,500
665 Telmisartan tab 40mg Micardis 40mg PT. Boehringer Ingelheim Dus, 2 alu-blister @10 tablet 3,900
666 Telmisartan tab 80 mg Micardis 80mg PT. Boehringer Ingelheim Box, 2 blisters @10 tablets 6,500
667 Temozolamid kaps 100 mg Temodal PT. Merck Sharp Dohme Pharma
Dus, 5 Tbk
sachet @ 1 kapsul 1,120,000
668 Temozolamid kaps 20 mg Temodal Dus, 5 Tbk

PT. Merck Sharp Dohme Pharma sachet @ 1 kapsul 223,000
669 Tenofovir tab 300 mg n/a PT. Kimia Farma Botol 30 tab 8,100
670 Teofilin tab SR 300 mg Rethapyl PT. Kimia Farma Dus 10-s @ 10 Kaptab 1,103
671 Teofilin tablet 150 mg Bronsolvan PT Kalbe Farma strip 250
672 Terazosin HCl tablet/kapsul/kaplet 1 mg Hytrin 1 mg PT. Abbott Indonesia strip/blister 1,900
673 Terazosin HCl tablet/kapsul/kaplet 2 mg HYTROZ 3MG PT. Dexa Medica DUS, 10 BLISTER @ 10 TAB 3,189
674 Terbutalin cairan ih 2,5 mg/mL Bricasma Respules PT. AstraZeneca indonesia Dus, 2 pak @ 5 respules 6,250
675 Terbutalin tablet 2,5 mg Molasma Tablet PT. Molex Ayus Box 50's 100
Bricasma Turbuhaler 0,5
676 Terbutalin turbu (serbuk ih) 0,50 mg mg PT. AstraZeneca indonesia
677 Testoteron soft capsul 40 mg Andriol Testocaps PT. Merck Sharp DohmeDus,
Pharma
6 blister
Tbk@ 10 kapsul lunak 6,200
678 Tetrakain HCl tetes mata 0,5% Pantocain 0.5% PT. Cendo Industri Farmasi botol 5 ml 11,500
679 Tetrasiklin kapsul/kaplet 250 mg n/a PT. Holi Pharma Dus, 10 strip @ 10 kapsul 154
680 Tetrasiklin tablet/kapsul/kaplet 500 mg n/a PT. Afifarma DUS,10 STRIP @ 10 KAPSUL 312
681 Tiamazol tab 10 mg Thyrozol 10 PT. Merck Tbk Dus, 10 blister @ 10 tablet 1,135
682 Tiamazol tab 5 mg Thyrozol 5 PT. Merck Tbk Dus, 10 blister @ 10 tablet 563
683 Timolol tetes mata 0,25% Isotic Adretor 0,25% PT. Pratapa Nirmala Dus, Botol Plastik @ 5ml 9,397
684 Timolol tetes mata 0,5% Isotic Adretor 0,5% PT. Pratapa Nirmala Dus, Botol Plastik @ 5ml 9,996
Spiriva powder for
685 Tiotropium 18 mcg refill inhalation 18mcg 30s PT. Boehringer IngelheimBox, 3 blisters @10 capsules 13,867
Dus, 1 blister @10 kapsul +
686 Tiotropium kaps 18 mcg + handihaller Spiriva 10s + Handihaler PT. Boehringer Ingelheim handihaler 152,543
687 Tramadol injeksi 50 mg/ml n/a PT. Natura Laboratoria PrimaDus, 10 Ampul @ 2 ml 2,520
Trastuzumab serbuk injeksi 440 mg/vial
(Skema Risk Sharing sesuai Kepmenkes RI Dus, 1 vial @ 440 mg + 1 vial
688 Nomor HK.02.02/Menkes/223/2014) Herceptin PT. Boehringer Ingelheim pelarut @ 20 ml 19,608,034
689 Travoprost tetes mata 0,004% Travatan PT. Tempo Scan Pacific botol, tetes mata 2,5 ml 115,000
Triamsinolon asetonid nasal spray 55
690 mcg/puff Nasacort AQ PT. Aventis Pharma Dus, botol plastik 120 dosis 90,000
691 Trifluoperazin tablet 5 mg n/a PT. Darya Varia strip 425
692 Tropikamid tetes mata 1% Cendo Mydriatil 1% PT. Cendo Industri Farmasi Botol 5ml 36,500
693 Urea krim 10% Soft U Derm PT. Galenium Pharmasia Laboratoriestube 6,720
Vaksin polio inj (Vaksin Poliomyelitis yang
694 diinaktifkan) Imovax Polio PT. Aventis Pharma 1 vial of 10ml (10 d's) 285,000
Vaksin rabies, untuk manusia serbuk injeksi Dus, 1 vial@ 1dosis + 1 Syringe
695 s.k./i.k. + booster Verorab PT. Bio Farma @ 0,5 ml NaCl 4% 78,000
Dus, 1 vial serbuk + 1 ampul @
Vaksin rabies, untuk manusia serbuk injeksi 1 ml pelarut + 1 syringe & jarum
696 s.k./i.k. + booster RABIPUR PT. Novartis Indonesia suntik 78,500
697 Valgansiklovir tab 450 mg Valcyte PT. Boehringer Ingelheim Boks, 60 tablet 170,000
698 Valproat sirup 250 mg/5 ml Depakene PT. Abbott Indonesia botol 41,800
699 Valproat tab SR 250 mg Depakote ER 250 mg PT. Abbott Indonesia Tablet 2,793
700 Valproat tab SR 500 mg Depakote ER 500 mg PT. Abbott Indonesia Tablet 5,450
701 Valproat tablet salut 250 mg Depakote Tab 250 mg PT. Abbott Indonesia Tablet salut 250 mg 1,680
DUS, 3 ALU-ALU STRIP @ 10
702 Valsartan tab 80 mg Diovan 80mg Tab PT. Novartis Indonesia tablet salut selaput. 3,900
DUS, 3 ALU-ALU STRIP @ 10
703 Valsartan tab 160 mg DIOVAN 160 MG PT. Novartis Indonesia tablet salut selaput. 6,500
704 Vankomisin serbuk injeksi 500 mg/vial Vancep PT. Pratapa Nirmala Box @ 2 vial 129,000
705 Verapamil tab 240 mg Isoptin 240 mg PT. Abbott Indonesia Tablet 6,200
706 Verapamil tablet 80 mg (HCl) n/a PT. Kimia Farma Ktk 10X10 TAB 234
707 Vinblastin serbuk injeksi 10 mg Vinblastine PT. Combiphar Vial 10mg/10ml 210,000
708 Vinkristin serb inj i.v 2 mg/vial Vincristine Kalbe PT Kalbe Farma vial @ 2 ml 78,000
709 Vinkristin serbuk injeksi i.v. 1 mg Vincristine Kalbe PT Kalbe Farma vial @ 1 ml 46,000
710 Vinorelbin inj. 10 mg/ml Navelbine injeksi 10 PT. Mugi Laboratories Dus, 1 vial @ 1 ml 1,229,998
711 Vitamin B Kompleks tablet n/a PT. Kimia Farma Dus 10 strip x 10 tab 110
712 Zidofudin 100 mg n/a PT. Kimia Farma Botol 60 Kapsul 1,654
713 Zidovudin 300 mg + Lamivudine 150 mg n/a PT. Kimia Farma Botol 60 tablet 3,600
714 Zinc drop 10 mg/mL Zincpro Drops PT. Combiphar Drops 10 mg/ml, Botol @15 ml 12,840
715 Zinc sir 20 mg/5 Ml Zircum Kid Sirup PT. Meprofarm Dus, botol 60 ml 7,770
Dus, 10 strip @ 10 tablet
716 Zinc tablet dispersible20 mg n/a PT. Indofarma dispersible 497
21
Amfoterisin B salep mata 1%
Fungicide PT. Cendo Industri Farmasi
tube 3.5 gr 18,500.00
KELOMPOK OBAT UNTUK MATA DI EKATALOG DAN FORNAS
NO KOMPOSIS MERK PABRIK
1 Amfoterisin B salep mata 1% Fungicide PT. Cendo Industri Farmasi
2 Atropin Sulfat tetes mata 0,5% Cendo Tropin 0,5% PT. Cendo Industri Farmasi
3 Atropin Sulfat tetes mata 1% Cendo Tropin 1% PT. Cendo Industri Farmasi
4 Dinatrium edetat tetes mata 0,35% E.D.T.A PT. Cendo Industri Farmasi
5 Homatropin tetes mata 2% Homatro 2% PT. Cendo Industri Farmasi
Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664 mg;
6 Kalium klorida 1,32 mg Cendo Lyteers PT. Cendo Industri Farmasi
7 Latanoprost tetes mata 0,01% Cendo Glaopen PT. Cendo Industri Farmasi
8 Tetrakain HCl tetes mata 0,5% Pantocain 0.5% PT. Cendo Industri Farmasi
9 Tropikamid tetes mata 1% Cendo Mydriatil 1% PT. Cendo Industri Farmasi
10 Levofloksasin tts mata 0,5% Optiflox PT. Erela
11 Betametason tetes mata 1 mg/ml Betam Ophtal ED PT. Sanbe Farma
12 Fluorometolon tetes mata 0,1 % Ocuflam ED PT. Sanbe Farma
13 Asiklovir salep mata 3% Temiral Eye Oint PT. Sanbe Farma
14 Timolol tetes mata 0,25% Isotic Adretor 0,25% PT. Pratapa Nirmala
15 Timolol tetes mata 0,5% Isotic Adretor 0,5% PT. Pratapa Nirmala
16 Gentamisin salep mata 0,3% Genoint Salep Mata PT. Erela
17 Gentamisin tetes mata 0,3% n/a PT. Indofarma
18 Kloramfenikol salep mata 1 % n/a PT. Kimia Farma
19 Kloramfenikol tetes mata 0,5 % tidak ada pemenang tender ADA DI FORNAS
20 Kloramfenikol tetes mata 1 % tidak ada pemenang tender ADA DI FORNAS
21 Natamisin 50 mg/mL tetes mata tidak ada pemenang tender ADA DI FORNAS
22 Moksifloksasin tetes mata 0,5% tidak ada pemenang tender ADA DI FORNAS
448 Manitol INF n/a PT. Finusolprima Farma Internasional
Copyright by Toni Dafia Putra, S.Farm, Apt

AS
KEMASAN HARGA
tube 3.5 gr 18,500.00
Botol 5ml 13,500.00
Botol 5ml 13,500.00
botol 15 ml 37,500.00
Botol 5ml 18,000.00
botol 15 ml 15,750.00
strip 5 x 0.6 ml 72,000.00
botol 5 ml 11,500.00
Botol 5ml 36,500.00
Btl @ 5 ml 13,365.00
botol @ 5 ml 25,106.00
botol @ 5 ml 30,493.00
Tube 3,5 gram 24,750.00
Dus, Botol Plastik @ 5ml 9,397.00
Dus, Botol Plastik @ 5ml 9,996.00
Tube @ 3,5 gr 2,660.00
Dus, botol plastik 5 ml 3,353.00
Tube 5 gr 1,600.00
botol 500 ml 62,000.00

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NO KOMPOSISI MERK PABRIK KEMASAN HARGA

ACT (Artesunate tablet 50 mg + Amodiaquine

2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera PT. SmithKline Beecham Phamaceuticals

43 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg PT. AstraZeneca indonesiaDus, 2 blister @ 14 Tablet 32,000

68 Atrakurium injeksi 25 mg/2,5 ml Tracrium PT. Glaxo Wellcome Indonesia

108 Deksametason tablet 0,5 mg n/a PT. Promedrahardjo Farmasi

110 Desoksimetason krim 0,25% DEXIGEN PT. Ifars Pharmaceutical Laboratories

DTPA (diethylene triamine pentaacetic acid)

138 Dutasterid kaps lunak 0,5 mg Avodart PT. SmithKline BeechamDus,

162 Etoposid injeksi 20 mg/ml Etopul PT. Novell Pharmaeutical Laboratories

172 Fenitoin injeksi 50 mg/ml n/a PT. Mersifarma Tirmaku Mercusana

176 Fenofibrat kaps 100 mg n/a PT. Hexpharm Jaya Laboratories

177 Fenofibrat kaps 300 mg n/a PT. Hexpharm Jaya Laboratories

Garam Oralit I serbuk, kombinasi : Natrium

247 Haloperidol tablet 2 mg Lodomer 2 PT. Mersifarma Tirmaku Mercusana

Human insulin intermediate acting inj 100

Human insulin intermediate acting inj 100

Imanitib Mesilat tablet salut selaput 100 mg

308 Kalsium polistirena sulfonat ktg 5 g KALQUEST kantong 5 g

318 Karbimazol tab 5 mg Neo-Mercazole PT. Nicholas Laboratories Indonesia

326 Ketokonazol krim 2% n/a PT. Novell Pharmaeutical Laboratories

Dus, 3 Strip @ 10 Kaplet salut

346 Klozapin 100 mg n/a PT. Mersifarma Tirmaku Mercusana

347 Klozapin 25 mg n/a PT. Mersifarma Tirmaku Mercusana

Kombinasi suspensi : Parafin + gliserin +

Kotrimoksazol DOEN I (dewasa) kombinasi :

374 Lapatinib tab 250 mg Tykerb PT. SmithKline Beecham Phamaceuticals

Larutan mengandung Asam Amino (Asam

Larutan mengandung Asam Amino (Asam

Larutan mengandung Asam Amino (BCAA 25

Larutan mengandung Asam Amino

Larutan mengandung Elektrolit (Tiap 1000 ml

Larutan mengandung Karbohidrat (Fructose

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Lipid (Kombinasi

Larutan mengandung Lipid (Kombinasi

431 Levofloksasin inf 5 mg/mL n/a PT. Novell Pharmaeutical Laboratories

432 Levofloksasin tablet 500 mg n/a PT. Promedrahardjo FarmasiDus,

439 Lisinopril tablet 10 mg n/a PT. Novell Pharmaeutical Laboratories

440 Lisinopril tablet 5 mg n/a PT. Novell Pharmaeutical Laboratories

443 Loperamid tablet 2 mg n/a PT. Ifars Pharmaceutical Laboratories

444 Loratadin tablet 10 mg n/a PT. Promedrahardjo FarmasiDus, 5 Strip@10 Tablet

445 Lorazepam tablet 0,5 mg MERLOPAM 0,5 mg KOTAK @ 10 x 10 TAB

446 Lorazepam tablet 2 mg Merlopam 2 PT. Mersifarma Tirmaku Mercusana

Low molecule feri sucrose inj amp 100 mg/5

448 Manitol n/a PT. Finusolprima Farma Internasional

450 Maprotilin HCl tab 50 mg Sandepril 50 PT. Mersifarma Tirmaku Mercusana

454 Melfalan tablet 2 mg Alkeran Box, Tablet 2 mg/25's

469 Metilprednisolon tablet 4 mg n/a PT. Natura Laboratoria Prima

Dus, 60 sachet tahap intensif @

527 Ofloxacin tablet 200 mg n/a PT. Novell Pharmaeutical Laboratories

528 Ofloxacin tablet 400 mg n/a PT. Novell Pharmaeutical Laboratories

561 Permetrin krim 5% Scabimite Cream 10 PT. Galenium Pharmasia Laboratories

576 Pravastatin tablet 20 mg n/a PT. Novell Pharmaeutical Laboratories

589 Ramipril tablet/kaplet/kapsul 10 mg n/a PT. Novell Pharmaeutical Laboratories

598 Risperidon tablet 2 mg n/a PT. Mersifarma Tirmaku Mercusana

618 Sefaleksin kapsul/kaplet 500 mg n/a PT. Ifars Pharmaceutical Laboratories

620 Sefepim inj 1 g n/a PT. Novell Pharmaeutical Laboratoriesvial 45,048

622 Sefiksim sirup kering 100 mg/ 5 ml n/a Dus, Botol 30 ml