NAMA OBAT / BMHP SATUAN KEBUTUHAN

1 2 3
Alopurinol Tablet 100 mg tablet 5000
Ambroxol tablet 30mg tablet 6000
Ambroxol sirup 15 mg/ 5 ml btl 60 ml 100
Aminofilin injeksi 24 mg/ml ampul 50
Amitriptilin tablet salut 25 mg (HCl) tablet 1500
Amlodipin tablet 5 mg tablet 10000
Amlodipin tablet 10 mg tablet 6000
Amoksisilin kapsul 250 mg kapsul 4500
Amoksisilin kaplet 500 mg kaplet 26000
Amoksisilin sirup kering 125 mg/5 ml btl 60 ml 300
Amoksisilin sirup kering forte 250 mg/5
btl 60 ml
ml 150
Ampisilin sirup kering 125 mg/ 5 ml btl 60 ml 300
Antasida DOEN Tab tablet 45000
Antasida DOEN II suspensi btl 60 ml 1000
Anti Bakteri DOEN salep tube @ 5 g
Antifungi DOEN pot @ 30 g 100
Antihemoroid DOEN supp @ 2 g 300
Articain hidrokloride 4 mg : efinefrin
ampul
bitartrat 0,01 mg (ORABLOC) 100
Asam asetilsalisilat tablet 80 mg tablet 300
Asam askorbat (Vit.C) tablet 50 mg tablet 35000
Asam Mefenamat kaplet 500 mg tablet 35000
Asetil sistein kapsul 200 mg tablet 4000
Asiklovir krim 5 % tube 5 g 150
Asiklovir tablet 400 mg tablet 1000
Attapulgite tablet 600 mg tablet 2000
Atropin injeksi 0,25 mg/ml ampul 100
Betametason krim 0,1 % tube @ 5 g 800
Bisakodil tab 5 mg tablet 1000
Bisakodil suppositoria 5 mg Suppositoria 50
Bisakodil suppositoria 10 mg Suppositoria 50

Dehidro Atemisin + Piperakuin (DHP) tablet

50
Deksametason injeksi i.v 0,5 mg/ml ampul 150
Deksametason tablet 0,5 mg tablet 31000
Diazepam injeksi 5 mg/ml ampul 50
Diazepam larutan rektal 5 mg/2,5 ml tube @ 2,5 ml 20
Diazepam rectal 10 mg/2,5 ml tube 20
Diazepam tablet 2 mg tablet
Diazepam tablet 5 mg tablet 600
Difenhidramin injeksi i.m 10 mg/ml (HCl) ampul
200
Dimenhidrinat tablet 50 mg tablet 1500
Doksisiklin 100 mg kapsul 500
Domperidon tablet 10 mg tablet 3500
Eritromisin kapsul 250 mg kapsul 1000
Etanol 70 % btl 100 ml 100
Fenobarbital tablet 30 mg tablet 1000
Fenol Gliserol tetes telinga 10% botol 5 ml 100
Fitomenadion (Vit K) tablet salut gula 10
tablet
mg 2600

Fitomenadion (Vit K) injeksi i.m.2 mg/ml ampul

500
Furosemid tab 40 mg tablet 1000
Garam Oralit serbuk 200 ml sachet 1000
Gentian violet larutan 1 % btl 10 ml 50
Glibenklamida tablet 5 mg tablet 4500
Glimepiride tablet 1 mg tablet 2000
Gliseril Guaiakolat tablet 100 mg tablet 3500
Glukosa larutan infus 5% btl 500 ml 500

Griseofulvin tablet 125mg Micorinized tablet

2000
Haloperidol tablet 1,5 mg tablet 27000
Haloperidol inj 5 mg/ml ampul 15
Haloperidol inj 50 mg/ml ampul @ 1 ml 15
Hidrokortison krim 2,5% tube @ 5 g 300

Hyosicine-N-Butilbromide tablet 10mg tablet

3000
Ibuprofen sirup 100 mg/ 5 ml btl 60 ml 200
Ibuprofen tablet 200 mg tablet 31000
Ibuprofen tablet 400 mg tablet 31000
Isoniazid tablet 100 mg tablet 7000
Kalsium Laktat (Kalk) tablet 500 mg tablet 6000
Ketokonazol tablet 200mg tablet 2500
Kloramfenikol kapsul 250 mg kapsul 1000
Kloramfenikol salep mata 1 % tube @ 5 g 50

Klorfeniramin Maleat (CTM) tablet 4 mg tablet

35000

Klorpromazin tablet salut 100 mg (HCl) tablet

6000
Kodein tablet 10 mg tablet 4000
Kotrimoksazol DOEN (dewasa) tablet 2500
Kotrimoksazol suspensi btl 60 ml 400
Lidokain injeksi 2% ampul @ 2 ml 300
Loratadin tablet 10 mg tablet 6000
Magnesium sulfat inj 20% vial 25 ml 50
Magnesium sulfat inj 40% vial 25 ml 50
Metformin HCl tablet 500 mg tablet 19000

Metil Ergometrin Maleat

tablet
(Metilergometrin) tablet salut 0,125 mg
1000
Metilprednisolon 4 mg tablet 3000
Metronidazol tablet 500 mg tablet 7200
Mikonazol krim/salep 2 % (Nitrat) tube @ 10 g 400
Natrium Diklofenak tablet 50 mg tablet
Natrium Diklofenak Gel emulsi (hotin
Tube
DCL) 11000
Natrium Klorida larutan infus 0,9% btl 500 ml
N.B Topical Oint tube 5 g
Nifedipin tablet 10 mg tablet
Nistatin tablet salut 100.000 IU/g tablet
Nistatin tablet 500.000 IU/g tablet
Obat antituberkulosis kategori 1 dewasa paket

Obat antituberkulosis kategori 2 dewasa paket

Kombipak Kategori 1 paket
Obat antituberkulosis kategori anak paket
Obat antituberkulosis sisipan dewasa paket
Obat Batuk Hitam ( O.B.H ) cairan btl 100 ml
Obat Batuk Hitam ( OBH Itra) btl 120 ml
Obat gigi :
Bahan Tumpatan sementara
pot @ 30 g
(Ceivitron)
Etil Klorida Spray btl 100 ml
Eugenol cairan Botol @ 10 ml
Glass Ionomer Cement ART set
Hemospon set
Kalsium Hidroksida Pasta set
Klorfenol kamfer Menthol (CHKM) set
Mummiffying pasta set
Semen seng Fosfat serbuk dan cairan set
Silver Amalgam set
Temporary Stopping Fletcher serbuk
set
dan cairan
Oksitetrasiklin salep mata 1% (HCl) tube @ 3,5 g
Oksitetrasiklin salep kulit 3% tube @ 5 g
Oksitosin injeksi 10 IU/ml - ml ampul @ 1 ml
Omeprazol injeksi 40 mg/10 ml vial
Papaverin tab 40 mg tablet
Paracetamol drops 100 mg/ml btl 15 ml
Parasetamol sirup 120 mg/ 5 ml btl 60 ml
Parasetamol tablet 100 mg tablet
Parasetamol tablet 500 mg tablet
Perak sulfadiazin krim 1% tube @ 35 g
Permetrin krim 5% tube @ 10 g
Pirantel suspensi 125 mg/ 5 ml btl 60 ml
Pirantel tab.Score (base) 125 mg tablet
Piridoksin (Vit. B6) tablet 10 mg (HCl) tablet
Piridoksin tab 25 mg tablet
Piroksikam tablet 10 mg tablet
Piroksikam tablet 20 mg tablet
Polikresulen cairan btl 10 ml
Povidon Iodida larutan 10% btl @ 300 ml
Prednison tablet 5 mg tablet
Primakuin tablet 15 mg tablet
Probenesid tab 500 mg tablet
Prokain Benzil Penisilin injeksi 3 jt IU vial
Propanolol tablet 10 mg (HCl) tablet
Propranolol 40 mg tablet
Propiltiourasil tablet 100 mg tablet
Ranitidin tablet 150 mg tablet
Ranitidin injeksi ampul
Reserpin tablet 0,25 mg tablet
Retinol (Vit.A) 100.000 IU kapsul lunak kapsul

Retinol (Vit.A) 200.000 IU kapsul lunak kapsul

Ringer Laktat larutan infus btl 500 ml
Risperidon 2 mg tablet
Salbutamol tablet 2 mg (sebagai sulfat) tablet

Salbutamol tablet 4 mg (sebagai sulfat) tablet

Salbutamol cairan ih 0,1% botol @ 2,5 ml
Salep 2-4,kombinasi : Asam sulfat 2 %
pot @ 30 g
+ Belerang endap 4 %
Salisil bedak serbuk 2 % ktk 50 gram
Sefadroxil sirup 250 mg/5 ml botol
Sefadroxil 500 mg kaplet
Setrizin drops botol
Setirizin sirup 5 mg/5 ml Botol @ 60 ml
Setrizin tab 10 mg tablet
Sianokobalamin (Vit.B 12) tablet 50 mcg tablet

Sianokobalamin (Vit.B 12) tablet 10 mcg tablet

Sianokobalamin (Vit.B 12) injeksi 500
ampul
mcg
Simetidine tablet 200 mg tablet
Simvastatin tablet 10 mg tablet
Simvastatin tablet 20 mg tablet
Siprofloksasin tablet 500 mg (HCl) tablet
Spironolakton tablet 25 mg tablet
Tablet tambah darah : tablet
_ Besi (II) sulfat 200 mg, asam folat
tablet
0,25 mcg
_ Ferrous Fumarate 180 mg, Folic Acid
tablet
400 mcg
Taburia sachet
Tetrakain HCl tetes mata 0,5% botol 5 ml
Tetrasiklin kapsul 250 mg kapsul
Tiamin (Vit.B1) tablet 50 mg tablet
Tiamin (Vit.B1) injeksi 100 mg/ml ampul
Triheksifenidil tablet 2 mg tablet
Triheksifenidil tablet 2 mg (Arkine) tablet
Vaksin BCG serb inj. 0,75 mg/ml +
vial
pelarut
Vaksin campak serb inj. + pelarut vial
Vaksin kombinasi DPT-HB-Hib inj vial
Vaksin jerap difteri tetanus (DT) inj.
vial
40/15 If per ml
Vaksin jerap difteri tetanus pertusis
vial
(DPT) inj.
Vaksin HB-PID vial
Vaksin polio b-OPV drops 10 dosis vial
Vaksin polio IPV inj. 0,5 ml vial
Vaksin Td vial
Vaksin rabies serb inj +booster vial
Vaksin HBIG vial
Vaksin MR vial
Vaksin Hepatitus B syringe
Vitamin B Kompleks tablet tablet
Zinc Tab 20 mg tablet
Zinc drop 10 mg/ml botol @ 15 ml
Zinc sirup 10 mg/ml botol 100 ml
Zinc sirup 20 mg/5 ml botol 60 ml
 Efavirens (EFV) 600 mg botol @ 30 tab
Nevirapine (NVP) 200 mg botol @ 60 tab
Lamivudin (3TC) 150 mg botol @ 60 tab
Tenofovir (TDF) 300 mg botol @ 30 tab
Zidovudin (ZDV) 100 mg botol @ 60 tab
ZDV+3TC+NVP Ped Triple FDC
botol @ 30 tab
(60/30/50)
TDF+3TC+EFV (300/300/600) Triple
botol @ 30 tab
FDC
Zidovudin (300 mg) + Lamivudin (150
botol @ 60 tab
mg)
Multivitamin :
- Anagens sirup botol @ 60 ml
- Becefort sirup botol @ 60 ml
- Biovitan syr botol
- Bioron tablet tablet
- Bioron injeksi amp
- Corobion tab tablet
- Corovit sirup botol @ 60 ml
- Corovit tablet tablet
- Takana sirup botol
Helmezin sirup botol
Hemafort tab tablet
Hustab tab tablet
Hustab P sirup botol 60 ml
Lactulose sirup botol
L-Bio sachet
Livron B plex tablet
Pehacain inj. ampul
Potensik (diaz, metampiron) tablet
Flufenazine decanoat 25 mg/ml ampul
Trifluoperazine HCl 5 mg tablet
Betahistin mesilate 6 mg tablet
Oseltamivir 75 mg tablet
Azithromycin 500 mg tablet
Chloroquine phosphate 150 mg tablet
Pehavral tab tablet
Becefort tab tablet

Alat suntik 0,05 ml set

Alat suntik 0,5 ml set
Alat suntik 1 ml set
Alat suntik 2,5 ml set
Alat suntik 3 ml set
Alat suntik 5 ml set
Alat suntik 10 ml Set
Alat suntik 20 ml Set
Alat suntik 50 ml Set
Alkohol swab ktk 100 lbr
Aquades steril btl 1000 ml
Aquades 20 liter gallon 20 L
Aquagel Steril Jelly 82 gram Tube
Asam Klorida (HCl) 0,1 N btl 1000 ml
Asam sulfosalisilat 20 % btl 100 ml
Aseptic Gel btl 500 ml
Blood Lancet ktk 100 pcs
Blood Lancet (BD Microtainer Contact
Pcs
Actived Lancet 21 G x 1.8 m)
Blood Collection Tube (BD Vacutainer) Tube
Blood Collection Tube (EDTA) tube
Boule cleaning kit set (3x450 ml)
Bracket Handwash plastik Pcs
Brugia Rapid (filariasis test) Test
Control Hematologi Normal vial
Cover glass 22x22 ktk 10 pak @ 10 pcs
CutGut No. 3-0 100 m set
CutGut Cromic SMI 3/0 HR 26 MM set
CutGut Cromic SMI 3/0 HR 30 MM set
Cutgut Cromic SMI 4/0 HR 30 MM set
Dengue Test/RDT Ns1 test
Etakridin larutan 0,1 % btl 300 ml
Etanol 70 % 1 Liter btl 1000 ml
Folley Catheher 12 Set
Folley Catheher 14 Set
Folley Catheher 16 Set
Folley Catheher 18 Set
Folley Catheher 20 Set
Folley Catheher 22 Set
HbsAg Fast Test test
HIV Test 1/2 3.0 test
HIV Test (Fokus) test
HIV Test (Vikia 1/2) test
HIV Test (Fokus HIV 1+2 (KHB)) test
ID Band Baby Pink ktk 100 pcs
ID Band Baby Blue ktk 100 pcs
ID Band Dws Pink ktk 100 pcs
ID Band Dws Blue ktk 100 pcs
Infuset Anak set
Infuset Dewasa set
IV Catheter No. 16 G set
IV Catheter No. 18 G set
IV Catheter No. 20 G set
IV Catheter No. 22 G set
IV Catheter No. 24 G set
IV Cannula with inj.port, snap fit cap,
set
and suture wings (22)
Immersion oil btl 100 ml
Iodium Test btl 10 ml
Kapas pembalut 250 g roll
Kapas Pembalut 500 g roll
Kartu golongan darah pak 100 lbr
Kasa kompres 40/40 steril roll
Kasa 2 x 80 cm roll
Kasa 4 x 15 cm roll
Kasa 4 x 10 cm roll
Kasa 4 x 5 cm roll
Kasa 4 x 3 cm roll
Kasa hidrofil uk. 36 m x 80 cm roll
Kasa Hydrophil 40 x 80 cm roll
Kapas pembalut 1000 gram Roll
Kasa steril 16x16 Lbr
Kasa steril 18x22 Lbr
Kertas Perkamen bks 200 lbr
Kantong urine steril 2L Pcs
Labstrip U11 Plus Urine Test Tube 150 strip
btl 1000 ml
Larutan Turk
btl 100 ml
btl 100 ml
Larutan Giemsa Stain
btl 500 ml
Larutan Karbol Fucsin btl 100 ml
Larutan HCl- Alkohol btl 100 ml
Larutan Metilen Blue btl 100 ml
Larutan Benedict btl 1000 ml
Larutan EDTA btl 100 ml
Larutan Eosin btl 100 ml
Larutan Hayem btl 1000 ml
Larutan Natrium Sitrat 3,8 % btl 500 ml
Larutan Rees Ekker btl 100 ml
Larutan Spiritus btl 1000 ml
Lisol btl 1000 ml
Malaria Test test
Masker 3 ply E/L Lbr
Masker 3 ply plus E/L Lbr
Masker 3 ply T/O Lbr
My Jelly 82 g btl
Nasal Oxygen canula child pcs
Nasal Oxygen canula adult pcs
Object glass pcs
One Clean (Chlorine) botol 1 L
Oxygen mask pediatric pcs
Oxygen mask adult pcs
Paraformaldehid tab tablet
Penjepit tali pusat Buah
Plester 2" x 5 yard roll
Plester hospital 2,5 cm x 4,5 m roll
Plester hospital 7,5 cm x 4,5 m roll
Pot sputum buah
Povidon iodida larutan 10 % (betadine) btl 60 ml
Povidon iodida larutan 10 % btl 300 ml
Reagensia Ziehl Neelsen 100 ml/btl paket
Refil strip asam urat strip
Refil strip glukosa strip
Refil strip Hb strip
Refil strip kolesterol strip
RDT Anti HCV (Hepatitis C) Test
Reagen Dual Pack Hematologi set
Reagen kimia cholesterol set (6 x 100 ml)
Reagen kimia creatinine set (2 x 125 ml)
Reagen kimia glukosa set (2 x 100 ml)
Reagen kimia SGOT (AST) set (2 x 62,5 ml)
Reagen kimia SGPT (ALT) set (2 x 62,5 ml)
Reagen kimia triglyserides set (4 x 50 ml)
Reagen kimia urea set (2 x 62,5 ml)
Reagen kimia uric acid set (4 x 50 ml)
Safety Box 2,5 Lt ktk
Safety Box 5 Lt kuning ktk
Salmonella Test/Widal Test test
Sarung tangan uk. 6 Psg
Sarung tangan uk. 6,5 Psg
Sarung tangan uk. 7 Psg
Sarung tangan uk. 7,5 Psg
Sarung tangan uk. 8 Psg
Sarung tangan S pcs
Sarung tangan M pcs
 Sarung tangan L pcs
Sarung tangan XL pcs
Shypilis 3,0 test test
Shypilis Test (RPR Fokus) test
Silk (benang bedah sutera) no.3/0 HR
set
30 MM
Silk Black 3/0 HR 26 MM set
Silk 4-0 100M roll
Silk braided black 6/0 DS 12 mm roll
Soft cloth tape on liner roll
Stomach tube FR 18 Set
Suction Catheter No. 6 Set
Suction Catheter No. 8 Set
Suction Catheter No. 10 Set
Suction Catheter No. 12 Set
Suction Catheter No. 14 Set
Surgical Blade No. 10 ktk 100 pcs
Surgical Blade No. 11 ktk 100 pcs
Surgical Blade No. 18 ktk 100 pcs
Surgical Scrub (hydrex) btl 500ml
Surgical glove sterile gynecolog No. 6,5
pasang
(Remedi)
Surgical glove sterile gynecolog No. 7
pasang
(Remedi)
Surgical glove sterile gynecolog No. 7,5
pasang
(Remedi)
Suture needle (jarum hecting) BT bks 12 pcs
Suture needle (jarum hecting) BR bks 12 pcs
Suture needle (jarum hecting) GT bks 12 pcs
Suture needle (jarum hecting) GR bks 12 pcs
Tes golongan darah A, B, AB set
Tes kehamilan (Ultraone) Strip
Tip warna putih Pcs
Tip warna putih (kecil) (10 ul) Pcs
Tip warna biru (1 ml) Pcs
Tip warna kuning (200 ul) Pcs
Transfusi set Set
Three way stopcock Pcs
Underpad 60 x 90 cm pads
Plastik klip 4 x 6 cm bks 100 lbr
Plastik klip 5x8 cm bks 100 lbr
Plastik klip beretiket 5 x 8 cm bks 100 lbr
Plastik klip 10 x 7 cm bks 100 lbr
Plastik klip beretiket 10 x 7 cm bks 100 lbr
Plastik 14 x 25 cm pak
Cavidagel tube
MILDEX 30 (glutaraldehyde 2,5 %) galon
MILZYME TRIPLE ENZYME botol 1 L
Pharmafix 10 cm x 500 cm roll
Softanol (etanol, propanol) botol 1 L
RDT SARS-CoV-2 Antibody Test
Septalkan
Plesterin bulat non woven
TABUNG VACUTAINER BTL
FLASHBACK NEEDLE PCS
PLESTER WP PCS
ALCOHOL SWAB PCS
SARUNG TANGAN 6.5 PCS
SARUNG TANGAN 7 PCS

BANTUAN COVID
PENUTUP KEPALA REMEDI BOX ISI 50 PCS
MASKER HIJAB/KERUDUNG BOX ISI 50 PCS
MASKER TELINGA/BEDAH BOX ISI 50 PCS
MASKER N-95 BOX ISI 20 PCS
APPRON
HAZMAT
KACAMATA PELINDUNG
SARUNG TANGAN STERIL NO 6,5 BOX ISI 50 PCS
SARUNG TANGAN S BOX ISI 100 PCS
SARUNG TANGAN M BOX ISI 100 PCS
SARUNG TANGAN L BOX ISI 100 PCS
FACE SHIELD
RAPID TEST COVID 19 BOX ISI 25 TEST
ASTAR C

PENGADAAN OBAT BHP JKN TH 2020

ALLOPURINOL 100 MG
BECEFORT TABLET
BECEFORT SYRUP
COROVIT TABLET
COROVIT SYRUP
COROBION TABLET
DEXAMETASONE TABLET
ETHYL CHLORIDE SPRAY
GLYCERIL GUAIACOLATE TAB 100 MG
GLIMEPIRIDE 1 MG
HUSTAB TABLET
IM BOOST FORCE TAB
IMUNOS TABLET
IMUNOS SYRUP
LIDOCAIN AMPUL 2 %
LIDOCAIN AMPUL 2 %
METFORMIN TAB 500 MG
OMEPRAZOLE CAP 30MG
PARASETAMOL SYRUP 125 MG
PEHACAIN INJEKSI
RANITIDINE AMPUL
ALKOHOL 70% KEMASAN 1 LITER
ASEPTIC GEL 1 LITER
ASEPTIC GEL JERGEN
LARUTAN H2O2
LARUTAN HCL
MASKER HIJAB
PAMPERS UKURAN M
STRIP HB EASY TOUCH KOTAK ISI 25 STRIP
NASAL CANULA DEWASA
DENTAL NEEDLE 30 G NO.16
DENTAL NEEDLE 30 G NO.21
BAYCLYN 5 LITER
PAMPERS UKURAN L
KANTONG SAMPAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui
Kepala Dinas Kesehatan Kab. Wajo

Dr.drg.HJ.ARMIN,M.Kes.,
NIP : 19700916 200012 2 002