No. Supplier No urut kas Tgl faktur No.

Faktur

1 Apotek Cempaka 7/15/2016

2 Apotek Cempaka 7/27/2016 01371

3 Apotek Cempaka M267 7/27/2016 01368

4 Apotek Cempaka 7/16/2016 00471

5 Bina San Prima M251 7/26/2016 FKPBR/201607/02695

6 Bina San Prima M250 7/26/2016 FKPBR/201607/02700

7 Bina San Prima M92 7/16/2016 FKPBR/201607/01336

8 Bina San Prima M93 7/16/2016 FKPBR/201607/01289

9 Rumah Sakit Ibu dan Anak 7/21/2016 POB2016000006435

10 Anugrah Argon Medica M263 7/27/2016 17160024235

11 Anugrah Argon Medica M264 7/27/2016 17160024275

12 Anugrah Argon Medica M255 7/16/2016 17160023854
13 Anugrah Argon Medica M249 7/26/2016 17160023956
14 Anugrah Argon Medica M254 7/26/2016 17160023883
15 Penta Valent M190 7/21/2016 0138-AK-16-00012096

16 Penta Valent M189 7/20/2016 0138-AK-16-00012087

17 United Dico Citas M245 7/25/2016 167520

18 United Dico Citas M213 7/22/2016 167449

19 DNR M195 7/21/2016 824633924

20 DNR M169 7/19/2016 824623440

21 DNR M206 7/22/2016 824639138

22 DNR M244 7/25/2016 824647491

23 Anugerah Pharmaindo Lestari M322 7/29/2016 2410688238

24 Anugerah Pharmaindo Lstari M94 7/16/2016 2410686258

25 Global Mitra Pekanbaru M199 7/21/2016 JD60721040/D02

26 Global Mitra Pekanbaru M246 7/25/2016 JD60726046/D02
27 Kemilau Rajawali M188 7/21/2016 00478/KRP/VII/2016

28 Tempo M114 7/18/2016 1152195101

29 Brataco M212 7/22/2016 SOPKB1601753

30 Brataco M203 7/21/2016 SOPKB1601742

31 Brataco M172 7/19/2016 SOPKB1601714
32 Talang Gugun Sari Nusantara M282 7/27/2016 16013211

33 Mensa Binasukses M266 7/26/2016 CD190495669

34 Mensa Binasukses M95 7/16/2016 CD19044424

35 Mensa Binasukses M96 7/16/2016 CD190444241

36 Rajawali Nusindo M198 7/21/2016 FKT6003002

37 Rajawali Nusindo M117 7/18/2016 FKT6002928

38 Rajawali Nusindo M118 7/18/2016 FKT6002933
39 Rajawali Nusindo M38 7/14/2016 FKT6002920

40 Central Medika Wiratama M91 7/16/2016 JL*1607.0045

41 Merapi Utama Pharma M208 7/21/2016 19-311221

42 Merapi Utama Pharma M207 7/18/2016 19-311081

43 Merapi Utama Farma M49 7/14/2016 19-310913

44 Merapi Utama Farma M40 7/14/2016 19-310914

45 Merapi Utama Farma M49 7/14/2016 19-310915

46 Merapi Utama Farma M178 7/20/2016 19-311172

49 Merapi Utama Farma M265 7/27/2016 19-311516

50 Merapi Utama Farma M126 7/18/2016 19-311077

51 Kebayoran Pharma M256 7/26/2016 15ASB16010633

52 Kebayoran Pharma M262 7/26/2016 15ASB16010684

53 Kebayoran Pharma M261 7/26/2016 15ASB16010685

54 Kebayoran Pharma M260 7/26/2016 15ASB16010665

55 Kebayoran Pharma M279 7/27/2016 15ASB16010736

56 Kebayoran Pharma M129 7/18/2016 15ASB16010284

57 Kebayoran Pharma M103 7/18/2016 15ASB16010239

58 Kebayoran Pharma M214 7/22/2016 15ASB16010470

59 Kebayoran Pharma M24 7/11/2016 15ASB16009968

Item Keterangan Qty Harga Total

3 Otsu RL 10 16,000.00 160,000.00

NACL Larutan 500ml 5 6,800.00 34,000.00
Atropin Sulfat 10 3,000.00 30,000.00
1 Ativan 1mg (+ongkir) 3 150,000.00 450,000.00
3 Ceftriaxone inj 10 356,400.00 3,564,000.00
Pantoprazol inj 10 51,425.00 514,250.00
Citiloline 10 105,875.00 1,058,750.00
5 Diuvar Inj 5 25,000.00 125,000.00
Phenytoin Inj 5 62,000.00 310,000.00
Sidiadyk Inj 5 15,000.00 75,000.00
Transfusion set GEA 5 7,000.00 35,000.00
Folley Catheter no.16 7 15,000.00 105,000.00
2 Sanmol Forte Tablet 2 30,000.00 60,000.00
Cortidex Inj 20 56,500.00 1,130,000.00
3 Infusan-RL DP 24'S 10 416,400.00 4,164,000.00
Infusan-NS-DP 24'S 5 405,600.00 2,028,000.00
Infusan NS Irigasi 1000ml 15's 5 22,650.00 113,250.00
1 Infusan Ring-AS DP 24'S 3 468,000.00 1,404,000.00
2 Infusan-RL DP 24'S 10 416,400.00 4,164,000.00
Infusan-NS-DP 24'S 10 405,600.00 4,056,000.00
1 Metvell Tablet 10 32,200.00 322,000.00
10 Dumin Rectal Tube 125mg/2.5ml 5 58,300.00 291,500.00
Fladystin Ovula/10* 3 130,000.00 390,000.00
Amikacin 250mg/12.5% 2ml (Box/1vL) 5 83,160.00 415,800.00
Amikacin 500mg/25% 2ml (Box/1vL) 5 138,600.00 693,000.00
Cefotaxime Inj 1g (box/10vL) 10 66,150.00 661,500.00
Meropenem Inj 1gr (Box/1vL) 10 210,000.00 2,100,000.00
Meropenem Inj 0.5gr (Box/1vL) 10 126,000.00 1,260,000.00
Tetagam P. Prefilled Syringe 1mL* 5 188,000.00 940,000.00
Tramus 1% 2.5ml (Box/5Amp)* 10 240,000.00 2,400,000.00
Recofol N (Box5Amp) 10 450,000.00 4,500,000.00
1 Merophenem Inj 1gr (box/1vL) 20 210,000.00 4,200,000.00
1 Ketesse Inj 50mg (Box/5Amp) 5 235,000.00 1,175,000.00
1 Raivas Inj 4ml (box/5)Amp 8 450,000.00 3,600,000.00
7 Vomizole Dry Injection 40mg (Box/1vL) 10 127,500.00 1,275,000.00
Raivas Inj 4ml (box/5)Amp 2 450,000.00 900,000.00
 Feldene Gel 0.5% x 15g (PFZ) 3 64,326.00 192,978.00
Pregnolin 5mg @ 50 2 80,000.00 160,000.00
Norelut 5mg @50 5 200,000.00 1,000,000.00
Dobutamine 50mg OGBDexa (Box/5Amp) 10 272,868.75 2,728,687.50
Dobuject 250mg.5ml @5 2 675,000.00 1,350,000.00
2 Ofloxacin 200mg Tablet 5x10's (0gb) 2 29,505.50 59,011.00
Ofloxacin 400mg Tablet 5x10's (0gb) 2 43,650.00 87,300.00
7 Cendo Fenicol 0.25% o.6ml @ 5's Minidose 5 19,012.50 95,062.50
Pantocain 2% 0.6ml @5's Minidose 5 17,325.00 86,625.00
Polygran 0.6ml @5's Minidose 5 19,250.00 96,250.00
Glimepride 1mg Tab. 5x10's (0GB) - Nolab 1 38,003.90 38,003.90
Glimepride 2mg Tab. 5x10's (0GB) - Nolab 1 71,663.90 71,663.90
Glimepride 3mg Tab. 5x10's (0GB) - Nolab 1 97,724.00 97,724.00
Glimepride 4mg Tab. 5x10's (0GB) - Nolab 1 130,299.00 130,299.00
3 Prosogan Fdtab 15mg 5 375,375.00 1,876,875.00
Prosogan Fdtab 30mg 5 486,310.00 2,431,550.00
Prosogan Inj 30mg 5 133,100.00 665,500.00
2 Alinamin Tab @100 1 44,072.00 44,072.00
Sulcolon Captab 500mg @100 1 700,000.00 700,000.00

3 Transofixpcs 250 6,900.00 1,725,000.00

Discofix 3-way Stopcock BluPCS 250 27,500.00 6,875,000.00
Discofix 3-way + 10cm TubiPCS 250 35,000.00 8,750,000.00
3 Vaxcel Hep Inj 5000IU/ML V 5ml 2 920,000.00 1,840,000.00
Gelofusine 500cc-btl 20 195,500.00 3,910,000.00
Ureofix 500 urine meter 10 250,000.00 2,500,000.00
1 Perifix 400F18x3 1/4pcs 10 360,000.00 3,600,000.00
2 Certofix Trio V720pcs 5 900,000.00 4,500,000.00
Medifix Manometer ScalePCS 5 258,000.00 1,290,000.00

4 Pulmicort Resp 0.5mg/1in 2ml 2 365,872.00 731,744.00

Pulmicort Resp 0.5mg/1in 2ml 3 365,872.00 1,097,616.00
Smecta 30zak/box 2 95,000.00 190,000.00
Ventolin Expectorant 100ml/bt 5 47,355.00 236,775.00
3 Neo-K 2mg/ml Inj box 5amp 10 62,000.00 620,000.00
Ventolin Nebules 2,5mg 20Amp 10 171,200.00 1,712,000.00
Pulmicort Resp 0.25mg/0.5in 2ml 3 309,040.00 927,120.00
10 Kloderma Cream 0.05% 5gr (M) 3 18,500.00 55,500.00
 Kloderma Cream 0.05% 10gr (M) 3 27,500.00 82,500.00
Kloderma Ointment 0.05% 5gr (M) 3 16,800.00 50,400.00
Kloderma Ointment 0.05% 10gr (M) 3 27,500.00 82,500.00
Creamed Cream 20% 40gr (M) 5 33,850.00 169,250.00
Niacefgli 4% 15gr (M) 5 26,050.00 130,250.00
Parasol Sunblock Lot SPF 30 120 ml (B) 3 76,900.00 230,700.00
BLN2OLAC-CL GLL5% 10gr (M) 5 26,400.00 132,000.00
Medi-klin TR Gel 15gr (M) 5 38,600.00 193,000.00
MOI Acort Cream 0.1% 5gr (M) 5 31,650.00 158,250.00
1 Retaquin Cream 15gr (M) 5 56,900.00 284,500.00
2 Folley Catheter no.16 Rusch 50 14,500.00 725,000.00
Folley Catheter no.18 Rusch 50 14,500.00 725,000.00
1 Catapres 0,15 mg/ml Amp 10's 3 529,605.00 1,588,815.00
6 Capsul Kosong 00 2 68,181.82 136,363.64
Capsul Kosong 0 2 40,909.09 81,818.18
Capsul Kosong 1 2 38,181.82 76,363.64
Capsul Kosong 2 2 36,363.64 72,727.28
Capsul Kosong 3 2 33,636.36 67,272.72
Triklorit 90% Tablet 2 54,545.45 109,090.90
1 Desinfectant 50% @1L 5 18,181.82 90,909.10
1 Glycerin PH@1l 5 54,545.45 272,727.25
2 Sibital Injeksi 3 99,000.00 297,000.00
Sibital 50 tablet 10 157,300.00 1,573,000.00
5 Tequinol Tab 500mg 30's 2 360,000.00 720,000.00
Rocer Serbuk Injeksi Steril 40mg/v 5 125,000.00 625,000.00
Prednicort 4 5 125,000.00 625,000.00
Prednicort 8 5 210,000.00 1,050,000.00
Dextafen Kaplet 5 110,000.00 550,000.00
2 Orasic Injeksi 5 Amp 10 75,000.00 750,000.00
Tramifen Kaplet 5 210,000.00 1,050,000.00
3 Etason Inj 1ml 5amo 1 33,000.00 33,000.00
Esomax Serbuk Injeksi Steril 40mg 2 135,000.00 270,000.00
Toramine 30 Injeksi 10 160,000.00 1,600,000.00
4 Pro TB 4 TSS/1 Bls 28' 1 138,133.00 138,133.00
Pro TB 2 TSS/1 BLS X 28' 1 184,450.00 184,450.00
Pro TB 3 Kid Tablet 1 Bls 1 119,000.00 119,000.00
Bio ATP 10x10's 2 214,180.00 428,360.00
3 Pehacain Inj 20x20ml 5 56,601.00 283,005.00
 Lidocain 28 Inj/100 5 104,580.00 522,900.00
Ephinepein Inj 0.18/30's 10 231,954.00 2,319,540.00
1 Phytomenadion 10mg Inj 30A 5 49,828.00 249,140.00
6 Ephinepein Inj 0.18/30's 3 231,954.00 695,862.00
Phytomenadion 10mg 10x10' 1 64,969.00 64,969.00
Phytomenadione 1 Inj 2mg 30 3 113,400.00 340,200.00
Phytomenadion 10mg Inj 30A 1 49,828.00 49,828.00
Lidocain 28 Inj/100 1 104,580.00 104,580.00
Vaksin Campak KRG 10Amp 10 87,000.00 870,000.00
2 Micropore 3M 1/2" 5 10,000.00 50,000.00
Micropore 3M 1" 5 20,000.00 100,000.00
10 Biosat 1.5 10 115,000.00 1,150,000.00
Otsu D5/RUBB 22 12,000.00 264,000.00
Otsu-D10 100 14,000.00 1,400,000.00
Otsu MGSO4 40 30 7,200.00 216,000.00
Mamypoko Pants STD L8 2 15,675.00 31,350.00
Mamypoko Pants STD M9 2 15,675.00 31,350.00
Mamypoko Pants STD S11 2 15,675.00 31,350.00
Otsu-NS/10ml Piggyback 50 11,000.00 550,000.00
Lifree PPK Dewasa T.P M9 2 57,962.00 115,924.00
Lifree PPK Dewasa T.P L8 2 57,962.00 115,924.00
6 Meylon 8,4% 25ml 30 11,000.00 330,000.00
Otsu-NGSO420 30 7,200.00 216,000.00
Otsu-D40 50 7,200.00 360,000.00
Otsu-NS 20ml 120 4,600.00 552,000.00
Otsu Water Inj 25ml 120 4,600.00 552,000.00
Wida B5-1/2ES 20 12,273.00 245,460.00
10 Meylon 8,4% 25ml 30 11,000.00 330,000.00
Aminofluid-L 500ml 20 121,000.00 2,420,000.00
FC Troches 120 Tabs 4 114,000.00 456,000.00
5% Glucose Unicap/OCB WB 40 6,273.00 250,920.00
10% Glucose Unicap/OCB WB 60 6,818.00 409,080.00
KA-EN 1R Sol 10 18,500.00 185,000.00
STEE Wtr 1l/rubb 50 18,000.00 900,000.00
Otsu Kcl 7,46 30 7,200.00 216,000.00
Kidmin 200ml Softbag 40 95,000.00 3,800,000.00
KA-EN 3A Softbag 500ml 10 18,500.00 185,000.00
10 Betadine Obat Kumur 100ml 3 9,500.00 28,500.00
 Otsu-MGSO4 20 10 7,200.00 72,000.00
Otsu-MGSO4 40 10 7,200.00 72,000.00
Otsu 040 60 7,200.00 432,000.00
Otsu Mamitol 20 20 80,000.00 1,600,000.00
Otsu- NS/100ml Piggyback 20 11,000.00 220,000.00
Otsu-Basin3 20 20,000.00 400,000.00
Otsu NS 25ml 12 4,600.00 55,200.00
Otsu NS 25ml 8 4,600.00 36,800.00
Otsu Water Inj 25ml 50 4,600.00 230,000.00
4 Pan Amin G softbag 50ml 20 60,000.00 1,200,000.00
Widakes 130 10 157,500.00 1,575,000.00
Wida KE- 1 10 13,000.00 130,000.00
Wida KE - 2 10 13,000.00 130,000.00
1 Otsu-D5, 1/4 NS RUBB 20 14,000.00 280,000.00
4 Biosat 1.5 50 115,000.00 5,750,000.00
Ster Wtr 1l/RUBB 30 18,000.00 540,000.00
Otsu-D5, 1/2 NS RUBB 40 14,000.00 560,000.00
Otsu-D5, 1/4 NS RUBB 40 14,000.00 560,000.00
3 Omnipaque 350mgl /50ml 1 2,960,000.00 2,960,000.00
Omnipaque 300mgl /100ml 1 4,980,000.00 4,980,000.00
Omnipaque 300mgl /50ml 1 2,530,000.00 2,530,000.00
2 Vascon Inj 5 425,000.00 2,125,000.00
Farpresin 10 400,000.00 4,000,000.00
1 Vascon Inj 10 425,000.00 4,250,000.00
2 Natrium Phenytoin Injeksi 50 50,914.00 2,545,700.00
Phenytoin 100cap 5 55,000.00 275,000.00
1 Inviclot Injeksi 10 60,000.00 600,000.00
4 Recolfar Tablet 5 129,000.00 645,000.00
Farscorbid Inj 5 120,000.00 600,000.00
Inpepsa Syrup 100ml 19 48,000.00 912,000.00
Tensilo Injeksi 10 160,000.00 1,600,000.00
1 Gastrul Tablet 5 300,000.00 1,500,000.00
3 Sojourn 1 2,600,000.00 2,600,000.00
Wokoba Injeksi 2 390,000.00 780,000.00
Renalyte Otc 12 14,000.00 168,000.00
2 Farnat Infus 10 66,000.00 660,000.00
Bunascan 0.5% Epidural 1 320,000.00 320,000.00
10 Inpepsa Syrup 100ml 6 48,000.00 288,000.00
Tensilo Injeksi 1 460,000.00 460,000.00
Farsix Tablet 1 90,000.00 90,000.00
Vascon Inj 1 425,000.00 425,000.00
Farbivent 1 85,000.00 85,000.00
Stabactam Inj 1 340,000.00 340,000.00
Sysmuco Tab 1 105,000.00 105,000.00
Estazor Kapsul 1 240,000.00 240,000.00
Pladogrel 2 360,000.00 720,000.00
Inviclot Injeksi 1 60,000.00 60,000.00
Discount Discount cash Total harga PPN Harga dibayar

224,000.00 224,000.00
450,000.00 10,000 (ongkir) 460,000.00

5,137,000.00 5,137,000.00

650,000.00 650,000.00
12,000.00
282,500.00 1,190,000.00 89,550.00 985,050.00

94,579.00 6,305,250.00 621,067.00 6,831,738.00

21,060.00 1,404,000.00 138,294.00 1,521,234.00

123,300.00 8,220,000.00 809,670.00 8,906,370.00

32,200.00 32,200.00

58,500.00
83,160.00
138,600.00
66,150.00
630,000.00
378,000.00
94,000.00
360,000.00
675,000.00 11,168,390.00 1,116,839.00 12,285,229.00
1,260,000.00 2,940,000.00 294,000.00 2,940,000.00
235,000.00 940,000.00 94,000.00 940,000.00
540,000.00 3,060,000.00 306,000.00 3,366,000.00
382,500.00
135,000.00
 24,000.00
150,000.00
955,040.63
202,500.00 5,927,624.88 592,762.00 6,520,387.00

14,631.10 146,311.00 131,679.90

94,829.44 610,628.70 515,799.26

4,973,925.00 497,392.00 5,471,317.00

744,072.00 74,407.00 818,479.00

3,376,250.00 125,764.00 17,350,000.00 1,384,799.00 15,232,785.00

1,204,500.00 63,410.00 8,250,000.00 698,209.00 7,680,299.00

160,000.00 29,160.00 3,600,000.00 321,084.00 3,531,924.00

868,500.00 44,294.00 5,790,000.00 487,721.00 5,364,927.00

2,256,135.00 225,613.00 2,481,748.00

16,296.00 3,259,120.00 324,282.00 9,567,106.00

 1,284,350.00 128,435.00 1,412,785.00
284,500.00 28,450.00 312,950.00

1,450,000.00 1,450,000.00
1,588,815.00 1,588,815.00

543,636.36 54,364.00 598,000.00

90,909.10 9,091.00 100,000.00
272,727.00 27,273.00 300,000.00

1,870,000.00 1,870,000.00

1,459,250.00 3,570,000.00 211,075.00 2,321,825.00

757,500.00 1,800,000.00 104,250.00 1,146,750.00

734,850.00 1,903,000.00 116,815.00 1,284,965.00

869,943.00 86,994.00 956,937.00

 3,125,445.00 312,545.00 3,437,990.00
249,140.00 24,914.00 274,054.00

21,750.00 2,103,689.00 210,369.00 2,314,058.00

150,000.00 150,000.00

177,325.00 3,905,898.00 372,857.00 4,101,430.00

82,500.00 2,255,460.00 217,296.00 2,390,256.00

 15,333,500.00 1,533,350.00 16,866,850.00
280,000.00 28,000.00 308,000.00

86,250.00 7,410,000.00 732,375.00 8,056,125.00

2,094,000.00 10,470,000.00 837,600.00 9,213,600.00

6,125,000.00 612,500.00 6,737,500.00

4,250,000.00 425,000.00 4,675,000.00

2,820,700.00 282,070.00 3,102,770.00

600,000.00 60,000.00 660,000.00

3,757,000.00 375,700.00 4,132,700.00

1,500,000.00 150,000.00 1,650,000.00

5,040.00 3,542,900.00 354,296.00 3,897,256.00

980,000.00 98,000.00 1,078,000.00

2,513,000.00 251,300.00 2,764,300.00