RINCIAN TAGIHAN OBAT

Apotik / Inst Farmasi : IF RSUD TGK CHIK DITIRO (0009A007)

Kantor Cabang : BANDA ACEH

Kedeputian Wilayah : REGIONAL I - MEDAN

Provinsi : NANGGROE ACEH DARUSSALAM

Bulan Pelayanan : JULI - 2022

No FPK : 0009A007220730

NO REFASALSEP JNS RESEP NO KARTU NO TGLPEL OBAT JMLOBA BIAYA JML OBAT BIAYA Keterangan Verifikasi
RESEP RSP T TAGIHAN SETUJU SETUJU
1 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Alopurinol 300 Hexp tab 300 mg 23,00 5.888 23,00 5.888

2 0104R0020722V001140 Obat Kronis Blm Stabil 0001796001783 00233 12/07/2022 Spironolacton Dexa 25 mg tab 25 mg 6,00 1.690 6,00 1.690

3 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Spironolacton Dexa 25 mg tab 25 mg 23,00 6.477 23,00 6.477

4 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Spironolacton Dexa 25 mg tab 25 mg 11,50 3.238 11,50 3.238

5 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Spironolacton Dexa 25 mg tab 25 mg 23,00 6.477 23,00 6.477

6 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Nitrokaf Retard 2.5 Kifa tab 2,5 mg 46,00 97.152 46,00 97.152

7 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Nitrokaf Retard 2.5 Kifa tab 2,5 mg 46,00 97.152 46,00 97.152

8 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Nitrokaf Retard 2.5 Kifa tab 2,5 mg 46,00 97.152 46,00 97.152

9 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Nitrokaf Retard 2.5 Kifa tab 2,5 mg 46,00 97.152 46,00 97.152

10 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Nitrokaf Retard 2.5 Kifa tab 2,5 mg 46,00 97.152 46,00 97.152

11 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Tanapress 5 Tana tab 5 mg 23,00 79.488 23,00 79.488

12 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Bisoprolol 5 Dexa tab 5 mg 23,00 4.210 23,00 4.210

13 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Bisoprolol 5 Dexa tab 5 mg 23,00 4.210 23,00 4.210

14 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Adalat Oros Bayr 30 mg tab oros 30 mg 23,00 117.348 23,00 117.348

15 0104R0020722V001865 Obat Kronis Blm Stabil 0002146348451 00326 13/07/2022 Miniaspi Mers 80 mg tab 80 mg 23,00 2.620 23,00 2.620

16 0104R0020722V002371 Obat Kronis Blm Stabil 0000003301918 00269 14/07/2022 Miniaspi Mers 80 mg tab 80 mg 23,00 2.620 23,00 2.620

17 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Miniaspi Mers 80 mg tab 80 mg 23,00 2.620 23,00 2.620

18 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Miniaspi Mers 80 mg tab 80 mg 23,00 2.620 23,00 2.620

19 0104R0020722V005441 Obat Kronis Blm Stabil 0001267681904 00002 27/07/2022 Diazepam 5 Mers tab 5 mg 23,00 3.180 23,00 3.180

20 0104R0020722V002087 Obat Kronis Blm Stabil 0001291238818 00058 14/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

21 0104R0020722V005896 Obat Kronis Blm Stabil 0002047157223 00030 28/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739
22 0104R0020722V006898 Obat Kronis Blm Stabil 0001115371157 00168 01/08/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

23 0104R0020722V006942 Obat Kronis Blm Stabil 0000228982691 00196 01/08/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

24 0104R0020722V005803 Obat Kronis Blm Stabil 0001115195264 00042 28/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

25 0104R0020722V005808 Obat Kronis Blm Stabil 0000000687295 00043 28/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

26 0104R0020722V006042 Obat Kronis Blm Stabil 0002088276614 00152 28/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

27 0104R0020722V005731 Obat Kronis Blm Stabil 0001113079601 00029 28/07/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

28 0104R0020722V006821 Obat Kronis Blm Stabil 0000000665875 00029 06/08/2022 Retaphyl SR Kifa 300 mg tab SR 300 mg 23,00 34.739 23,00 34.739

29 0104R0020722V000262 Obat Kronis Blm Stabil 0000218523352 00180 08/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

30 0104R0020722V000787 Obat Kronis Blm Stabil 0001264647273 00124 11/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

31 0104R0020722V000619 Obat Kronis Blm Stabil 0000000728763 00078 11/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

32 0104R0020722V000904 Obat Kronis Blm Stabil 0000218786128 00176 11/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

33 0104R0020722V000836 Obat Kronis Blm Stabil 0000219871168 00247 11/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

34 0104R0020722V001362 Obat Kronis Blm Stabil 0000219961449 00105 12/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

35 0104R0020722V005920 Obat Kronis Blm Stabil 0001082317768 00063 28/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

36 0104R0020722V008511 Obat Kronis Blm Stabil 0001836043108 00092 05/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

37 0104R0020722V006942 Obat Kronis Blm Stabil 0000228982691 00196 01/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

38 0104R0020722V007160 Obat Kronis Blm Stabil 0000000590027 00099 02/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

39 0104R0020722V007881 Obat Kronis Blm Stabil 0000220024462 00293 03/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

40 0104R0020722V008069 Obat Kronis Blm Stabil 0000000526645 00109 04/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

41 0104R0020722V005803 Obat Kronis Blm Stabil 0001115195264 00042 28/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

42 0104R0020722V006042 Obat Kronis Blm Stabil 0002088276614 00152 28/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

43 0104R0020722V005015 Obat Kronis Blm Stabil 0000220301649 00221 26/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

44 0104R0020722V005212 Obat Kronis Blm Stabil 0000000768789 00371 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

45 0104R0020722V006419 Obat Kronis Blm Stabil 0001274457036 00190 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

46 0104R0020722V006327 Obat Kronis Blm Stabil 0000219665237 00204 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

47 0104R0020722V006402 Obat Kronis Blm Stabil 0000217230309 00000 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

48 0104R0020722V006765 Obat Kronis Blm Stabil 0001112898666 00070 01/08/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

49 0104R0020722V005549 Obat Kronis Blm Stabil 0000217466256 00293 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

50 0104R0020722V005629 Obat Kronis Blm Stabil 0000979745051 00295 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

51 0104R0020722V005625 Obat Kronis Blm Stabil 0000220176371 00297 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

52 0104R0020722V004837 Obat Kronis Blm Stabil 0000979816127 00047 26/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532
53 0104R0020722V006190 Obat Kronis Blm Stabil 0000000568293 00051 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

54 0104R0020722V006193 Obat Kronis Blm Stabil 0000000529558 00052 29/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

55 0104R0020722V005209 Obat Kronis Blm Stabil 0000218558081 00003 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

56 0104R0020722V005227 Obat Kronis Blm Stabil 0000218684676 00060 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

57 0104R0020722V005230 Obat Kronis Blm Stabil 0000000669486 00064 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

58 0104R0020722V005240 Obat Kronis Blm Stabil 0001267137472 00067 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

59 0104R0020722V005460 Obat Kronis Blm Stabil 0002050582162 00089 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

60 0104R0020722V005430 Obat Kronis Blm Stabil 0000219565991 00288 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

61 0104R0020722V004403 Obat Kronis Blm Stabil 0000217932434 00027 25/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

62 0104R0020722V004372 Obat Kronis Blm Stabil 0000220489806 00024 25/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

63 0104R0020722V004528 Obat Kronis Blm Stabil 0000219845463 00032 25/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

64 0104R0020722V004581 Obat Kronis Blm Stabil 0002750716135 00037 25/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

65 0104R0020722V003558 Obat Kronis Blm Stabil 0000203512127 00106 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

66 0104R0020722V005210 Obat Kronis Blm Stabil 0000000754727 00002 27/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

67 0104R0020722V003127 Obat Kronis Blm Stabil 0000228677747 00126 20/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

68 0104R0020722V003822 Obat Kronis Blm Stabil 0000219767411 00024 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

69 0104R0020722V003896 Obat Kronis Blm Stabil 0001113265372 00034 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

70 0104R0020722V004045 Obat Kronis Blm Stabil 0001113102314 00046 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

71 0104R0020722V003989 Obat Kronis Blm Stabil 0001112755487 00068 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

72 0104R0020722V004098 Obat Kronis Blm Stabil 0000219725234 00084 22/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

73 0104R0020722V003421 Obat Kronis Blm Stabil 0000979829842 00031 21/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

74 0104R0020722V003682 Obat Kronis Blm Stabil 0000219234249 00105 21/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

75 0104R0020722V002075 Obat Kronis Blm Stabil 0001115126335 00231 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

76 0104R0020722V002285 Obat Kronis Blm Stabil 0000000805937 00246 16/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

77 0104R0020722V003370 Obat Kronis Blm Stabil 0000194843248 00304 20/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

78 0104R0020722V003178 Obat Kronis Blm Stabil 0000000566976 00077 20/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

79 0104R0020722V002105 Obat Kronis Blm Stabil 0000283945983 00061 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

80 0104R0020722V002157 Obat Kronis Blm Stabil 0000979745567 00087 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

81 0104R0020722V002018 Obat Kronis Blm Stabil 0000000447221 00104 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

82 0104R0020722V002623 Obat Kronis Blm Stabil 0001897564149 00097 15/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

83 0104R0020722V002592 Obat Kronis Blm Stabil 0000218431258 00180 15/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532
84 0104R0020722V003419 Obat Kronis Blm Stabil 0000198169029 00023 21/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

85 0104R0020722V001292 Obat Kronis Blm Stabil 0002914186329 00148 12/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

86 0104R0020722V001364 Obat Kronis Blm Stabil 0000219664067 00266 12/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

87 0104R0020722V001658 Obat Kronis Blm Stabil 0000219911668 00243 13/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

88 0104R0020722V002061 Obat Kronis Blm Stabil 0002146694016 00036 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

89 0104R0020722V002043 Obat Kronis Blm Stabil 0001820388666 00042 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

90 0104R0020722V002087 Obat Kronis Blm Stabil 0001291238818 00058 14/07/2022 Berotec Boeh 100 mcg/puff inh 200 dosis 1,00 109.532 1,00 109.532

91 0104R0020722V007393 Obat Kronis Blm Stabil 0001112854577 00144 02/08/2022 Karbamazepin 200 Mers tab 200 mg 46,00 12.718 46,00 12.718

92 0104R0020722V000173 Obat Kronis Blm Stabil 0001115428544 00004 08/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

93 0104R0020722V000336 Obat Kronis Blm Stabil 0001996379616 00003 09/07/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

94 0104R0020722V001567 Obat Kronis Blm Stabil 0000000702898 00034 13/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

95 0104R0020722V003424 Obat Kronis Blm Stabil 0000000499781 00033 21/07/2022 Triheksilfenidil 2 Mers tab 2 mg 69,00 5.564 69,00 5.564

96 0104R0020722V003583 Obat Kronis Blm Stabil 0000000490059 00062 21/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

97 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

98 0104R0020722V007401 Obat Kronis Blm Stabil 0000220893265 00003 03/08/2022 Triheksilfenidil 2 Mers tab 2 mg 11,50 927 11,50 927

99 0104R0020722V006896 Obat Kronis Blm Stabil 0002200826957 00002 01/08/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

100 0104R0020722V006851 Obat Kronis Blm Stabil 0002241189527 00001 01/08/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

101 0104R0020722V008346 Obat Kronis Blm Stabil 0001115546051 00004 04/08/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

102 0104R0020722V004474 Obat Kronis Blm Stabil 0001813698281 00117 25/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

103 0104R0020722V004971 Obat Kronis Blm Stabil 0001115369504 00001 26/07/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

104 0104R0020722V004813 Obat Kronis Blm Stabil 0000000754749 00002 26/07/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

105 0104R0020722V005934 Obat Kronis Blm Stabil 0002233974115 00001 28/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

106 0104R0020722V005441 Obat Kronis Blm Stabil 0001267681904 00002 27/07/2022 Triheksilfenidil 2 Mers tab 2 mg 46,00 3.709 46,00 3.709

107 0104R0020722V006212 Obat Kronis Blm Stabil 0002286314785 00003 31/07/2022 Triheksilfenidil 2 Mers tab 2 mg 23,00 1.855 23,00 1.855

108 0104R0020722V000336 Obat Kronis Blm Stabil 0001996379616 00003 09/07/2022 Trifluoperazin 5 mers tab 5 mg 23,00 6.477 23,00 6.477

109 0104R0020722V004971 Obat Kronis Blm Stabil 0001115369504 00001 26/07/2022 Trifluoperazin 5 mers tab 5 mg 23,00 6.477 23,00 6.477

110 0104R0020722V001662 Obat Kronis Blm Stabil 0001115454014 00229 13/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
111 0104R0020722V004403 Obat Kronis Blm Stabil 0000217932434 00027 25/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
112 0104R0020722V004648 Obat Kronis Blm Stabil 0000979890895 00000 25/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
113 0104R0020722V003275 Obat Kronis Blm Stabil 0000000440695 00157 20/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
114 0104R0020722V005236 Obat Kronis Blm Stabil 0001969085586 00073 27/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
115 0104R0020722V005080 Obat Kronis Blm Stabil 0000218466033 00116 26/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
116 0104R0020722V005625 Obat Kronis Blm Stabil 0000220176371 00297 27/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
117 0104R0020722V005125 Obat Kronis Blm Stabil 0001309168743 00235 26/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
118 0104R0020722V005747 Obat Kronis Blm Stabil 0001267061589 00050 28/07/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
119 0104R0020722V006821 Obat Kronis Blm Stabil 0000000665875 00029 06/08/2022 Seretide Diskus 100 Glax 100 mcg/puff 1,00 140.931 1,00 140.931
inh 60 dosis
120 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Gabapentin 100 SK21 kaps 100 mg 46,00 72.893 46,00 72.893

121 0104R0020722V008346 Obat Kronis Blm Stabil 0001115546051 00004 04/08/2022 Lorazepam 2 mg Mers tab 2 mg 23,00 20.255 23,00 20.255

122 0104R0020722V005441 Obat Kronis Blm Stabil 0001267681904 00002 27/07/2022 Clozapine 100 Dexa Klozapin 100 mg 23,00 36.888 23,00 36.888

123 0104R0020722V007401 Obat Kronis Blm Stabil 0000220893265 00003 03/08/2022 Clozapine 100 Dexa Klozapin 100 mg 11,50 18.444 11,50 18.444

124 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Fenofibrat 100 Dexa tab 100 mg 23,00 13.925 23,00 13.925

125 0104R0020722V000173 Obat Kronis Blm Stabil 0001115428544 00004 08/07/2022 Risperidon 2 Dexa tab 2 mg 46,00 7.654 46,00 7.654

126 0104R0020722V004813 Obat Kronis Blm Stabil 0000000754749 00002 26/07/2022 Risperidon 2 Dexa tab 2 mg 23,00 3.827 23,00 3.827

127 0104R0020722V005934 Obat Kronis Blm Stabil 0002233974115 00001 28/07/2022 Risperidon 2 Dexa tab 2 mg 46,00 7.654 46,00 7.654

128 0104R0020722V005441 Obat Kronis Blm Stabil 0001267681904 00002 27/07/2022 Risperidon 2 Dexa tab 2 mg 46,00 7.654 46,00 7.654

129 0104R0020722V007747 Obat Kronis Blm Stabil 0002147095585 00001 03/08/2022 Risperidon 2 Dexa tab 2 mg 46,00 7.654 46,00 7.654

130 0104R0020722V006896 Obat Kronis Blm Stabil 0002200826957 00002 01/08/2022 Risperidon 2 Dexa tab 2 mg 23,00 3.827 23,00 3.827

131 0104R0020722V008346 Obat Kronis Blm Stabil 0001115546051 00004 04/08/2022 Risperidon 2 Dexa tab 2 mg 23,00 3.827 23,00 3.827

132 0104R0020722V003424 Obat Kronis Blm Stabil 0000000499781 00033 21/07/2022 Levopar 125 Mepr komb kap 125 mg 46,00 53.228 46,00 53.228

133 0104R0020722V003583 Obat Kronis Blm Stabil 0000000490059 00062 21/07/2022 Levopar 125 Mepr komb kap 125 mg 46,00 53.228 46,00 53.228

134 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Levopar 125 Mepr komb kap 125 mg 46,00 53.228 46,00 53.228

135 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Ramipril 5 Dexa tab 5 mg 23,00 4.652 23,00 4.652

136 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Ramipril 5 Dexa tab 5 mg 23,00 4.652 23,00 4.652

137 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Ramipril 5 Dexa tab 5 mg 23,00 4.652 23,00 4.652

138 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Candesartan Cilexetil 8 Dexa tab 8 mg 23,00 6.241 23,00 6.241

139 0104R0020722V001119 Obat Kronis Blm Stabil 0001477591367 00205 12/07/2022 Candesartan Cilexetil 16 Dexa 16 mg tab 23,00 9.391 23,00 9.391
16 mg
140 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Candesartan Cilexetil 16 Dexa 16 mg tab 23,00 9.391 23,00 9.391
16 mg
141 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

142 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

143 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928
144 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

145 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

146 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

147 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

148 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Clopidogrel 75 Kifa Klopidogrel tab 75 mg 23,00 16.928 23,00 16.928

149 0104R0020722V007401 Obat Kronis Blm Stabil 0000220893265 00003 03/08/2022 Risperidon 1 Dexa tab 1 mg 23,00 3.916 23,00 3.916

150 0104R0020722V007393 Obat Kronis Blm Stabil 0001112854577 00144 02/08/2022 Vitamin B6 Piridoksi 10 Imfi tab 10 mg 23,00 2.120 23,00 2.120

151 0104R0020722V001865 Obat Kronis Blm Stabil 0002146348451 00326 13/07/2022 Hidroklorotiazid (HCT) 25 Kifa tab 25 mg 23,00 4.357 23,00 4.357

152 0104R0020722V008297 Obat Kemoterapi 0001449702483 00270 28/07/2022 Tamoksifen 20 mg SK21 tab 20 mg 23,00 43.976 23,00 43.976

153 0104R0020722V000223 Obat Kronis Blm Stabil 0000219000407 00064 08/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
154 0104R0020722V000300 Obat Kronis Blm Stabil 0001304326697 00198 08/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
155 0104R0020722V000194 Obat Kronis Blm Stabil 0001871723349 00275 08/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
156 0104R0020722V000594 Obat Kronis Blm Stabil 0000219721959 00032 11/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
157 0104R0020722V000655 Obat Kronis Blm Stabil 0001112840392 00061 11/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
158 0104R0020722V000680 Obat Kronis Blm Stabil 0001267098309 00103 11/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
159 0104R0020722V005519 Obat Kronis Blm Stabil 0000218434724 00178 27/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
160 0104R0020722V005731 Obat Kronis Blm Stabil 0001113079601 00029 28/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
161 0104R0020722V006337 Obat Kronis Blm Stabil 0000218569059 00283 29/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
162 0104R0020722V008510 Obat Kronis Blm Stabil 0000206699433 00261 05/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
163 0104R0020722V008550 Obat Kronis Blm Stabil 0000000677632 00234 05/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
164 0104R0020722V007775 Obat Kronis Blm Stabil 0001115158397 00083 03/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
165 0104R0020722V007793 Obat Kronis Blm Stabil 0000219066805 00240 03/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
166 0104R0020722V008103 Obat Kronis Blm Stabil 0000979839944 00062 04/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
167 0104R0020722V008028 Obat Kronis Blm Stabil 0000979813056 00078 04/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
168 0104R0020722V008093 Obat Kronis Blm Stabil 0000979611906 00090 04/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
169 0104R0020722V008078 Obat Kronis Blm Stabil 0001265255695 00141 04/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
170 0104R0020722V006711 Obat Kronis Blm Stabil 0000979897858 00057 01/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
171 0104R0020722V006776 Obat Kronis Blm Stabil 0000979816127 00069 01/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
172 0104R0020722V006898 Obat Kronis Blm Stabil 0001115371157 00168 01/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
173 0104R0020722V006707 Obat Kronis Blm Stabil 0001112301347 00169 01/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
174 0104R0020722V007314 Obat Kronis Blm Stabil 0001816619343 00079 02/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
175 0104R0020722V007318 Obat Kronis Blm Stabil 0000979811403 00046 02/08/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
176 0104R0020722V004917 Obat Kronis Blm Stabil 0002204201079 00069 26/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
177 0104R0020722V006168 Obat Kronis Blm Stabil 0000203931753 00018 29/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
178 0104R0020722V004794 Obat Kronis Blm Stabil 0000219032954 00212 26/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
179 0104R0020722V004951 Obat Kronis Blm Stabil 0000000821823 00092 26/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
180 0104R0020722V004981 Obat Kronis Blm Stabil 0000979852948 00073 29/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
181 0104R0020722V006363 Obat Kronis Blm Stabil 0001292991131 00180 29/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
182 0104R0020722V003946 Obat Kronis Blm Stabil 0000980001483 00054 22/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
183 0104R0020722V004566 Obat Kronis Blm Stabil 0000000416349 00084 25/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
184 0104R0020722V004422 Obat Kronis Blm Stabil 0000218393638 00113 25/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
185 0104R0020722V003027 Obat Kronis Blm Stabil 0000219043923 00023 22/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
186 0104R0020722V005477 Obat Kronis Blm Stabil 0001267309012 00077 27/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
187 0104R0020722V004921 Obat Kronis Blm Stabil 0000220120749 00070 26/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
188 0104R0020722V002522 Obat Kronis Blm Stabil 0000219619304 00114 15/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
189 0104R0020722V002544 Obat Kronis Blm Stabil 0000218715276 00144 15/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
190 0104R0020722V003180 Obat Kronis Blm Stabil 0000218997966 00149 20/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
191 0104R0020722V003302 Obat Kronis Blm Stabil 0002146780001 00168 20/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
192 0104R0020722V002992 Obat Kronis Blm Stabil 0000218993949 00060 20/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
193 0104R0020722V003871 Obat Kronis Blm Stabil 0000218644029 00033 22/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
194 0104R0020722V000632 Obat Kronis Blm Stabil 0001481956031 00153 11/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
195 0104R0020722V001618 Obat Kronis Blm Stabil 0000979740281 00038 13/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
196 0104R0020722V001571 Obat Kronis Blm Stabil 0001114683399 00049 13/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
197 0104R0020722V001713 Obat Kronis Blm Stabil 0001115777351 00138 13/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
198 0104R0020722V002476 Obat Kronis Blm Stabil 0000000580746 00078 15/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
199 0104R0020722V002451 Obat Kronis Blm Stabil 0001274037232 00055 15/07/2022 Symbicort 120 dosis Asca 160/4.5mcg 1,00 189.887 1,00 189.887
inh
200 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Ramipril 2.5 Dexa tab 2,5 mg 23,00 7.066 23,00 7.066

201 0104R0020722V003935 Obat Kronis Blm Stabil 0003104242626 00041 22/07/2022 Ramipril 2.5 Dexa tab 2,5 mg 19,00 5.837 19,00 5.837

202 0104R0020722V006372 Obat Kronis Blm Stabil 0000217642454 00251 29/07/2022 Ramipril 2.5 Dexa tab 2,5 mg 23,00 7.066 23,00 7.066

203 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Valsartan 80 mg Dexa tab 80 mg 23,00 12.218 23,00 12.218

204 0104R0020722V001865 Obat Kronis Blm Stabil 0002146348451 00326 13/07/2022 Valsartan 80 mg Dexa tab 80 mg 23,00 12.218 23,00 12.218

205 0104R0020722V003502 Obat Kronis Blm Stabil 0002203134816 00068 21/07/2022 Propranolol 10 Holi tab 10 mg 11,50 927 11,50 927

206 0104R0020722V008213 Obat Kronis Blm Stabil 0000219708775 00177 04/08/2022 Propranolol 10 Holi tab 10 mg 23,00 1.855 23,00 1.855

207 0104R0020722V008334 Obat Kronis Blm Stabil 0000218814928 00267 04/08/2022 Propranolol 10 Holi tab 10 mg 23,00 1.855 23,00 1.855

208 0104R0020722V008017 Obat Kronis Blm Stabil 0002132092179 00271 04/08/2022 Propranolol 10 Holi tab 10 mg 23,00 1.855 23,00 1.855

209 0104R0020722V008323 Obat Kronis Blm Stabil 0000145127114 00272 04/08/2022 Propranolol 10 Holi tab 10 mg 11,50 927 11,50 927

210 0104R0020722V005705 Obat Kronis Blm Stabil 0001114692399 00002 30/07/2022 Propranolol 10 Holi tab 10 mg 11,50 927 11,50 927

211 0104R0020722V008186 Obat Kronis Blm Stabil 0000979873187 00272 04/08/2022 Propranolol 10 Holi tab 10 mg 11,50 927 11,50 927

212 0104R0020722V001119 Obat Kronis Blm Stabil 0001477591367 00205 12/07/2022 Mestinon 60 mg Meil tab 60 mg 69,00 693.312 69,00 693.312

213 0104R0020722V003308 Obat Kronis Blm Stabil 0000218643265 00277 20/07/2022 Mestinon 60 mg Meil tab 60 mg 69,00 693.312 69,00 693.312

214 0104R0020722V003167 Obat Kronis Blm Stabil 0001851758291 00086 21/07/2022 Mestinon 60 mg Meil tab 60 mg 92,00 924.416 92,00 924.416

215 0104R0020722V007177 Obat Kronis Blm Stabil 0001114962783 00091 02/08/2022 Mestinon 60 mg Meil tab 60 mg 69,00 693.312 69,00 693.312

216 0104R0020722V008047 Obat Kronis Blm Stabil 0000979943455 00021 04/08/2022 Mestinon 60 mg Meil tab 60 mg 92,00 924.416 92,00 924.416

217 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Isosorbid Dinitrat 5 Yari tab 5 mg 23,00 2.915 23,00 2.915

218 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Isosorbid Dinitrat 5 Yari tab 5 mg 23,00 2.915 23,00 2.915

219 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Isosorbid Dinitrat 5 Yari tab 5 mg 23,00 2.915 23,00 2.915

220 0104R0020722V004520 Obat Kronis Blm Stabil 0001310794738 00005 25/07/2022 Haloperidol 5 Mers tab 5 mg 23,00 1.590 23,00 1.590

221 0104R0020722V006212 Obat Kronis Blm Stabil 0002286314785 00003 31/07/2022 Haloperidol 5 Mers tab 5 mg 11,50 795 11,50 795

222 0104R0020722V006851 Obat Kronis Blm Stabil 0002241189527 00001 01/08/2022 Haloperidol 5 Mers tab 5 mg 11,50 795 11,50 795

223 0104R0020722V002125 Obat Kronis Blm Stabil 0002146348394 00140 14/07/2022 Kalsium Laktat 500 Mers tab 500 mg 23,00 1.766 23,00 1.766

224 0104R0020722V002358 Obat Kronis Blm Stabil 0000094516547 00000 14/07/2022 Kalsium Laktat 500 Mers tab 500 mg 23,00 1.766 23,00 1.766

225 0104R0020722V003651 Obat Kronis Blm Stabil 0000217817087 00162 21/07/2022 Kalsium Laktat 500 Mers tab 500 mg 23,00 1.766 23,00 1.766

226 0104R0020722V002285 Obat Kronis Blm Stabil 0000000805937 00245 16/07/2022 Kalsium Laktat 500 Mers tab 500 mg 46,00 3.533 46,00 3.533

227 0104R0020722V005917 Obat Kronis Blm Stabil 0002608851587 00021 28/07/2022 Kalsium Laktat 500 Mers tab 500 mg 23,00 1.766 23,00 1.766

228 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Concor 1.25 Merc tab 1.25 mg 23,00 56.083 23,00 56.083

229 0104R0020722V002346 Obat Kronis Blm Stabil 0001314529075 00134 14/07/2022 Fenobarbital Kifa tab 30 mg 23,00 5.358 23,00 5.358
230 0104R0020722V001140 Obat Kronis Blm Stabil 0001796001783 00233 12/07/2022 Valproat Sirup Dexa 250 mg/5 ml sir 250 2,00 32.645 2,00 32.645
mg/5 ml, btl 100 ml
231 0104R0020722V002330 Obat Kronis Blm Stabil 0002930120291 00129 14/07/2022 Valproat Sirup Dexa 250 mg/5 ml sir 250 2,00 32.645 2,00 32.645
mg/5 ml, btl 100 ml
232 0104R0020722V004552 Obat Kronis Blm Stabil 0002899368448 00044 27/07/2022 Valproat Sirup Dexa 250 mg/5 ml sir 250 1,00 16.323 1,00 16.323
mg/5 ml, btl 100 ml
233 0104R0020722V008602 Obat Kronis Blm Stabil 0001309077088 00036 05/08/2022 Valproat Sirup Dexa 250 mg/5 ml sir 250 3,00 48.968 3,00 48.968
mg/5 ml, btl 100 ml
234 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Asam Ursodeoksikholik 250 Dexa tab 250 46,00 108.751 46,00 108.751
mg
235 0104R0020722V000173 Obat Kronis Blm Stabil 0001115428544 00004 08/07/2022 Diazepam 2 mg Yari tab 2 mg 23,00 2.061 23,00 2.061

236 0104R0020722V005934 Obat Kronis Blm Stabil 0002233974115 00001 28/07/2022 Diazepam 2 mg Yari tab 2 mg 23,00 2.061 23,00 2.061

237 0104R0020722V007747 Obat Kronis Blm Stabil 0002147095585 00001 03/08/2022 Diazepam 2 mg Yari tab 2 mg 23,00 2.061 23,00 2.061

238 0104R0020722V007401 Obat Kronis Blm Stabil 0000220893265 00003 03/08/2022 Diazepam 2 mg Yari tab 2 mg 11,50 1.030 11,50 1.030

239 0104R0020722V000173 Obat Kronis Blm Stabil 0001115428544 00004 08/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

240 0104R0020722V000336 Obat Kronis Blm Stabil 0001996379616 00003 09/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

241 0104R0020722V006896 Obat Kronis Blm Stabil 0002200826957 00002 01/08/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

242 0104R0020722V004971 Obat Kronis Blm Stabil 0001115369504 00001 26/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

243 0104R0020722V004813 Obat Kronis Blm Stabil 0000000754749 00002 26/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

244 0104R0020722V005934 Obat Kronis Blm Stabil 0002233974115 00001 28/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 46,00 27.850 46,00 27.850

245 0104R0020722V006212 Obat Kronis Blm Stabil 0002286314785 00003 31/07/2022 Clozapine 25 Dexa Klozapin tab 25 mg 23,00 13.925 23,00 13.925

246 0104R0020722V007747 Obat Kronis Blm Stabil 0002147095585 00001 03/08/2022 Clozapine 25 Dexa Klozapin tab 25 mg 46,00 27.850 46,00 27.850

247 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Colcitine 500 Imph Kolkisin tab 500 mcg 23,00 19.754 23,00 19.754

248 0104R0020722V006289 Obat Kronis Blm Stabil 0000977965896 00248 29/07/2022 Simvastatin 20 Kifa tab 20 mg 23,00 4.416 23,00 4.416

249 0104R0020722V001876 Obat Kronis Blm Stabil 0001114593164 00026 13/07/2022 Amlodipin 5 Kifa tab 5 mg 23,00 1.619 23,00 1.619

250 0104R0020722V004520 Obat Kronis Blm Stabil 0001310794738 00005 25/07/2022 Klorpromazin SK21 100 mg tab sal 100 11,50 3.180 11,50 3.180
mg
251 0104R0020722V006851 Obat Kronis Blm Stabil 0002241189527 00001 01/08/2022 Klorpromazin SK21 100 mg tab sal 100 11,50 3.180 11,50 3.180
mg
252 0104R0020722V000727 Obat Kronis Blm Stabil 0001113311529 00244 11/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

253 0104R0020722V001567 Obat Kronis Blm Stabil 0000000702898 00034 13/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

254 0104R0020722V001589 Obat Kronis Blm Stabil 0000219383649 00269 13/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

255 0104R0020722V003583 Obat Kronis Blm Stabil 0000000490059 00062 21/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

256 0104R0020722V002116 Obat Kronis Blm Stabil 0000218865519 00180 17/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

257 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

258 0104R0020722V005499 Obat Kronis Blm Stabil 0002269981607 00318 27/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

259 0104R0020722V006186 Obat Kronis Blm Stabil 0000218852649 00187 29/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243
260 0104R0020722V006970 Obat Kronis Blm Stabil 0001264649635 00052 01/08/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

261 0104R0020722V007393 Obat Kronis Blm Stabil 0001112854577 00144 02/08/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

262 0104R0020722V008047 Obat Kronis Blm Stabil 0000979943455 00021 04/08/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

263 0104R0020722V006006 Obat Kronis Blm Stabil 0000000522178 00211 28/07/2022 Asam Folat 5mg SK2020 tab 5 mg 23,00 8.243 23,00 8.243

264 0104R0020722V003583 Obat Kronis Blm Stabil 0000000490059 00062 21/07/2022 Pramipeksol 0,125 Dexa tab 0,125 mg 15,00 26.880 15,00 26.880

265 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Pramipeksol 0,125 Dexa tab 0,125 mg 15,00 26.880 15,00 26.880

266 0104R0020722V005499 Obat Kronis Blm Stabil 0002269981607 00318 27/07/2022 Pramipeksol 0,125 Dexa tab 0,125 mg 23,00 41.216 23,00 41.216

267 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Allopurinol 100 Hexp tab 100 mg 23,00 2.620 23,00 2.620

268 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Allopurinol 100 Hexp tab 100 mg 23,00 2.620 23,00 2.620

269 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Allopurinol 100 Hexp tab 100 mg 23,00 2.620 23,00 2.620

270 0104R0020722V002371 Obat Kronis Blm Stabil 0000003301918 00269 14/07/2022 Amlodipin 10 Samp tab 10 mg 23,00 2.179 23,00 2.179

271 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Amlodipin 10 Samp tab 10 mg 23,00 2.179 23,00 2.179

272 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Atovastatin 20 Dexa tab 20 mg 46,00 27.497 46,00 27.497

273 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Atovastatin 20 Dexa tab 20 mg 46,00 27.497 46,00 27.497

274 0104R0020722V000731 Obat Kronis Blm Stabil 0000206629964 00072 11/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

275 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

276 0104R0020722V001865 Obat Kronis Blm Stabil 0002146348451 00326 13/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

277 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

278 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

279 0104R0020722V006323 Obat Kronis Blm Stabil 0001114845592 00157 29/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

280 0104R0020722V006372 Obat Kronis Blm Stabil 0000217642454 00251 29/07/2022 Bisoprolol 2.5 Dexa tab 2,5 mg 23,00 3.974 23,00 3.974

281 0104R0020722V002613 Obat Kronis Blm Stabil 0002146355043 00123 17/07/2022 Valproat ER 250 Dexa Natrium Valproat 46,00 188.416 46,00 188.416
tab ER 250 mg
282 0104R0020722V007747 Obat Kronis Blm Stabil 0002147095585 00001 03/08/2022 Valproat ER 250 Dexa Natrium Valproat 23,00 94.208 23,00 94.208
tab ER 250 mg
283 0104R0020722V007401 Obat Kronis Blm Stabil 0000220893265 00003 03/08/2022 Valproat ER 250 Dexa Natrium Valproat 23,00 94.208 23,00 94.208
tab ER 250 mg
284 0104R0020722V008589 Obat Kronis Blm Stabil 0002200684994 00195 05/08/2022 Valproat ER 250 Dexa Natrium Valproat 69,00 282.624 69,00 282.624
tab ER 250 mg
285 0104R0020722V002068 Obat Kronis Blm Stabil 0000219387216 00050 14/07/2022 Valproate ER 500 Dexa Natrium Valproat 46,00 87.790 46,00 87.790
tab 500 mg
286 0104R0020722V005836 Obat Kronis Blm Stabil 0002044658002 00000 28/07/2022 Valproate ER 500 Dexa Natrium Valproat 46,00 87.790 46,00 87.790
tab 500 mg
287 0104R0020722V001567 Obat Kronis Blm Stabil 0000000702898 00034 13/07/2022 Pramifol 0.375 Soho Pramipeksol tab 375 23,00 89.792 23,00 89.792
mcg
288 0104R0020722V003424 Obat Kronis Blm Stabil 0000000499781 00033 21/07/2022 Pramifol 0.375 Soho Pramipeksol tab 375 23,00 89.792 23,00 89.792
mcg
289 0104R0020722V003583 Obat Kronis Blm Stabil 0000000490059 00062 21/07/2022 Pramifol 0.375 Soho Pramipeksol tab 375 15,00 58.560 15,00 58.560
mcg
290 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Pramifol 0.375 Soho Pramipeksol tab 375 15,00 58.560 15,00 58.560
mcg
291 0104R0020722V004474 Obat Kronis Blm Stabil 0001813698281 00117 25/07/2022 Pramifol 0.375 Soho Pramipeksol tab 375 23,00 89.792 23,00 89.792
mcg
292 0104R0020722V000619 Obat Kronis Blm Stabil 0000000728763 00078 11/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

293 0104R0020722V000762 Obat Kronis Blm Stabil 0002146706109 00131 11/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

294 0104R0020722V001571 Obat Kronis Blm Stabil 0001114683399 00049 13/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

295 0104R0020722V002061 Obat Kronis Blm Stabil 0002146694016 00036 14/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

296 0104R0020722V002087 Obat Kronis Blm Stabil 0001291238818 00058 14/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

297 0104R0020722V002217 Obat Kronis Blm Stabil 0000219746171 00118 14/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

298 0104R0020722V006707 Obat Kronis Blm Stabil 0001112301347 00169 01/08/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

299 0104R0020722V005803 Obat Kronis Blm Stabil 0001115195264 00042 28/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

300 0104R0020722V005808 Obat Kronis Blm Stabil 0000000687295 00043 28/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

301 0104R0020722V005541 Obat Kronis Blm Stabil 0000211384078 00041 27/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

302 0104R0020722V005731 Obat Kronis Blm Stabil 0001113079601 00029 28/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

303 0104R0020722V003822 Obat Kronis Blm Stabil 0000219767411 00024 22/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

304 0104R0020722V004354 Obat Kronis Blm Stabil 0000000679342 00033 25/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

305 0104R0020722V006132 Obat Kronis Blm Stabil 0001082489826 00027 29/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

306 0104R0020722V005212 Obat Kronis Blm Stabil 0000000768789 00371 29/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

307 0104R0020722V006402 Obat Kronis Blm Stabil 0000217230309 00000 29/07/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

308 0104R0020722V006898 Obat Kronis Blm Stabil 0001115371157 00168 01/08/2022 Salbutamol tab 2 Imfi tab 2 mg 69,00 4.504 69,00 4.504

309 0104R0020722V000139 Obat Kronis Blm Stabil 0000219858287 00062 08/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
310 0104R0020722V000655 Obat Kronis Blm Stabil 0001112840392 00061 11/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
311 0104R0020722V001022 Obat Kronis Blm Stabil 0000219926046 00208 12/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
312 0104R0020722V001590 Obat Kronis Blm Stabil 0000218613993 00041 13/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
313 0104R0020722V002471 Obat Kronis Blm Stabil 0000000410185 00069 15/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
314 0104R0020722V007905 Obat Kronis Blm Stabil 0000218219319 00326 03/08/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
315 0104R0020722V008041 Obat Kronis Blm Stabil 0000218501368 00040 04/08/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
316 0104R0020722V005757 Obat Kronis Blm Stabil 0000218724581 00033 28/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
317 0104R0020722V005747 Obat Kronis Blm Stabil 0001267061589 00050 28/07/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
318 0104R0020722V008482 Obat Kronis Blm Stabil 0000000455848 00141 05/08/2022 Suprasma 100mcg/dosis inhaler Dexa 1,00 28.160 1,00 28.160
100 mcg/dosis
319 0104R0020722V000308 Obat Kronis Blm Stabil 0000218778388 00085 08/07/2022 Fenitoin 100 SK21 kaps 100 mg 46,00 11.069 46,00 11.069

320 0104R0020722V000253 Obat Kronis Blm Stabil 0000979650742 00081 08/07/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

321 0104R0020722V000727 Obat Kronis Blm Stabil 0001113311529 00244 11/07/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

322 0104R0020722V001589 Obat Kronis Blm Stabil 0000219383649 00269 13/07/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

323 0104R0020722V002116 Obat Kronis Blm Stabil 0000218865519 00180 17/07/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

324 0104R0020722V004791 Obat Kronis Blm Stabil 0000166178935 00003 26/07/2022 Fenitoin 100 SK21 kaps 100 mg 92,00 22.139 92,00 22.139

325 0104R0020722V006186 Obat Kronis Blm Stabil 0000218852649 00187 29/07/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

326 0104R0020722V006970 Obat Kronis Blm Stabil 0001264649635 00052 01/08/2022 Fenitoin 100 SK21 kaps 100 mg 92,00 22.139 92,00 22.139

327 0104R0020722V007137 Obat Kronis Blm Stabil 0001115275667 00172 02/08/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

328 0104R0020722V006006 Obat Kronis Blm Stabil 0000000522178 00211 28/07/2022 Fenitoin 100 SK21 kaps 100 mg 92,00 22.139 92,00 22.139

329 0104R0020722V008589 Obat Kronis Blm Stabil 0002200684994 00195 05/08/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

330 0104R0020722V008598 Obat Kronis Blm Stabil 0001793116484 00196 05/08/2022 Fenitoin 100 SK21 kaps 100 mg 69,00 16.604 69,00 16.604

331 0104R0020722V000196 Obat Kronis Blm Stabil 0000218604284 00188 08/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
332 0104R0020722V000207 Obat Kronis Blm Stabil 0001285533483 00276 08/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
333 0104R0020722V000338 Obat Kronis Blm Stabil 0000220034283 00204 09/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
334 0104R0020722V000619 Obat Kronis Blm Stabil 0000000728763 00078 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
335 0104R0020722V000748 Obat Kronis Blm Stabil 0000219374256 00130 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
336 0104R0020722V000762 Obat Kronis Blm Stabil 0002146706109 00131 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
337 0104R0020722V008546 Obat Kronis Blm Stabil 0000218431258 00253 05/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
338 0104R0020722V008596 Obat Kronis Blm Stabil 0002086558852 00260 06/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
339 0104R0020722V008124 Obat Kronis Blm Stabil 0000000580645 00106 04/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
340 0104R0020722V008237 Obat Kronis Blm Stabil 0001798268703 00143 04/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
341 0104R0020722V005808 Obat Kronis Blm Stabil 0000000687295 00043 28/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
342 0104R0020722V005541 Obat Kronis Blm Stabil 0000211384078 00041 27/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
343 0104R0020722V005992 Obat Kronis Blm Stabil 0000219633164 00146 28/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
344 0104R0020722V008676 Obat Kronis Blm Stabil 0000218522485 00161 05/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
345 0104R0020722V007730 Obat Kronis Blm Stabil 0000219813658 00254 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
346 0104R0020722V007652 Obat Kronis Blm Stabil 0000000420467 00307 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
347 0104R0020722V007910 Obat Kronis Blm Stabil 0000168398717 00317 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
348 0104R0020722V007873 Obat Kronis Blm Stabil 0002080424608 00325 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
349 0104R0020722V008041 Obat Kronis Blm Stabil 0000218501368 00040 04/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
350 0104R0020722V008036 Obat Kronis Blm Stabil 0000218501875 00041 04/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
351 0104R0020722V007054 Obat Kronis Blm Stabil 0000000621268 00059 01/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
352 0104R0020722V007093 Obat Kronis Blm Stabil 0000979951667 00088 02/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
353 0104R0020722V007597 Obat Kronis Blm Stabil 0000171652566 00084 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
354 0104R0020722V007549 Obat Kronis Blm Stabil 0000219062733 00099 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
355 0104R0020722V007593 Obat Kronis Blm Stabil 0000219321966 00146 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
356 0104R0020722V007654 Obat Kronis Blm Stabil 0000219205899 00180 03/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
357 0104R0020722V006132 Obat Kronis Blm Stabil 0001082489826 00027 29/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
358 0104R0020722V006190 Obat Kronis Blm Stabil 0000000568293 00051 29/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
359 0104R0020722V006193 Obat Kronis Blm Stabil 0000000529558 00052 29/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
360 0104R0020722V005037 Obat Kronis Blm Stabil 0001273446235 00067 26/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
361 0104R0020722V006327 Obat Kronis Blm Stabil 0000219665237 00204 29/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
362 0104R0020722V006769 Obat Kronis Blm Stabil 0002618655581 00083 01/08/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
363 0104R0020722V004354 Obat Kronis Blm Stabil 0000000679342 00033 25/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
364 0104R0020722V003558 Obat Kronis Blm Stabil 0000203512127 00106 22/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
365 0104R0020722V003032 Obat Kronis Blm Stabil 0001899297977 00024 22/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
366 0104R0020722V005355 Obat Kronis Blm Stabil 0000218081439 00081 27/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
367 0104R0020722V005896 Obat Kronis Blm Stabil 0002047157223 00030 28/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
368 0104R0020722V004936 Obat Kronis Blm Stabil 0002146707832 00048 26/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
369 0104R0020722V002475 Obat Kronis Blm Stabil 0000219082577 00092 16/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
370 0104R0020722V003013 Obat Kronis Blm Stabil 0000219327017 00278 20/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
371 0104R0020722V003073 Obat Kronis Blm Stabil 0001112347361 00137 20/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
372 0104R0020722V003740 Obat Kronis Blm Stabil 0000000566223 00018 21/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
373 0104R0020722V003739 Obat Kronis Blm Stabil 0000000651148 00019 21/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
374 0104R0020722V004007 Obat Kronis Blm Stabil 0000219810532 00071 22/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
375 0104R0020722V001910 Obat Kronis Blm Stabil 0000000708041 00235 13/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
376 0104R0020722V001859 Obat Kronis Blm Stabil 0001115385581 00268 13/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
377 0104R0020722V002348 Obat Kronis Blm Stabil 0000000583525 00107 14/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
378 0104R0020722V002157 Obat Kronis Blm Stabil 0000979745567 00087 14/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
379 0104R0020722V002217 Obat Kronis Blm Stabil 0000219746171 00118 14/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
380 0104R0020722V002471 Obat Kronis Blm Stabil 0000000410185 00069 15/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
381 0104R0020722V000781 Obat Kronis Blm Stabil 0000000761962 00150 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
382 0104R0020722V000870 Obat Kronis Blm Stabil 0000219957401 00170 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
383 0104R0020722V000756 Obat Kronis Blm Stabil 0002091208105 00190 11/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
384 0104R0020722V001079 Obat Kronis Blm Stabil 0000218455121 00034 12/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
385 0104R0020722V001072 Obat Kronis Blm Stabil 0001115274958 00085 12/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
386 0104R0020722V001032 Obat Kronis Blm Stabil 0000218775521 00107 12/07/2022 Seretide Diskus 250 SK21 250 mcg/puff 1,00 158.402 1,00 158.402
inh 60 dosis
387 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Digoksin 0.25 SK21 tab 0,25 mg 11,50 2.179 11,50 2.179

388 0104R0020722V000590 Obat Kronis Blm Stabil 0001243330053 00046 11/07/2022 Furosemide 40 SK21 tab 40 mg 11,50 1.678 11,50 1.678

389 0104R0020722V001140 Obat Kronis Blm Stabil 0001796001783 00233 12/07/2022 Furosemide 40 SK21 tab 40 mg 4,00 584 4,00 584

390 0104R0020722V001584 Obat Kronis Blm Stabil 0000217422674 00261 13/07/2022 Furosemide 40 SK21 tab 40 mg 23,00 3.356 23,00 3.356

391 0104R0020722V003022 Obat Kronis Blm Stabil 0000000833826 00065 20/07/2022 Furosemide 40 SK21 tab 40 mg 11,50 1.678 11,50 1.678

392 0104R0020722V003935 Obat Kronis Blm Stabil 0003104242626 00041 22/07/2022 Furosemide 40 SK21 tab 40 mg 3,00 438 3,00 438

393 0104R0020722V005302 Obat Kronis Blm Stabil 0000980031969 00049 27/07/2022 Furosemide 40 SK21 tab 40 mg 11,50 1.678 11,50 1.678

394 0104R0020722V004090 Obat Kronis Blm Stabil 0002274142061 00139 22/07/2022 Kombinasi: Levodopa 100 mg; Karbidopa 69,00 777.216 69,00 777.216
25 mg; Entekapon 200 mg
395 0104R0020722V004474 Obat Kronis Blm Stabil 0001813698281 00117 25/07/2022 Kombinasi: Levodopa 100 mg; Karbidopa 69,00 777.216 69,00 777.216
25 mg; Entekapon 200 mg
396 0104R0020722V003502 Obat Kronis Blm Stabil 0002203134816 00068 21/07/2022 Tiamazol 10 SK21 tab 10 mg 23,00 39.008 23,00 39.008

397 0104R0020722V008213 Obat Kronis Blm Stabil 0000219708775 00177 04/08/2022 Tiamazol 10 SK21 tab 10 mg 23,00 39.008 23,00 39.008

398 0104R0020722V008334 Obat Kronis Blm Stabil 0000218814928 00267 04/08/2022 Tiamazol 10 SK21 tab 10 mg 23,00 39.008 23,00 39.008

399 0104R0020722V008017 Obat Kronis Blm Stabil 0002132092179 00271 04/08/2022 Tiamazol 10 SK21 tab 10 mg 46,00 78.016 46,00 78.016

400 0104R0020722V008323 Obat Kronis Blm Stabil 0000145127114 00272 04/08/2022 Tiamazol 10 SK21 tab 10 mg 23,00 39.008 23,00 39.008

401 0104R0020722V005705 Obat Kronis Blm Stabil 0001114692399 00002 30/07/2022 Tiamazol 10 SK21 tab 10 mg 23,00 39.008 23,00 39.008

402 0104R0020722V008199 Obat Kronis Blm Stabil 0000218737776 00142 04/08/2022 Tiamazol 5 SK21 tab 5 mg 23,00 19.990 23,00 19.990
 403 0104R0020722V008186 Obat Kronis Blm Stabil 0000979873187 00272 04/08/2022 Tiamazol 5 SK21 tab 5 mg 23,00 19.990 23,00 19.990

404 0104R0020722V002125 Obat Kronis Blm Stabil 0002146348394 00140 14/07/2022 Euthyrox 100 Merc tab 100 mcg 23,00 31.560 23,00 31.560

405 0104R0020722V002358 Obat Kronis Blm Stabil 0000094516547 00000 14/07/2022 Euthyrox 100 Merc tab 100 mcg 23,00 31.560 23,00 31.560

406 0104R0020722V003651 Obat Kronis Blm Stabil 0000217817087 00162 21/07/2022 Euthyrox 100 Merc tab 100 mcg 23,00 31.560 23,00 31.560

407 0104R0020722V002285 Obat Kronis Blm Stabil 0000000805937 00245 16/07/2022 Euthyrox 100 Merc tab 100 mcg 23,00 31.560 23,00 31.560

408 0104R0020722V005917 Obat Kronis Blm Stabil 0002608851587 00021 28/07/2022 Euthyrox 100 Merc tab 100 mcg 23,00 31.560 23,00 31.560

Menyetujui,
Pidie,06 Oktober 2022
Kabid PMP/PMR Verifikator
Petugas Apotek / Ins.Farmasi

Cut Novarita RA. Ratih Prawulan Sari A

Maina Rizki, Amd. Farm
NPP:03662 NPP : 07493
022105932016

Mengetahui,

Kepala Cabang BPJS Kesehatan

Direktur/Pimpinan Apotek/Ins.Farmasi

Neni Fajar
Cut Nurfauziah, M.Farm, APt
NPP:04179
Ka. Instalasi Farmasi