No Nama Barang Satuan

No Nama Barang Satuan
1 Albendazol Tablet 400 mg Tablet

2 Alopurinol Tablet 100 mg Tablet
3 Aminofilin Inj 24 mg/ml-10 ml Ampul
4 Aminofilin Tablet 200 mg Tablet
5 Amitriptilina HCl Tablet salut 25 mg Tablet
6 Amlodipin Tablet 5 mg Tablet
7 Amoksisilin Kaplet 500 mg Kaplet
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol
9 Antasida DOEN I Tablet Kunyah Tablet
10 Antasida II Suspensi 60 ml Botol
11 Anti Hemmoroid DOEN Supp
12 Antibakteri DOEN Tube
13 Antifungi DOEN kombinasi Pot
14 Antimigren DOEN Tablet
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial
16 ARV: Efavirenz 600 mg Tablet
17 ARV: Lamivudine 150 mg Tablet
18 ARV: Lovinapir 200 mg Ronavir Tablet
19 ARV: Nevirapine 200 mg Tablet
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet
21 ARV: Tenofovir 300 mg Tablet
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet
26 Asam Folat Tablet 0,4 mg Tablet
27 Asam Mefenamat kaplet 500 mg Tablet
28 Asiklovir Krim 5%/5g Tube
29 Asiklovir Tablet 400 mg Tablet
30 Atapulgit Tablet 600 mg Tablet
31 Atropin Sulfat Inj 0,25 mg/ml Ampul
32 Azithromisin Tablet 500 mg Tablet
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial
34 Betahistin Tablet 6 mg Tablet
35 Betametason Krim 0.1 % Tube
36 Bisoprolol Tablet 5 mg Tablet
37 Bromheksin Tablet 8 mg Tablet
38 Clobazam Tablet 10 mg Tablet
39 Clozapine Tablet 25 mg Tablet
40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket
41 Deksametason Inj 5 mg/ml-1 ml Ampul
42 Deksametason Tablet 0,5 mg Tablet
43 Dekstrometorfan Tablet kombinasi Tablet
44 Dektrometorfan Sirup kombinasi Botol
45 Devitalisasi Pasta Botol
46 Dextrose Inj 40% Vial
47 Diazepam Inj 5 mg/ml-2 ml Ampul
48 Diazepam Rectal 5 mg/2,5 ml tube
49 Diazepam Tablet 2 mg Tablet
50 Difenhidramin Inj 10 mg/ml Ampul
51 Digoksin Tablet 0,25 mg Tablet
52 Dimenhidrinat Tablet 50 mg Tablet
53 Doksisilin Tablet 100 mg Tablet
54 Domperidon Suspensi 5mg/5ml Botol
55 Domperidon Tablet 10 mg Tablet
56 Endometason Botol
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul
58 Eritromisin Kapsul 250 mg Kapsul
60 Eritromisin Sirup 200 mg/5 ml Botol
61 Etakridin Larutan 0,1 % Botol
62 Etanol 70 %- 1000 ml Botol
63 Etil Klorida Spray Botol
64 Eugenol Cairan Botol
65 Fenitoin Natrium Kapsul 100 mg Kapsul
66 Fenobarbital Tablet 30 mg Tablet
67 Fenoksimetil Penisilin Tablet 500 mg Tablet
68 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul
70 Fluconazol Tablet 150 mg Tablet
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul
72 Formokresol Cair Botol
73 Furosemid Tablet 40 mg Tablet
74 Garam Oralit I Serbuk Sachet
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial
76 Gentamisin Salep Kulit 0,1% Tube
77 Glass Ionomer Cement Botol
78 Glibenklamid Tablet 5 mg Tablet
79 Gliseril Guaiakolat Tablet 100 mg Tablet
80 Glukosa Larutan Infus 5% steril Fls
81 Griseofulvin Tablet 125 mg Micronized Tablet
82 Haloperidol 5 mg Tablet
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul
84 Haloperidol Inj 5 mg/ml Ampul
85 Haloperidol Tablet 1,5 mg Tablet
86 Hidrokortison Krim 2,5 % Tube
87 Hiosina butilbromida tab 10 mg Tablet
88 Human Tetanus Imunoglobulin Im 250UI (Tetagam) Set
89 Ibuprofen Tablet 400 mg Tablet
90 Isoniazid Tablet 100 mg Tablet
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet
92 Kalsium glukonat inj 100 mg/ml Ampul
93 Kalsium hidroksida pasta Botol
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet
95 Kaptropil Tablet 25 mg Tablet
96 Karbamazepin Tablet 200 mg Tablet
97 Karbogliserin Tetes Telinga 10 % Botol
98 Karbon aktif tab 0,5 mg Tablet
99 Ketokonazol Tablet 200 mg Tablet
100 Ketoprofen Supp 100 mg Supp
101 Kina Inj 26 % 2 ml Ampul
102 Kina Tablet 222 mg Tablet
103 Klindanmisin Tablet 300 mg Tablet
104 Kloramfenikol Kapsul 250 mg Kapsul
106 Kloramfenikol Salep Kulit 2% Tube
107 Kloramfenikol Salep Mata 1 % Tube
108 Kloramfenikol Sirup 125 mg/5 ml Botol
109 Kloramfenikol Tetes Mata 0.5% Botol
110 Kloramfenikol Tetes telinga 3 % Tube
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet
112 Klorpropmazin HCl Tablet salut 100 mg Tablet
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet
115 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 80000-2 ml Ampul
116 Lidokain Jelly 2 % Tube
117 Lidokain Spray 10 % Botol
118 Lisol Botol
119 Loratadin Tablet 10 mg Tablet
120 Magnesium sulfat Inj (IV) 20 % Ampul
122 MB Anak Blister
123 MB Dewasa Blister
124 Metformin HCl Tablet 500 mg Tablet
125 Metildopa Tablet 250 mg Tablet
126 Metilergomatrin Maleat Inj 0,200 mg Ampul
127 Metilergometrin Maleat (Metilergometrin) Tablet Salut 0,125 mg Tablet
128 Metilprednisolon Tablet 4 mg Tablet
129 Metronidazol Tablet 500 mg Tablet
130 Mikonazol Krim/Salep 2% Tube
131 Mineral Mix Sachet
132 Monoklorkamfer mentol cairan Botol
133 Multivitamin + DHA + Lysin Sirup Botol
134 Multivitamin + Mineral Kaplet Kaplet
135 N-asetil sistein kaps 200 mg Kapsul
136 Natrium Bikarbonat Tablet 500 mg Tablet
137 Natrium Diklofenak Tablet 50 mg Tablet
138 Natrium Hipoklorit 3% Botol
139 Natrium Klorida Larutan Infus 0,9% Fls
140 Natrium Tiroksin Tablet 100 µg Tablet
141 Nipedipin Tablet 10 mg Tablet
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet
143 Nistatin Tablet Vaginal 100.000 IU/g Tablet
144 OAT FDC Katagori 1 Paket
146 OAT FDC Kategori Anak paket
147 OAT FDC Kategori Sisipan Paket
148 OAT Kombipak Kat I paket
149 Obat Batuk Hitam (OBH) Cairan Botol
150 Oksitosin Inj 10 IU/ml- 1 ml Ampul
151 Omeprazol Kapsul 20 mg Kapsul
152 Ondansetron Inj 4 mg/2 ml Ampul
153 Parasetamol Sirup 120 mg / 5ml Botol
154 Parasetamol Tablet 500 mg Tablet
155 PB Anak Blister
156 PB Dewasa Blister
157 Permetrin 5% Krim (Scabimite) Tube
158 Phenolphtalein, Paraffin Liquidum, Gliserin Sirup (Laxadin syr) botol
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet
160 Pirimetamin Tablet 25 mg Tablet
161 Polikresulen (Albotyl) Botol 5 ml botol
162 Povidon Iodida 10 %-30 ml Botol
164 Prednison Tablet 5 mg Tablet
165 Primakuin Tablet 15 mg Tablet
166 Prokain Benzilpenisilin Serb Inj 3 juta UI/vial (i.m.) Vial
167 Propanolol HCl Tablet 40 mg Tablet
168 Propiltiourasil Tablet 100 mg Tablet
169 Ranitidin Inj 25 mg/ml Ampul
170 Ranitidin Tablet 150 mg Tablet
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul
173 Ringer Laktat Larutan Infus Steril Fls
174 Risperidon Tablet 2 mg Tablet
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul
176 Salbutamol Tablet 4 mg Tablet
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot
178 Salisil Bedak 2 % Kotak
179 Sefadroksil Sirup 125 mg/5 ml Botol
180 Sefadroxil Kapsul 500 mg Kapsul
181 Sefiksime 200 mg + Azitromisin 500 mg Paket
182 Sefotaksim Inj 1 g Vial
183 Seftriaxon Inj 1 g Vial
184 Semen seng fosfat serbuk cairan Botol
185 Serum Anti Difteri (ADS) Vial
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial
188 Setirizin Sirup 5 mg/5 ml Botol
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul
190 Simvastatin Tablet 10 mg Tablet
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet
192 Tablet Tambah Darah (Camabion) Buah
193 Tablet Tambah Darah Kombinasi Tablet
194 Temporary Restorative Material Botol
195 Tetrasiklin Kapsul 500 mg Kapsul
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet
197 Triheksifenidil HCl Tablet 2 mg Tablet
198 Vaksin BCG + Pelarut Set
199 Vaksin DPT-Hb-Hib Vial
200 Vaksin DT Vial
201 Vaksin Hb-0 Set
202 Vaksin IPV 10 ds Vial
204 Vaksin Measles Rubella (MR) Vial
205 Vaksin Meningitis Paket
206 Vaksin Papillomavirus (HPV) Vial
207 Vaksin Pneumococcus Vial
208 Vaksin Polio 10 ds bopv + Penetes Set
209 Vaksin Rabies Vero Set
210 Vaksin Td Vial
211 Vitamin B Kompleks Tablet Tablet
212 Zinc Tablet 20 mg Tablet
0 BAHAN MEDIS HABIS PAKAI 0
213 ADS 0.05 ml Buah
214 ADS 0.5 ml Buah
215 ADS 5 ml Buah
216 Alat Suntik Sekali Pakai 1ml Set
217 Alat Suntik Sekali Pakai 3 ml Set
219 Alkohol Swab Buah
220 Bisturi Buah
221 Blood set Buah
222 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set
224 Folley Catheter No.18 Buah
225 Infusion set anak Kantong
226 Infusion set dewasa Kantong
227 IV Catheter No.18 Set
231 Jarum kulit Buah
232 Jarum otot Buah
233 Kaca Slide Buah
234 Kantung mayat Buah
235 Kapas Pembalut/absorben 250 mg Roll
236 Kasa Hidrofil 2x80 Roll
237 Kasa Hidrofil Steril 16 X 16 Lembar
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll
239 Kasa Pembalut hidrofil 4 x 5 cm Roll
240 Kassa Pembalut elastic 4 inchi Roll
241 Masker Tie on Buah
242 Masker N-95 Buah
243 Plester 5 yard x 2 inch Roll
244 Polybag Medis Lembar
245 Polybag Nonmedis Lembar
246 Polybag Ramah Lingkungan Lembar
247 Pot Dahak Buah
248 Safety box Buah
249 Sarung Tangan Non Steril Uk.S Buah
250 Sarung Tangan Non Steril Uk.M Buah
251 Sarung Tangan Non Steril Uk.L Buah
252 Sarung Tangan Steril No.6 Set
253 Sarung Tangan Steril No.6,5 Set
255 Sendok Obat Buah
256 Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum Bedah Set
257 Urin Bag Buah
0 REAGEN 0
258 Cybow 10 Reagent Strip Set
259 Golongan darah anti A - 10 ml Botol
260 Golongan darah anti A-B - 10 ml Botol
261 Golongan darah anti B - 10 ml Botol
262 Humasens Plus Set
263 Humasens Plus Strip Uric Acid Kotak
264 Humasens Strip Glucose Kotak
265 Humasens Strip Kolesterol Kotak
266 Iodin test Botol
267 Larutan Asam Asetat 6% 100 ml Botol
268 Larutan Benedict 100 ml Botol
269 Larutan EDTA 10 % 100 ml Botol
270 Larutan HCl 0,1 N 100 ml Botol
271 Larutan Natrium Citrat 3,13 % Botol
272 Larutan Rees Ecker 100 ml Botol
273 Larutan Turk 100 ml Botol
274 Larutan Ziehl Neelsen Botol
275 Rapid HIV 1/2 Device test
276 Rapid HIV 2 Fokus test
277 Rapid HIV Biomedika Sachet
278 Rapid HIV Biomeriux Sachet
279 Rapid HIV Intec Sachet
280 Rapid HIV Oncoprobe Sachet
281 Rapid HIV SD Sachet
282 Rapid Malaria Sachet
283 Rapid Syphilis SD Sachet
284 Reagen CD4 kontrol test
285 Reagen CD4 tipe 1 (Alere Pima CD4) test
286 RPR Syphilis Sachet
287 Salmonella Thyphi H - 5 ml Botol
288 Salmonella Thyphi O - 5 ml Botol
289 Test Kehamilan Buah
0 LAIN-LAIN OBAT
290 Fenobarbital inj 50mg/ml Ampul
291 Vaksin Campak Vial
292 Piridoksin HCl (Vit B6) Tablet 25 mg tablet
293 Isoniazid Tablet 300 mg tablet
294 Diethyk karbamazin 100 mg Tablet
295 Hepatitis B Imunoglobulin vial
296 ARV: Lovinavir/ ritonavir( 100/25mg)/Aluvia Anak Tablet
297 Ampicillin Serbuk Inj 100 mg/ml Vial
298 Metronidazol Inf Botol
299 Oxitetracyclin Hcl Sm 1% Tube
300 ARV: zidovudin 100 Tablet
301 ARV: Efaviren 200 Tablet
302 ARV: Abacavir 300 mg Tablet
303 Amoxcicillin Forte Syr Botol
304 Arte Sunat Inj 60 mg Ampul
305 Tamiflu Cap ( Osel Tamivir ) Capsul
306 Omeprazol Inj Vial
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
LAIN-LAIN BMHP
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
LAIN-LAIN REAGEN
342 Rapid SD HBsAG test
343 Tuberculin test Pcs
344 DBS Collecsion Kit Kit
345 SD HCV Sachet
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
Jan Feb Mar Apr Mei Jun Jul Ags Sept Okt
7000 0 0 0 0 0 640 8000 650 0
100 240 150 210 130 150 200 135 150 65
0 0 0 0 0 0 0 0 0 0
37 35 20 32 30 21 30 29 0 31
0 0 0 0 0 0 3 40 0 0
660 690 650 610 630 418 197 360 295 202
3700 3850 3700 2800 3100 3920 3210 3210 3422 2900
135 165 165 185 30 50 30 90 459 45
7120 4780 4600 4100 4100 3120 4930 3200 4472 2845
56 45 45 34 13 43 49 12 60 18
20 5 12 10 15 12 35 10 13 18
45 45 43 43 32 42 69 27 42 33
0 10 20 25 15 8 23 0 5 8
0 0 0 0 0 0 0 200 0 0
10 11 0 3 3 10 2 4 3 6
0 5 21 0 0 0 17 23 0 21
690 460 430 450 610 520 430 378 430 225
0 0 0 79 60 36 380 157 50 0
710 430 520 0 510 630 810 540 820 0
35 25 45 0 60 20 27 9 0 8
90 690 0 0 25 418 10 100 24 25
250 210 350 95 9 430 320 312 230 85
0 0 0 0 0 0 18 71 32 0
58 43 25 34 24 43 48 43 4 0
230 0 500 300 430 580 580 432 657 0
246 5 280 750 5 0 0 420 0 8

30 120 45 0 810 81 410 0 230 82
745 120 650 400 338 410 415 478 230 265
101 10 30 25 8 20 15 0 0 6
3 0 0 0 7 30 5 0 0 7
1 0 0 0 0 1 0 0 0 0
35 32 36 3 0 0 35 36 16 30
60 0 30 30 30 25 30 30 30 30
0 0 20 20 0 0 3 12 0 0
700 345 110 230 210 210 280 310 340 220
0 15 0 38 27 310 310 254 239 29

65 0 0 0 1 37 40 27 23 14
0 230 0 130 65 90 110 90 0 0

0 0 0 60 15 30 30 60 30 15
0 0 120 0 0 63 90 35 60 0
120 0 60 90 36 234 140 90 135 60
300 160 90 32 0 30 60 45 35 35
210 280 210 93 34 120 6 35 0 10
0 0 0 6 0 4 6 5 3 5
65 45 15 54 8 32 53 35 5 15
230 130 420 320 60 220 230 210 390 60

2800 230 1450 970 474 1150 1410 390 450 924
0 0 0 2 0 0 0 0 0 4
0 0 0 90 0 12 0 0 0 15
60 30 65 60 20 60 0 60 0 30
0 0 0 0 0 0 30 60 0 0
90 30 65 0 0 30 30 60 80 30
45 45 54 45 7 42 54 45 58 33
0 0 90 60 0 30 79 0 290 64
300 150 0 300 175 290 310 336 430 245
0 0 0 0 0 20 10 0 0 0
0 0 0 0 0 0 20 0 0 0
0 0 12 0 0 0 380 0 0 12
900 900 1650 1550 346 2310 2320 1830 1850 456
310 500 810 1230 66 620 690 925 890 678
350 210 0 90 103 195 45 245 290 20
3 36 12 23 0 0 5 8 0 8
0 0 0 0 0 0 60 38 13 15
210 230 0 139 20 130 90 0 34 60
36 55 45 10 2 39 9 21 56 10
35 23 25 6 0 10 9 12 23 11
45 45 43 12 10 26 45 42 17 26
25 0 55 1 3 39 30 0 34 0
4200 3500 3850 876 249 3210 3455 2115 2130 887
120 35 0 30 0 130 10 65 40 0
180 110 110 25 19 145 196 86 120 45
2300 650 650 166 0 750 610 430 640 425
35 0 30 0 0 43 32 35 35 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 1 1 0 0 2 2 1 0 2
310 330 430 59 44 260 169 312 395 56
0 0 30 0 0 10 0 0 0 0
0 0 0 0 0 10 0 0 0 0
390 112 390 688 168 390 380 230 210 112
30 30 110 12 0 30 60 60 30 0
0 0 0 0 0 40 30 0 0 0
120 140 0 12 62 166 210 220 120 56
0 0 0 97 60 286 345 321 435 323
1500 350 400 513 0 180 37 230 420 60
36 20 26 5 5 10 7 9 5 19
55 25 45 15 22 31 29 22 32 35
210 298 365 245 46 296 412 60 315 60
0 0 2480 0 0 0 45 70 0 45
0 450 200 101 66 490 370 480 356 350
1800 1320 1150 425 312 1160 1410 720 435 1452
10 5 5 0 0 1 1 0 0 3
79 0 0 0 0 100 0 50 6 0
0 0 0 3 0 0 3 5 0 0
9 6 4 0 0 2 3 3 3 4
1 2 0 0 0 0 0 0 0 0
70 90 120 40 2 113 50 27 0 26
100 0 100 0 0 0 100 0 0 0
690 430 350 244 428 329 49 49 0 231
340 254 230 94 34 211 321 290 245 324

9200 6800 7200 2817 1724 7450 6233 8560 6545 7345
0 0 0 0 0 0 0 0 0 0
15 3 0 8 3 10 10 10 3 5
8 8 5 12 4 3 0 0 8 2
450 450 420 114 209 436 410 618 980 289
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 1 2 1
1100 1950 320 49 66 296 320 230 451 55
7 0 20 0 0 0 0 5 0 5
2100 1120 1100 285 437 760 930 1120 910 295
750 0 0 0 0 0 4 2 0 0
4700 0 0 4 102 212 2 0 4 4
40 20 30 0 0 27 45 45 26 0
0 0 30 4 0 0 0 20 0 30
0 0 0 0 0 0 0 0 0 0
0 100 0 30 44 108 180 90 140 45
20 12 20 3 0 4 3 3 5 5
50 32 30 7 0 5 5 0 0 6
95 85 70 34 7 47 40 42 37 33
1900 1870 1130 591 284 890 670 620 540 456
0 0 0 0 0 0 0 0 0 0
10 3 0 0 5 17 30 0 0 6
145 120 100 0 0 80 60 50 60 50
110 54 30 20 0 65 120 120 230 30
230 280 200 20 69 140 320 380 590 80
30000 5200 1650 2638 280 710 1690 3120 3200 1453
200 0 100 36 0 110 100 0 230 0

1450 1350 1700 591 362 1650 2340 1450 1560 697
0 0 0 0 10 20 60 60 60 20
0 27 26 0 0 0 0 0 37 0
0 209 59 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
93 23 0 0 0 0 0 0 26 0
5 8 64 0 0 0 0 0 0 0
0 51 6 0 0 0 0 0 15 0
22 34 28 0 0 0 0 0 0 0
89 0 0 0 0 0 0 0 40 0
0 0 0 0 0
315 27 26 0 0 0 0 0 0 0
0 6500 6500 878 261 3450 955 3120 235 697
0 400 400 160 120 410 342 420 600 332
0 465 0 0 0 0 0 0 0 0
2910 0 0 0 0 0 0 0 0 0
0 27 0 0 0 0 0 0 0 0
0 0 0 0 0 100 100 0 0 0
2500 1200 800 62 24 810 610 450 500 0
0 0 0 1 0 200 100 50 100 55
6300 0 0 0 0 0 0 0 0 0
0 0 0 0 0 1 0 0 0 0
10 2 0 0 0 0 5 5 10 5
5 0 12 0 0 10 5 0 5 5
25 24 15 0 0 15 8 0 5 0
0 0 0 0 0 10 0 2 0 2
30 20 15 0 6 10 10 7 15 5
15 10 15 0 0 12 8 5 7 7
20 15 10 0 0 22 8 16 10 8
10 5 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
250 90 45 0 0 50 25 25 28 0
0 10 0 0 0 0 5 20 20 5
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
150 150 100 5 100 100 20 120 120 5
2 1 1 0 0 0 0 0 0 1
15 0 8 0 0 0 0 0 0 0
100 100 100 0 0 100 100 100 100 100
300 300 50 0 0 100 100 100 100 50
0 100 100 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
100 100 100 0 0 50 0 30 50 30
0 0 8 0 0 30 0 30 30 50
0 600 0 6 0 0 300 0 0 0
7 3 3 0 0 5 2 2 3 3
10 0 8 0 0 2 0 0 0 2
0 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0
25 0 0 0 0 0 0 0 0 0
500 0 0 0 0 0 0 0 0 0
100 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Rata2 menurut Pemakaian Rata-Rata
Nov Des Jumlah
rumus dianalisa
0 0 16,290 1,358 640
35 32 1,597 133 10
0 0 - - -
26 102 393 33 7
0 0 43 4 40
135 264 5,111 426 17
806 2046 36,664 3,055 55
33 49 1,436 120 7
3234 2049 48,550 4,046 65
35 59 469 39 5
12 3 165 14 14
22 3 446 37 5
0 5 119 10 12
0 0 200 17 17
4 0 56 5 5
- -
- -
- -
- -
- -
- -
- -
- -
8 6 101 8 18
312 59 4,994 416 28
0 25 787 66 22
326 404 5,700 475 27
0 6 235 20 2
0 74 1,456 121 15
54 74 2,419 202 15
- -
- -
- -
0 0 121 10 18
0 26 348 29 5
- -
328 218 4,255 355 20
- -
- -
- -
0 2 1,716 143 5
50 596 2,454 205 20
220 60 4,331 361 15
0 8 223 19 4
- -
- -
3 0 55 5 6
0 0 2 0 1
15 0 238 20 30
25 56 376 31 30
0 3 58 5 15
265 12 3,232 269 15
- -
0 61 1,283 107 35
29 12 248 21 22
- -
- -
- -
- -
- -
- -
- -
- -
- -
0 0 715 60 60
30 0 270 23 35
- -
35 100 503 42 60
38 0 1,003 84 15
- -
- -
- -
28 65 880 73 15
45 64 1,107 92 5
8 0 37 3 3
30 10 367 31 5
- -
220 15 2,505 209 20
564 786 11,598 967 30
9 0 15 1 3
0 12 129 11 13
45 0 430 36 30
- -
0 0 90 8 30
60 0 475 40 30
7 29 464 39 4
45 115 773 64 10
- -
0 548 3,084 257 15
0 0 30 3 10
0 0 20 2 20
12 0 416 35 12
- -
324 1218 15,654 1,305 40
875 74 7,668 639 25
0 0 1,548 129 30
8 0 103 9 12
- -
0 15 141 12 15
- -
- -
- -
- -
30 30 973 81 10
- -
- -
5 17 305 25 5
35 0 189 16 5
35 9 355 30 4
0 5 192 16 3
345 721 25,538 2,128 65
0 0 430 36 30
19 24 1,079 90 7
0 161 6,782 565 12
0 24 234 20 20
0 0 - -
0 0 - -
4 1 14 1 1
234 76 2,675 223 24
2 0 42 4 2
2 0 12 1 2
- -
- -
380 95 3,545 295 20
60 0 422 35 15
0 0 70 6 30
60 112 1,278 107 10
224 26 2,117 176 20
126 150 3,966 331 15
15 0 157 13 3
- -
- -
25 12 348 29 5
223 124 2,654 221 25
45 0 2,685 224 30
380 104 3,347 279 15
1245 118 11,547 962 30
- -
3 0 28 2 4
- -
- -
0 0 235 20 5
0 0 11 1 4
0 0 34 3 1
0 0 3 0 1
- -
- -
- -
0 0 538 45 5
100 0 400 33 10
50 13 2,863 239 10
- -
323 52 2,718 227 12
1567 3648 69,089 5,757 75
0 0 - -
- -
8 7 82 7 4
1 1 52 4 2
312 58 4,746 396 30
- -
- -
0 0 - -
0 0 4 0 1
39 44 4,920 410 25
- -
- -
- -
- -
8 0 45 4 5
347 0 9,404 784 15
0 0 756 63 2
2 0 5,030 419 4
0 35 268 22 4
0 40 124 10 15
0 0 - -
73 33 843 70 10
3 1 79 7 2
5 19 159 13 3
45 0 535 45 4
547 76 9,574 798 20
- -
- -
- -
0 0 - -
- -
- -
- -
18 0 89 7 5
60 0 725 60 2
54 30 863 72 15
220 0 2,529 211 20
- -
2346 1440 53,727 4,477 75
- -
0 0 776 65 10
3323 3452 19,925 1,660 40
30 0 260 22 30
0 0 90 8 5
0 0 268 22 20
0 0 - -
0 0 142 12 8
0 0 77 6 10
0 0 72 6 5
0 0 84 7
- -
- -
- -
0 0 129 11 10
0 0 - -
0 0 368 31 10
3213 665 26,474 2,206 50
150 180 3,514 293 25
- -
0 0 465 39 15
0 0 2,910 243 2
0 0 27 2 3
100 200 500 42 25
125 400 7,481 623 15
50 100 656 55 25
0 0 6,300 525 5
0 0 1 0 1
0 0 37 3 3
0 0 42 4 6
0 9 101 8 5
- -
3 0 17 1 2
4 0 122 10 2
5 0 84 7 1
6 8 123 10 1
0 0 15 1 2
0 0 - -
0 0 - -
0 0 - -
0 0 - -
- -
- -
0 30 543 45 5
10 0 70 6 5
0 10 10 1
0 0 - -
0 0 - -
5 300 1,175 98 50
- -
2 0 7 1 2
- -
- -
- -
- -
0 0 23 2 3
0 100 900 75 25
100 100 1,300 108 20
50 0 250 21 22
0 - -
0 200 660 55 7
25 100 273 23 8
0 0 906 76 8
3 3 34 3 2
3 5 30 3 4
- -
- -
- -
- -
- -
- -
- -
- -
- -
0 0 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
0 0 25 2 2
- -
0 0 25 2 2
- -
- -
0 0 500 42 3
- -
- -
- -
- -
0 0 100 8 4
- -
- -
- -
- -
0 0 - -
- -
- -
0 0 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
Harga Satuan
403.00
105.00
2,789.00
95.00
167.00
75.00
249.00
2,000.00
58.00
2,129.00
3,167.00
3,035.00
4,798.00
185.00
2,449.00
6,375.00
1,500.00
6,600.00
2,800.00
3,276.00
8,100.00
3,058.00
3,700.00
105.00
105.00
55.00
103.00
3,599.20
380.00
145.00
1,639.00
1,778.00
-
110.00
1,340.00
252.00
199.10
739.00
1,121.00
2,000.00
1,097.00
32.00
682.00
11,999.90
217,429.00
-
1,735.00
12,573.00
86.00
1,095.00
104.00
99.00
280.00
2,700.00
91.00
167,667.00
1,408.00
546.00
750.00
6,090.00
3,150.00
26,250.00
-
18,824.00
158.00
171.00
629.00
710.00
3,682.00
18,720.00
59,800.00
116,000.00
82.00
274.00
3,509.00
2,499.20
270,583.00
119.00
82.50
6,900.00
224.00
60.00
101,300.00
4,000.00
59.00
2,475.00
1,100.00
176,800.00
220.00
-
89.00
10,351.00
227,700.00
63.00
75.00
245.00
2,590.00
-
288.00
2,380.00
-
-
-
310.00
1,090.00
3,242.00
2,007.00
5,015.00
7,260.00
7,480.00
23.00
157.00
2,190.00
133.00
1,152.00
41,600.00
177,216.00
43,050.00
131.00
3,328.00
3,796.00
28,354.00
31,760.00
102.00
946.00
2,959.00
224.00
143.00
220.00
3,414.00
2,920.00
65,429.00
9,999.00
605.00
382.00
66.00
123.00
64,800.00
6,410.00
1,021.00
99.00
790.00
560.00
389,344.00
1,297,889.00
232,518.00
173,030.00
-
3,999.60
1,199.00
139.00
1,070.00
1,181.00
53.00
20,554.00
20,554.00
11,825.00
7,700.00
131.00
-
-
3,045.00
18,900.00
73.00
253.00
8,615.00
81.00
550.00
1,155.00
112.00
307.00
517.00
7,630.00
287.00
4,550.00
70.00
2,797.00
1,774.30
4,185.00
478.00
31,231.00
4,482.00
4,483.00
64,833.00
2,480,000.00
130,999.00
512,204.00
2,915.00
1,104.00
117.00
265.00
-
353.00
52,833.00
323.00
91.00
91.00
61,996.00
78,991.00
17,996.00
23,991.00
-
158,994.00
155,813.00
135,000.00
-
-
19,954.00
165,000.00
16,995.00
89.00
524.00
1,458.00
1,348.00
1,458.00
865.00
879.00
928.00
110.00
770.00
4,760.00
8,208.33
8,208.33
9,590.00
3,030.00
2,880.00
6,280.00
6,280.00
6,250.00
6,250.00
2,300.00
2,300.00
296.49
200,000.00
20,600.00
9,870.00
461.00
2,415.00
1,100.00
330.00
6,707.00
37,371.00
5,800.00
22,433.00
470.00
530.00
530.00
3,674.00
3,674.00
3,674.00
250.00
3,958.33
3,820.00
138,950.00
81,000.00
81,000.00
103,000.00
-
550,800.00
252,300.00
544,400.00
5,000.00
-
32,950.00
87,100.00
32,950.00
32,475.00
59,550.00
36,750.00
168,200.00
13,235.00
13,235.00
22,475.00
22,475.00
14,340.00
22,385.00
14,340.00
26,527.00
26,527.00
823,000
158,400.00
4,150.00
43,000.00
43,000.00
7,251.00
-
1,857.00
28,204.00
60.00
173.00
312.00
1,325,000.00
2,255.00
8,237.00
8,110.00
2,500.00
1,768.00
3,202.00
2,219.00
3,628.00
312,000.00
11,790.00
10,393.00
-
-
9,870.00
625,900.00
487,000.00
13,252.00
No Nama Barang Satuan
OBAT
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial
1 Albendazol Tablet 400 mg Tablet

2 Alopurinol Tablet 100 mg Tablet
3 Aminofilin Inj 24 mg/ml-10 ml Ampul
4 Aminofilin Tablet 200 mg Tablet

5 Amitriptilina HCl Tablet salut 25 mg Tablet
6 Amlodipin Tablet 5 mg Tablet
303 Amoxcicillin Forte Syr Botol

8 Amoksisilin Sirup Kering 125 mg/5 ml Botol
7 Amoksisilin Kaplet 500 mg Kaplet

297 Ampicillin Serbuk Inj 100 mg/ml Vial
115 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 8000 Ampul
9 Antasida DOEN I Tablet Kunyah Tablet
10 Antasida II Suspensi 60 ml Botol
13 Antifungi DOEN kombinasi Pot
11 Anti Hemmoroid DOEN Supp
304 Arte Sunat Inj 60 mg Ampul
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet

26 Asam Folat Tablet 0,4 mg Tablet
27 Asam Mefenamat kaplet 500 mg Tablet
29 Asiklovir Tablet 400 mg Tablet

30 Atapulgit Tablet 600 mg Tablet
31 Atropin Sulfat Inj 0,25 mg/ml Ampul
194 Temporary Restorative Material Botol

178 Salisil Bedak 2 % Kotak
35 Betametason Krim 0.1 % Tube
41 Deksametason Inj 5 mg/ml-1 ml Ampul

42 Deksametason Tablet 0,5 mg Tablet
48 Diazepam Rectal 5 mg/2,5 ml tube

47 Diazepam Inj 5 mg/ml-2 ml Ampul
49 Diazepam Tablet 2 mg Tablet
294 Diethyk karbamazin 100 mg Tablet

50 Difenhidramin Inj 10 mg/ml Ampul
51 Digoksin Tablet 0,25 mg Tablet
52 Dimenhidrinat Tablet 50 mg Tablet
53 Doksisilin Tablet 100 mg Tablet
54 Domperidon Suspensi 5mg/5ml Botol
55 Domperidon Tablet 10 mg Tablet
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul

60 Eritromisin Sirup 200 mg/5 ml Botol
62 Etanol 70 %- 1000 ml Botol

63 Etil Klorida Spray Botol
64 Eugenol Cairan Botol
65 Fenitoin Natrium Kapsul 100 mg Kapsul
66 Fenobarbital Tablet 30 mg Tablet
67 Fenoksimetil Penisilin Tablet 500 mg Tablet
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul

68 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet
72 Formokresol Cair Botol
73 Furosemid Tablet 40 mg Tablet
74 Garam Oralit I Serbuk Sachet

77 Glass Ionomer Cement Botol
78 Glibenklamid Tablet 5 mg Tablet
46 Dextrose Inj 40% Vial
80 Glukosa Larutan Infus 5% steril Fls

81 Griseofulvin Tablet 125 mg Micronized Tablet
84 Haloperidol Inj 5 mg/ml Ampul
85 Haloperidol Tablet 1,5 mg Tablet
82 Haloperidol 5 mg Tablet
295 Hepatitis B Imunoglobulin vial
86 Hidrokortison Krim 2,5 % Tube
87 Hiosina butilbromida tab 10 mg Tablet

88 Human Tetanus Imunoglobulin Im 250UI (TetagamSet
89 Ibuprofen Tablet 400 mg Tablet
90 Isoniazid Tablet 100 mg Tablet

293 Isoniazid Tablet 300 mg tablet
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet
92 Kalsium glukonat inj 100 mg/ml Ampul

93 Kalsium hidroksida pasta Botol
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet
95 Kaptropil Tablet 25 mg Tablet
96 Karbamazepin Tablet 200 mg Tablet

98 Karbon aktif tab 0,5 mg Tablet
97 Karbogliserin Tetes Telinga 10 % Botol
99 Ketokonazol Tablet 200 mg Tablet
103 Klindanmisin Tablet 300 mg Tablet

106 Kloramfenikol Salep Kulit 2% Tube
107 Kloramfenikol Salep Mata 1 % Tube
108 Kloramfenikol Sirup 125 mg/5 ml Botol
110 Kloramfenikol Tetes telinga 3 % Tube
109 Kloramfenikol Tetes Mata 0.5% Botol
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet

132 Monoklorkamfer mentol cairan Botol
112 Klorpropmazin HCl Tablet salut 100 mg Tablet
39 Clozapine Tablet 25 mg Tablet
40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket

14 Antimigren DOEN Tablet
193 Tablet Tambah Darah Kombinasi Tablet
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol
101 Kina Inj 26 % 2 ml Ampul

102 Kina Tablet 222 mg Tablet
116 Lidokain Jelly 2 % Tube
117 Lidokain Spray 10 % Botol
119 Loratadin Tablet 10 mg Tablet

124 Metformin HCl Tablet 500 mg Tablet
126 Metilergomatrin Maleat Inj 0,200 mg Ampul

127 Metilergometrin Maleat (Metilergometrin) Tablet SaTablet
128 Metilprednisolon Tablet 4 mg Tablet
298 Metronidazol Inf Botol
129 Metronidazol Tablet 500 mg Tablet

130 Mikonazol Krim/Salep 2% Tube
131 Mineral Mix Sachet
135 N-asetil sistein kaps 200 mg Kapsul

139 Natrium Klorida Larutan Infus 0,9% Fls
137 Natrium Diklofenak Tablet 50 mg Tablet
138 Natrium Hipoklorit 3% Botol
141 Nipedipin Tablet 10 mg Tablet
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet

143 Nistatin Tablet Vaginal 100.000 IU/g Tablet
146 OAT FDC Kategori Anak paket

147 OAT FDC Kategori Sisipan Paket
148 OAT Kombipak Kat I paket
299 Oxitetracyclin Hcl Sm 1% Tube

150 Oksitosin Inj 10 IU/ml- 1 ml Ampul
306 Omeprazol Inj Vial

151 Omeprazol Kapsul 20 mg Kapsul
153 Parasetamol Sirup 120 mg / 5ml Botol

154 Parasetamol Tablet 500 mg Tablet
45 Devitalisasi Pasta Botol

56 Endometason Botol
157 Permetrin 5% Krim (Scabimite) Tube
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet

292 Piridoksin HCl (Vit B6) Tablet 25 mg tablet

164 Prednison Tablet 5 mg Tablet
165 Primakuin Tablet 15 mg Tablet
166 Prokain Benzilpenisilin Serb Inj 3 juta UI/vial (i.m.) Vial

168 Propiltiourasil Tablet 100 mg Tablet
167 Propanolol HCl Tablet 40 mg Tablet
170 Ranitidin Tablet 150 mg Tablet
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul
173 Ringer Laktat Larutan Infus Steril Fls
174 Risperidon Tablet 2 mg Tablet

176 Salbutamol Tablet 4 mg Tablet
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial
185 Serum Anti Difteri (ADS) Vial
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul
188 Setirizin Sirup 5 mg/5 ml Botol

189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul
190 Simvastatin Tablet 10 mg Tablet
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet
21 ARV: Tenofovir 300 mg Tablet
195 Tetrasiklin Kapsul 500 mg Kapsul
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet
197 Triheksifenidil HCl Tablet 2 mg Tablet
198 Vaksin BCG + Pelarut Set

208 Vaksin Polio 10 ds bopv + Penetes Set
201 Vaksin Hb-0 Set
200 Vaksin DT Vial

210 Vaksin Td Vial
199 Vaksin DPT-Hb-Hib Vial
204 Vaksin Measles Rubella (MR) Vial
205 Vaksin Meningitis Paket
209 Vaksin Rabies Vero Set
211 Vitamin B Kompleks Tablet Tablet
212 Zinc Tablet 20 mg Tablet

12 Antibakteri DOEN Tube
302 ARV: Abacavir 300 mg Tablet
301 ARV: Efaviren 200 Tablet
16 ARV: Efavirenz 600 mg Tablet
17 ARV: Lamivudine 150 mg Tablet
18 ARV: Lovinapir 200 mg Ronavir Tablet
296 ARV: Lovinavir/ ritonavir( 100/25mg)/Aluvia Anak Tablet
19 ARV: Nevirapine 200 mg Tablet
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet
300 ARV: zidovudin 100 Tablet
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet
28 Asiklovir Krim 5%/5g Tube
32 Azithromisin Tablet 500 mg Tablet
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial
34 Betahistin Tablet 6 mg Tablet
36 Bisoprolol Tablet 5 mg Tablet
37 Bromheksin Tablet 8 mg Tablet
38 Clobazam Tablet 10 mg Tablet
43 Dekstrometorfan Tablet kombinasi Tablet
44 Dektrometorfan Sirup kombinasi Botol
61 Etakridin Larutan 0,1 % Botol
290 Fenobarbital inj 50mg/ml Ampul
70 Fluconazol Tablet 150 mg Tablet
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial
76 Gentamisin Salep Kulit 0,1% Tube
79 Gliseril Guaiakolat Tablet 100 mg Tablet
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul
100 Ketoprofen Supp 100 mg Supp
118 Lisol Botol
122 MB Anak Blister
123 MB Dewasa Blister
125 Metildopa Tablet 250 mg Tablet
133 Multivitamin + DHA + Lysin Sirup Botol
134 Multivitamin + Mineral Kaplet Kaplet
136 Natrium Bikarbonat Tablet 500 mg Tablet
140 Natrium Tiroksin Tablet 100 µg Tablet
149 Obat Batuk Hitam (OBH) Cairan Botol
152 Ondansetron Inj 4 mg/2 ml Ampul
155 PB Anak Blister
156 PB Dewasa Blister
158 Phenolphtalein, Paraffin Liquidum, Gliserin Sirup ( botol
160 Pirimetamin Tablet 25 mg Tablet
169 Ranitidin Inj 25 mg/ml Ampul
179 Sefadroksil Sirup 125 mg/5 ml Botol
180 Sefadroxil Kapsul 500 mg Kapsul
181 Sefiksime 200 mg + Azitromisin 500 mg Paket
182 Sefotaksim Inj 1 g Vial
183 Seftriaxon Inj 1 g Vial
184 Semen seng fosfat serbuk cairan Botol
305 Tamiflu Cap ( Osel Tamivir ) Capsul
206 Vaksin Papillomavirus (HPV) Vial
207 Vaksin Pneumococcus Vial
307 - -
308 - -
309 - -
310 - -
311 - -
312 - -
313 - -
314 - -
315 - -
316 - -
317 - -
318 - -
319 - -
320 - -
321 - -
0 BAHAN MEDIS HABIS PAKAI 0
213 ADS 0.05 ml Buah
214 ADS 0.5 ml Buah
215 ADS 5 ml Buah
219 Alkohol Swab Buah
220 Bisturi Buah
221 Blood set Buah
222 Catgut/Benang Bedah No.2/0 dengan jarum bedahSet
223 Catgut/Benang Bedah No.3/0 dengan jarum bedahSet
231 Jarum kulit Buah
232 Jarum otot Buah
233 Kaca Slide Buah
242 Masker N-95 Buah
247 Pot Dahak Buah
248 Safety box Buah
255 Sendok Obat Buah
256 Silk (Benang Bedah Sutera) No.2/0 Dengan JarumSet
257 Urin Bag Buah
322 - -
323 - -
324 - -
325 - -
326 - -
327 - -
328 - -
329 - -
330 - -
331 - -
332 - -
333 - -
334 - -
335 - -
336 - -
337 - -
338 - -
339 - -
340 - -
341 - -
0 REAGEN 0
262 Humasens Plus Set
266 Iodin test Botol
### #NAME? ###
345 SD HCV Sachet
346 - -
347 - -
348 - -
349 - -
350 - -
351 - -
352 - -
353 - -
354 - -
355 - -
356 - -
357 - -
358 - -
359 - -
360 - -
Pemakaian Rata-Rata dianalHarga Satuan -
5 2,449.00 -
2,449.00
4,000.00
640 430.00 -
10 105.00 -
105.00
- 2,789.00 -
95.00
7 95.00 -
40 167.00 -
99.00
17 75.00 -
26,620.00
- 3,628.00 -
7 2,000.00 -
195.00
55 249.00 -
8,237.00 -
8,237.00
20 1,152.00 -
65 58.00 -
5 2,129.00 -
1,298.00
12 4,798.00 -
14 3,167.00 -
- 312,000.00 -
38,999.00
80,000.00
18 105.00 -
105.00
28 105.00 -
22 55.00 -
55.00
55.00
64.00
27 103.00 -
103.00
5,000.00
3,000.00
1,500.00
200.00
15 380.00 -
15 145.00 -
145.00
145.00
145.00
529.00
748.00
- 1,639.00 -
1,595.00
- 52,833.00 -
3 1,774.30 -
5 1,340.00 -
1,340.00
1,380.00
2,500.00
5,730.00
5,800.00
319.00
10,378.00
10,378.00
10,378.00
14,000.00
140,000.00
140,000.00
140,000.00
141,600.00
500,000.00
5 1,097.00 -
20 32.00 -
18,279.00
1 12,573.00 -
6 1,735.00 -
30 86.00 -
114.00
- 312.00 -
30 1,095.00 -
15 104.00 -
127.00
4,290.00
4,650.00
127.00
15 99.00 -
- 280.00 -
35 2,700.00 -
22 91.00 -
- 1,408.00 -
1,408.00
135.00
- 546.00 -
- 6,090.00 -
- 750.00 -
92,100.00
- 26,250.00 -
- 99,000.00 -
230,000.00
- 18,824.00 -
7,980.00
60 158.00 -
158.00
171.00
35 171.00 -
629.00
- 629.00 -
50.00
2,000.00
50.00
15 3,682.00 -
60 710.00 -
2,349.00
150.00
2,000.00
150.00
2,500.00
- 116,000.00 -
10,000.00
2,500.00
15 82.00 -
5,000.00
5 274.00 -
5,000.00
6,000.00
270,583.00
- 270,583.00 -
270,583.00
119.00
20 119.00 -
1,000.00
218.00
289.00
300.00
1,500.00
4,000.00
4,000.00
5,000.00
7,500.00
- 4,000.00 -
4,000.00
5,000.00
3 6,900.00 -
13 224.00 -
224.00
400,000.00
400,000.00
30 4,000.00 -
59.00
30 59.00 -
59.00
30 60.00 -
17,099.00
- 1,325,000.00 -
15,000.00
15,000.00
149.00
4 2,475.00 -
2,000.00
10 1,100.00 -
- 176,800.00 -
200,000.00
2,475.00
3,000.00
105.00
15 220.00 -
83,500.00
98,000.00
90,000.00
10 74.00 -
- 173.00 -
20 89.00 -
500,000.00
350,000.00
11,000.00
12 10,351.00 -
- 227,700.00 -
400.00
40 63.00 -
75.00
25 75.00 -
75.00
3,500.00
200.00
30 245.00 -
- 300.00 -
12 2,590.00 -
15 288.00 -
578.00
- 578.00 -
300.00
350.00
200.00
10 310.00 -
- 3,242.00 -
5 2,007.00 -
5 5,015.00 -
3 7,480.00 -
4 7,260.00 -
7,260.00
65 23.00 -
- 65,429.00 -
90,000.00
150,000.00
1,500.00
1,000.00
30 157.00 -
147.00
300.00
2,000.00
- 1,121.00 -
100.00
- 2,000.00 -
3,498.00
1,000.00
5,000.00
17 185.00 -
75 353.00 -
9,000.00
10,000.00
- 3,276.00 -
- 4,550.00 -
200.00
100,000.00
12 133.00 -
300.00
7 2,190.00 -
- 6,200.00 -
- 670.00 -
10,000.00
7,000.00
10,000.00
10,000.00
10,000.00
10,000.00
57,750.00
57,750.00
60,000.00
50,000.00
50,000.00
50,000.00
47,000.00
50,000.00
8,025.00
50,000.00
50,000.00
50,000.00
50,000.00
50,000.00
50,000.00
9,350.00
9,400.00
39,325.00
50,000.00
50,000.00
10,050.00
10,050.00
50,000.00
- 41,600.00 -
2,000.00
- 177,216.00 -
500.00
85.00
24 131.00 -
200.00
250.00
300.00
50,000.00
3,328.00
2 3,328.00 -
3,796.00
2 3,796.00 -
2,000.00
10,000.00
5,000.00
8,800.00
6,100.00
6,100.00
10,000.00
20 102.00 -
102.00
30 2,959.00 -
10 224.00 -
20 143.00 -
3,960.00
90.00
115.00
- 8,110.00 -
3,800.00
94.00
113.00
15 220.00 -
3 3,414.00 -
3,414.00
- 2,920.00 -
30 382.00 -
4 6,410.00 -
6,410.00
6,410.00
123.00
30 123.00 -
3,000.00
- 64,800.00 -
2,000.00
- 99.00 -
500.00
400.00
5,000.00
5 790.00 -
4 560.00 -
300.00
2,000.00
- 232,518.00 -
1 389,344.00 -
1 1,297,889.00 -
- 173,030.00 -
232,200.00
- 288,200.00 -
25,000.00
30,000.00
31,000.00
- 2,500.00 -
10 1,199.00 -
16,997.00
- 10,393.00 -
10 139.00 -
150.00
12 1,181.00 -
75 53.00 -
246,400.00
- 217,429.00 -
- 167,667.00 -
50,000.00
20,700.00
4 11,825.00 -
2,500.00
500.00
291.00
350.00
3,000.00
30 131.00 -
- 60.00 -
18,900.00
1 18,900.00 -
18,900.00
- 3,045.00 -
25 73.00 -
- 253.00 -
1,780.00
- 8,615.00 -
- 550.00 -
- 81.00 -
15 112.00 -
2 307.00 -
4 517.00 -
683.00
4 7,630.00 -
287.00
15 287.00 -
3,999.60
3,000.00
4,750.00
66.00
10 70.00 -
2,797.00
2 2,797.00 -
- 512,204.00 -
512,204.00
- 2,480,000.00 -
150,000.00
200,000.00
250,000.00
- 130,999.00 -
250,000.00
5 2,915.00 -
2 1,104.00 -
1,104.00
15 117.00 -
117.00
117.00
20 265.00 -
5,000.00
294.00
20,000.00
5,000.00
- 8,100.00 -
170,000.00
5,000.00
163.00
10 323.00 -
3,000.00
40 91.00 -
3,000.00
4,000.00
30 91.00 -
5,000.00
5 61,996.00 -
10 19,954.00 -
8 23,991.00 -
82,005.00
100,000.00
- 17,996.00 -
10 16,995.00 -
20 78,991.00 -
- 155,813.00 -
- 135,000.00 -
5 158,994.00 -
165,000.00
- 165,000.00 -
296,000.00
189,607.00
1,750.00
6,000.00
50 89.00 -
20,000.00
500.00
14,980.00
6,290.00
25 524.00 -
5 3,035.00 -
- 2,219.00 -
- 3,202.00 -
- 6,375.00 -
- 1,500.00 -
- 6,600.00 -
- 2,255.00 -
- 2,800.00 -
- 3,058.00 -
- 1,768.00 -
- 3,700.00 -
2 3,599.20 -
- 1,778.00 -
- - -
18 110.00 -
- 252.00 -
20 199.10 -
- 739.00 -
15 682.00 -
4 11,999.90 -
- 3,150.00 -
- 1,857.00 -
- 18,720.00 -
- 59,800.00 -
3 3,509.00 -
5 2,499.20 -
30 82.50 -
- 101,300.00 -
- 2,380.00 -
- 1,090.00 -
1 43,050.00 -
- 28,354.00 -
- 31,760.00 -
15 946.00 -
5 9,999.00 -
25 605.00 -
15 66.00 -
- 1,021.00 -
5 3,999.60 -
- 1,070.00 -
- 20,554.00 -
- 20,554.00 -
2 7,700.00 -
- - -
5 1,155.00 -
4 4,185.00 -
20 478.00 -
- 31,231.00 -
- 4,482.00 -
- 4,483.00 -
- 64,833.00 -
- 11,790.00 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
15 1,458.00 -
2 1,348.00 -
3 1,458.00 -
25 865.00 -
15 879.00 -
25 928.00 -
5 110.00 -
1 770.00 -
3 4,760.00 -
6 8,208.33 -
5 8,208.33 -
- 9,590.00 -
2 3,030.00 -
2 2,880.00 -
1 6,280.00 -
1 6,280.00 -
2 6,250.00 -
- 6,250.00 -
- 2,300.00 -
- 2,300.00 -
- 296.49 -
- 200,000.00 -
- 20,600.00 -
5 9,870.00 -
5 461.00 -
- 2,415.00 -
- 1,100.00 -
- - -
50 330.00 -
- 6,707.00 -
2 37,371.00 -
- - -
- - -
- - -
- 5,800.00 -
3 22,433.00 -
25 470.00 -
20 530.00 -
22 530.00 -
- 3,674.00 -
7 3,674.00 -
8 3,674.00 -
8 250.00 -
2 3,958.33 -
4 3,820.00 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- 138,950.00 -
- 81,000.00 -
- 81,000.00 -
- 103,000.00 -
- - -
- 550,800.00 -
- 252,300.00 -
- 544,400.00 -
- 5,000.00 -
- - -
- 32,950.00 -
- 87,100.00 -
- 32,950.00 -
- 32,475.00 -
- 59,550.00 -
- 36,750.00 -
- 168,200.00 -
- 13,235.00 -
2 13,235.00 -
- 22,475.00 -
2 22,475.00 -
- 14,340.00 -
- 22,385.00 -
3 14,340.00 -
- 26,527.00 -
- 26,527.00 -
- 823,000.00 -
- 158,400.00 -
4 4,150.00 -
- 43,000.00 -
- 43,000.00 -
- 7,251.00 -
- 9,870.00 -
#NAME? #NAME? ###
- 625,900.00 -
- 487,000.00 -
- 13,252.00 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
Air untuk injeksi amp 20 ml ampul/vial/botol
Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL
Albendazol susp 200 mg/5 ml Botol
Albendazol tab 400 mg tablet/kapsul/kaplet
Alopurinol tab 100 mg Tab
Alopurinol tab 300 mg tablet/kapsul/kaplet
Aminofilin inj 24 mg/ml ampul/vial 10 ml
Aminofilin tab 150 mg tablet/kapsul/kaplet
Aminofilin Tab 200 mg tablet/kapsul/kaplet
Amitriptilin tab sal 25 mg tablet/kapsul/kaplet
Amlodipin tab 10 mg tablet/kapsul/kaplet
Amlodipin tab 5 mg tablet/kapsul/kaplet
Amoksisilin drops 100 mg/ml Botol
Amoksisilin sir forte 250 mg/5 ml botol 60 ml
Amoksisilin sir kering 125 mg/5 ml Botol
Amoksisilin tab 250 mg tablet/kapsul/kaplet
Amoksisilin tab 500 mg tablet/kapsul/kaplet
Ampisilin serb inj 1000 mg/vial ampul/vial
Ampisilin serb inj 250 mg/vial Vial
Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 ampul/vial
inj 2 ml
Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium tablet/kapsul/kaplet
hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium botol 60 ml
hidroksida 200 mg
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps
Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% pot 30 g
Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen Suppositoria

2,5 mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial

Articulating paper kertas warna penanda oklusi Kertas warna penanda oklusi
Asam asetat tetes telinga 2% Botol
Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet
Asam askorbat (vitamin C) tab 250 mg Tab
Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet
Asam folat tab 0,4 mg tablet/kapsul/kaplet
Asam folat tab 1 mg tablet/kapsul/kaplet
Asam folat tab 5 mg Tab
Asam mefenamat kaps 250 mg tablet/kapsul/kaplet
Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/kaptab
Asam salisilat lar 0,1% Botol
Asam salisilat salep 10% Tube
Asiklovir tab 200 mg tablet/kapsul/kaplet
Asiklovir tab 400 mg tablet/kapsul/kaplet
Atapulgit 600 mg tablet/kapsul/kaplet
Atapulgit tab 630 mg tablet/kapsul/kaplet
Atapulgit tablet 650 mg tablet/kapsul/kaplet
Atapulgit tablet 750 mg Tab
Atenolol tab 100 mg tablet/kapsul/kaplet
Atenolol tab 50 mg tablet/kapsul/kaplet
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Dus/Sachet/Plastik
Betametason krim 0,1% tube 5 gram
Betametason krim 0,5 mg/g Tube
Betametason salep 0,1% tube 5 gram
Betametason tts mata 1 mg/ml botol
Bisakodil sup 10 mg Suppositoria
Bisakodil sup 5 mg Suppositoria
Bisakodil tab sal 5 mg tablet/kapsul/kaplet
Budesonid cairan ih 0,25mg/ml Botol @ 4 ml
Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml
Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
Budesonid serb ih 100 mcg/dosis Botol
Budesonid serb ih 200 mcg/dosis 100 dosis
Budesonid serb ih 200 mcg/dosis 200 dosis
Coal tar lar 5 % Botol
Copper T set/buah
Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial
Deksametason tab 0,5 mg tablet/kapsul/kaplet
Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL
Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial
Diazepam tab 2 mg tablet/kapsul/kaplet
Diazepam tab 5 mg tablet/kapsul/kaplet
Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet
Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
Digoksin tab 0,25 mg tablet/kapsul/kaplet
Diltiazem hcl tab 30 mg tablet/kapsul/kaplet
Diltiazem kaps SR 100 mg Kapsul lepas lambat
Diltiazem kaps SR 200 mg Kapsul lepas lambat
Diltiazem tab 30 mg Tab
Dimenhidrinat tab 50 mg tablet/kapsul/kaplet
Doksisiklin kaps 100 mg tablet/kapsul/kaplet
Domperidon susp 5 mg/5 ml botol @60 ml
Domperidon tab 10 mg tablet/kapsul/kaplet
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul/vial
Epinefrin (adrenalin) inj 1 mg/ml Ampul
Ergotamin tab 1 mg Tab
Eritromisin kaps 250 mg tablet/kapsul/kaplet
Eritromisin sir 200 mg/5 ml Botol @ 60 ml
Eritromisin tab 500 mg tablet/kapsul/kaplet
Estrogen terkonjugasi tab sal 0,625 mg tablet salut gula/kaplet salut gula
Etanol 70% cairan 70% Botol
Etil klorida semprot 100 ml Botol
Etonogestrel implan 68 mg Set
Eugenol Botol
Fenitoin Na inj 50 mg/ml ampul @ 2 ml
Fenitoin Na kaps 100 mg Kaps
Fenitoin Na kaps 30 mg Kaps
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg tablet/kapsul/kaplet
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
Ferro fumarat kaps lunak 300 mg Kaps lunak
Ferro sulfat sir. 150 mg/5 ml Botol
Ferro sulfat tab salut 300 mg Tab sal
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/kaplet salut gula
Fluoksetin kaps 10 mg tablet/kapsul/kaplet
Fluor kapl 1 mg Kaplet
Fluor sediaan topikal Tube
Fluoresein tts mata 2,5 mg/ml Botol
Formokresol Botol
Framisetin Sulfat Tulle 1% Patch
Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial
Furosemid tab 40 mg tablet/kapsul/kaplet
Galactose microparticle 200-400 mg micropart/ml Vial
Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 sachet
g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
Gentamisin salep mata 0,3% Tube
Gentamisin tts mata 0,3% Botol
Glass ionomer ART (Atraumatic Restorative Treatment) cocoa Sachet
butter 5 g
Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol
Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
Glibenklamid tab 2,5 mg tablet/kapsul/kaplet
Glibenklamid tab 5 mg tablet/kapsul/kaplet
Glikuidon tab 30 mg tablet/kapsul/kaplet
Glimepirid tab 1 mg tablet/kapsul/kaplet
Glimepirid tab 2 mg tablet/kapsul/kaplet
Glipizid tab 5 mg tablet/kapsul/kaplet
Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet
Gliserin tts 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 40% Ampul @25 ml
Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet
Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet
Gutta percha dan paper points 15 - 40 mm Roll
Gutta percha dan paper points 45 - 80 mm Roll
Haloperidol inj 5 mg/ml (i.m.) Vial
Haloperidol tab 0,5 mg tablet/kapsul/kaplet
Haloperidol tab 1,5 mg tablet/kapsul/kaplet
Haloperidol tab 2 mg tablet/kapsul/kaplet
Haloperidol tab 5 mg tablet/kapsul/kaplet
Haloperidol tts 2 mg/ml botol
Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml Ampul
Hidrogen peroksida cairan 3% Botol
Hidrogen peroksida lar. Konsentrat 3% Botol
Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet
Hidrokortison krim 2,5% tube @ 5 g
Hidrokortison serb inj 100 mg Vial
Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet
Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
Ibuprofen sir 100 mg/5 ml botol @ 60 ml
Ibuprofen sir 200 mg/5 ml botol @ 60 ml
Ibuprofen tab 200 mg tablet/kapsul/kaplet
Ibuprofen tab 400 mg tablet/kapsul/kaplet
Ipratropium bromida aerosol 20 mcg/semprot Botol
Ipratropium bromida cairan ih 0,025% Botol
Ipratropium bromida ih 20mcg/puff Botol
Isoniazid tab 100 mg Tab
Isoniazid tab 300 mg Tab
Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet
IUD Cu T 380 A Set
IUD Levonorgestrel Set
Kalamin Tube
Kalsium glukonat inj 100 mg/ml ampul/vial
Kalsium hidroksida bubuk, pasta Tube
Kalsium karbonat tab 500 mg tablet/kapsul/kaplet
Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet
Kaptopril tab 12,5 mg tablet/kaplet
Kaptopril tab 25 mg tablet/kaplet
Kaptopril tab 50 mg tablet/kaplet
Karbamazepin sir 100 mg/5 ml Botol
Karbamazepin tab 100 mg Tab
Karbamazepin Tab 200 mg Tablet
Karbo adsorben tab 0,5 g Tab
Karbogliserin tts telinga 10 % Botol
Ketokonazol tab 200 mg tablet/kapsul/kaplet
Klindamisin kaps 150 mg Kaps
Klindamisin kaps 300 mg tablet/kapsul/kaplet
Klofazimin, micronized kaps 50 mg Kapsul
Klofazimin, micronizedkaps 100 mg kapsul
Klonidin tab 0,15 mg tablet/kapsul/kaplet
Kloramfenikol kaps 250 mg tablet/kapsul/kaplet
Kloramfenikol salep kulit 2% tube 15g
Kloramfenikol salep mata 1% tube @ 5 gram
Kloramfenikol susp 125 mg/5 ml botol 60 ml
Kloramfenikol tetes telinga 3% Botol
Kloramfenikol tts mata 0,5% botol
Kloramfenikol tts mata 1% Botol
Klorfeniramin tab 4 mg tablet/kapsul/kaplet
Klorfenol kamfer mentol (CHKM) Botol
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol
Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
Klorpromazin tab sal 100 mg tablet salut selaput/kaplet salut selap
Klorpromazin tab sal 25 mg Tab sal
Klortalidon tab 50 mg Tab
Klozapin tab 100 mg tablet
Klozapin tab 25 mg tablet
Kodein tab 10 mg tablet/kapsul/kaplet
Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab tablet salut selaput/kaplet salut selap
sal selaput
Kombinasi : artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kaplet
Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet
Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut tablet salut gula
Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg tab salut gula
Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab
Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 Tab
mg
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules ampul/vial
Kombinasi: kaolin 550 mg + pektin 20 mg Tab
Komposit resin Set
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ tab/kaptab
trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ tab/kaptab
trimetoprim 160 mg
Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol 200 botol 60 mL
mg + trimetoprim 40 mg
Kuinin inj 25% (i.v.) Vial
Kuinin tab 200 mg tablet/kapsul/kaplet
Laktulosa sir 3,335 g/5 ml botol @ 60 mL
Larutan mengandung Elektrolit (Kalium Klorida) Botol
Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol
Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Botol plastik @ 500 ml
Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Softbag @ 500 ml
Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) Botol
(KA EN 1B)
Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
Larutan mengandung Elektrolit (Tiap 1000 ml mengandung Botol

electrolit: Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5
mmol/l, Magnesium 1.0 mmol/l, Chloride 118 mmol/l, Acetate 24
mmol/l, Malate 5.0 mmol/l)
Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Botol
Xylitol 60 g/ L)
Xylitol 100 g/ L)
Xylitol 30 g/ L)
Larutan mengandung Karbohidrat (Maltose 10%) Botol
Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 Botol
g sodium chloride, 0.15 g potassium chloride, 0.10 g calcium
chloride dihydrate dan 1.55 g sodium lactate)
Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Botol
Ca, Mg, Sorbitol 50 gr/L)
Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL Botol
0,45%, KCl) (HSD)
Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, Botol
glucose 66 g, Xylitol 60 g/ L + elektrolit)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl Botol
2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Botol

Natrium Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; Botol
NaCl: 4,5 g)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; Botol
NaCl: 2.25 g) (D5-1/4NS)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; Botol
NaCl: 4.5 g) (D5-1/2NS)
Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi Botol
kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg
6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Botol
Glukosa 5%)
Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL Botol
1.5g, Glukosa 100 gr)
Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL Botol
1.5g, Na Lactate 2.24 g, Glukosa 100 gr)
Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 Botol
gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Botol
Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set
Lidokain gel 2% syringe/syringe plastik
Lidokain inj 2% (infiltr/p.v.) ampul/vial
Lidokain spray oral 10% botol
Linestrenol tab 0,5 mg tablet/kapsul/kaplet
Loperamid tab 2 mg Tab
Loratadin tab 10 mg tablet/kapsul/kaplet
Lorazepam tab 0,5 mg tablet/kapsul/kaplet
Lorazepam tab 1 mg tablet/kapsul/kaplet
Lorazepam tab sal 2 mg Tab sal
Lugol Botol
Magnesium sulfat inj 20% ampul/vial
Magnesium sulfat inj 20% ampul/vial @25 ml
Magnesium sulfat inj 40% ampul/vial
Magnesium sulfat inj 40% ampul/vial @25 ml
Magnesium sulfat serb, ktg 30 g Sachet
Mebendazol sir 100 mg/5 ml Botol
Mebendazol tab 100 mg Tan
Mebendazol tab 500 mg tablet/kapsul/kaplet
Medroksi progesteron asetat inj 150 mg/ml ampul/vial
Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial
Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut
Metformin tab 500 mg tablet/kapsul/kaplet

Metformin tab 850 mg tablet/kapsul/kaplet
Metilergometrin inj 0,2 mg/ml ampul/vial
Metilergometrin tab salut 0,125 mg tablet/kaplet salut selaput
Metilprednisolon tab 4 mg tablet/kapsul/kaplet
Metoklopramid inj 5 mg/ml ampul/vial
Metoklopramid tab 10 mg tablet/kapsul/kaplet
Metoklopramid tab 5 mg tablet/kapsul/kaplet
Metronidazol lar inf 5 mg/ml botol
Metronidazol susp 125 mg/5 ml Botol @ 60 ml
Metronidazol susp 125 mg/5 ml Botol @ 100 ml
Metronidazol tab 250 mg tablet/kapsul/kaplet
Metronidazol tab 500 mg tablet/kapsul/kaplet
Mikonazol krim 2% tube
Mikonazol serb 2% botol / sachet
Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Sachet
Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Acetate)
N-asetil sistein kaps 200 mg tablet/kapsul/kaplet

NaCl 0,9% Larutan Botol plastik/botol plastik pi
NaCl 0,9% Larutan Botol
NaCl 0,9% Larutan ampul/botol plastik/botol plas
Natrium diklofenak tab 25 mg tablet salut enterik/kaplet salut enter
Natrium diklofenak tab 50 mg tablet salut enterik/kaplet salut enter
Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL
Natrium hipoklorit cairan konsentrat 5% Botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg tablet/kapsul/kaplet
Nikotinamid tab 100 mg Tab
Nikotinamid tab 5 mg Tab
Nistatin susp 100.000 UI/ml botol/vial
Nistatin tab salut 500.000 UI tablet salut gula/kaplet salut gula
Nistatin tab vaginal 100.000 UI tablet/kaplet
Nitrofurantoin tab 50 mg Tab
Norepinefrin inj 1 mg/ml ampul/vial
Obat Anti Tuberculosis FDC Kategori Anak paket
Obat Anti Tuberculosis FDC Kategori I paket
Obat Anti Tuberculosis FDC Kategori II paket
Obat Anti Tuberculosis FDC Kategori Sisipan paket
Obat Anti Tuberculosis Kombipak Anak Paket
Obat Anti Tuberculosis Kombipak Dewasa paket
Oksigen ih, gas dlm tabung Botol
Oksimetazolin tts hidung 0,025% botol @ 10 mL
Oksimetazolin tts hidung 0,050% botol @ 10 mL
Oksitetrasiklin 1% Salep Mata tube
Oksitosin inj 10 UI/ml ampul/vial
Olopatadin tts mata 0,1% Botol
Omeprazol inj 40 mg/10 ml ampul/vial
Omeprazol kaps 20 mg tablet/kapsul/kaplet
Paraformaldehid tab 1 g Tab
Parasetamol sir 120 mg/5 ml botol @ 60 mL
Parasetamol tab 500 mg tablet/kapsul/kaplet
Parasetamol tts 60 mg/0,6 ml botol @ 15 mL
Pasta devitalisasi (non arsen) Tube
Pasta pengisi saluran akar (pasta) Tube
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube
Permetrin krim 5 % Tube
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab 500 mg Tab
Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet
Pirantel pamoat tab scored 250 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl
Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet
Povidon iodin lar 100 mg/ml botol @ 60 mL
Povidon iodin lar 100 mg/ml Botol 300 ml
Povidon iodin lar 100 mg/ml botol @ 1.000 mL
Povidon iodin lar 100 mg/ml botol 30 mL
Prednison tab 5 mg tablet/kapsul/kaplet
Primakuin tab 15 mg Tab
Probenesid tab 500 mg tablet/kapsul/kaplet
Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial
Propiltiourasil tab 100 mg tablet/kapsul/kaplet
Propranolol tab 10 mg tablet/kapsul/kaplet
Ranitidin tab 150 mg tablet/kapsul/kaplet
Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak
Rifampisin kaps 300 mg tablet/kapsul/kaplet
Ringer Laktat Larutan Botol
Risperidon tab sal 1 mg tablet/kapsul/kaplet
Risperidon tab sal 2 mg tablet/kapsul/kaplet
Salbutamol cairan ih 0,1% ampul/vial/botol
Salbutamol lar ih 0,5 % Botol
Salbutamol sir 2 mg/5 ml Botol
Salbutamol tab 2 mg tablet/kapsul/kaplet
Salbutamol tab 4 mg tablet/kapsul/kaplet
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 15 gram
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 30 gram
Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj Vial
(i.m./i.v.)
Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
Serum antirabies inj 100 UI/ml Vial
Serum antirabies inj 200 UI/ml Vial
Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
Setirizin sir 5 mg/5 ml. botol @ 60 mL
Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial
Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet
Simvastatin tab sal 10 mg tablet/kapsul/kaplet/tablet salut selap
Simvastatin tab sal 20 mg tablet/kapsul/kaplet/tablet salut selap
Simvastatin tab sal selaput 40 mg Tab sal
Siprofloksasin tab scored 500 mg tablet salut selaput/kaplet salut selap
Siprofloksasin tetes mata 3 mg/ml Catchcover, botol 0,6 ml
Spironolakton tab 25 mg tablet/kapsul/kaplet
Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
Streptomisin serb inj 1.000 mg/vial ampul/vial
Surgical ginggival pack Tube
Tenofovir tab 300 mg tablet salut selaput/kaplet salut selap
Tetanus toxoid inj Ampul
Tetrakain tts mata 0,5% Botol
Tetrasiklin kaps 250 mg tablet/kapsul/kaplet
Tetrasiklin kaps 500 mg tablet/kapsul/kaplet
Tetrasiklin Salep Mata 1% Tube
Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet
Timolol tts mata 0,25% botol @ 5 mL
Timolol tts mata 0,5% botol @ 5 mL
Triheksifenidil tab 2 mg tablet/kapsul/kaplet
Urea krim 10 % pot
Vaksin BCG inj (i.k) Vial
Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) Vial
0,5 ml (i.m)
Vaksin Influenza Vial
Vaksin Japanese Enchepalitis (J.E) Vial
Vaksin jerap difteri tetanus (DT) Vial
Vaksin jerap difteri tetanus (Td) Vial
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
Vaksin Meningitis Meningokokus Vial
Vaksin polio IPV inj 0,5 ml Vial
Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
Vaksin Yellow Fever Vial
Valproat sir 250 mg/5 ml botol @ 120 ml
Valproat tab sal 250 mg tablet salut enterik/ kaplet salut enter
Valproat tab sal 500 mg Tab sal
Vitamin B kompleks tablet
Zinc drops 10 mg/ml Botol
Zinc serb 10 mg Sachet
Zinc sir 10 mg/ml Botol
Zinc sir 20 mg/5 ml botol
Zinc tab disp 20 mg tablet dispersible
nanda oklusi
aplet salut gula
aplet salut gula

ut/kaplet salut selaput

l plastik pi
k/botol plas
ik/kaplet salut enterik
ik/kaplet salut enterik
aplet salut gula

et/tablet salut selaput/kaplet salut selaput
et/tablet salut selaput/kaplet salut selaput

k/ kaplet salut enterik
RENCANA KE
NO NAMA OBAT SATUAN
(1) (2) (3)

OBAT
1 Air untuk injeksi amp 20 ml ampul/vial/botol
2 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL
3 Albendazol susp 200 mg/5 ml Botol
4 Albendazol tab 400 mg tablet/kapsul/kaplet
5 Alopurinol tab 100 mg Tab
6 Alopurinol tab 300 mg tablet/kapsul/kaplet
7 Aminofilin inj 24 mg/ml ampul/vial 10 ml
8 Aminofilin tab 150 mg tablet/kapsul/kaplet
9 Aminofilin Tab 200 mg tablet/kapsul/kaplet
10 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet
11 Amlodipin tab 10 mg tablet/kapsul/kaplet
13 Amoksisilin drops 100 mg/ml Botol
14 Amoksisilin sir forte 250 mg/5 ml botol 60 ml
15 Amoksisilin sir kering 125 mg/5 ml Botol
16 Amoksisilin tab 250 mg tablet/kapsul/kaplet
18 Ampisilin serb inj 1000 mg/vial ampul/vial
19 Ampisilin serb inj 250 mg/vial Vial
20 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : ampul/vial
80.000 inj 2 ml
21 Antasida, kombinasi : aluminium hidroksida 200 mg + tablet/kapsul/kaplet
magnesium hidroksida 200 mg
22 Antasida, kombinasi : aluminium hidroksida 200 mg + botol 60 ml
23 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 Kaps
mg
24 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat pot 30 g
3%
25 Antihemoroid, kombinasi: bismut subgalat 150 mg + Suppositoria
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida
120 mg + sup ad 2 g
26 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial
27 Articulating paper kertas warna penanda oklusi Kertas warna penanda
28 Asam asetat tetes telinga 2% Botol
29 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet
30 Asam askorbat (vitamin C) tab 250 mg Tab
31 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet
32 Asam folat tab 0,4 mg tablet/kapsul/kaplet
33 Asam folat tab 1 mg tablet/kapsul/kaplet
34 Asam folat tab 5 mg Tab
35 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet
36 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/ka
37 Asam salisilat lar 0,1% Botol
38 Asam salisilat salep 10% Tube
41 Asiklovir tab 200 mg tablet/kapsul/kaplet
43 Atapulgit 600 mg tablet/kapsul/kaplet
44 Atapulgit tab 630 mg tablet/kapsul/kaplet
45 Atapulgit tablet 650 mg tablet/kapsul/kaplet
46 Atapulgit tablet 750 mg Tab
47 Atenolol tab 100 mg tablet/kapsul/kaplet
49 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
50 Atropin tab 0,5 mg Tab
51 Bahan tumpatan sementara lar, serb Botol
52 Bedak salisil serb 2% Dus/Sachet/Plastik
53 Betametason krim 0,1% tube 5 gram
54 Betametason krim 0,5 mg/g Tube
55 Betametason salep 0,1% tube 5 gram
56 Betametason tts mata 1 mg/ml botol
57 Bisakodil sup 10 mg Suppositoria
59 Bisakodil tab sal 5 mg tablet/kapsul/kaplet
60 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml
61 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
62 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml
63 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
64 Budesonid serb ih 100 mcg/dosis Botol
65 Budesonid serb ih 200 mcg/dosis 100 dosis
67 Coal tar lar 5 % Botol
68 Copper T set/buah
69 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial
70 Deksametason tab 0,5 mg tablet/kapsul/kaplet
71 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
73 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial
74 Diazepam tab 2 mg tablet/kapsul/kaplet
76 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet
77 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
78 Digoksin tab 0,25 mg tablet/kapsul/kaplet
79 Diltiazem hcl tab 30 mg tablet/kapsul/kaplet
80 Diltiazem kaps SR 100 mg Kapsul lepas lambat
82 Diltiazem tab 30 mg Tab
83 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet
84 Doksisiklin kaps 100 mg tablet/kapsul/kaplet
85 Domperidon susp 5 mg/5 ml botol @60 ml
86 Domperidon tab 10 mg tablet/kapsul/kaplet
87 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul/vial
88 Epinefrin (adrenalin) inj 1 mg/ml Ampul
89 Ergotamin tab 1 mg Tab
90 Eritromisin kaps 250 mg tablet/kapsul/kaplet
91 Eritromisin sir 200 mg/5 ml Botol @ 60 ml
92 Eritromisin tab 500 mg tablet/kapsul/kaplet
93 Estrogen terkonjugasi tab sal 0,625 mg tablet salut gula/kaplet
94 Etanol 70% cairan 70% Botol
95 Etil klorida semprot 100 ml Botol
96 Etonogestrel implan 68 mg Set
97 Eugenol Botol
98 Fenitoin Na inj 50 mg/ml ampul @ 2 ml
99 Fenitoin Na kaps 100 mg Kaps
101 Fenobarbital tab 100 mg Tab
102 Fenobarbital tab 30 mg tablet/kapsul/kaplet
103 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
105 Ferro fumarat kaps lunak 300 mg Kaps lunak
106 Ferro sulfat sir. 150 mg/5 ml Botol
107 Ferro sulfat tab salut 300 mg Tab sal
108 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial
109 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
110 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/kaplet
111 Fluoksetin kaps 10 mg tablet/kapsul/kaplet
112 Fluor kapl 1 mg Kaplet
113 Fluor sediaan topikal Tube
114 Fluoresein tts mata 2,5 mg/ml Botol
115 Formokresol Botol
116 Framisetin Sulfat Tulle 1% Patch
117 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial
118 Furosemid tab 40 mg tablet/kapsul/kaplet
119 Galactose microparticle 200-400 mg micropart/ml Vial
120 Garam oralit kombinasi : natrium klorida 0,52 g + kalium sachet
klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7
g
121 Gentamisin salep mata 0,3% Tube
122 Gentamisin tts mata 0,3% Botol
123 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa Sachet
butter 5 g
124 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol
125 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
126 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet

127 Glibenklamid tab 5 mg tablet/kapsul/kaplet
128 Glikuidon tab 30 mg tablet/kapsul/kaplet
129 Glimepirid tab 1 mg tablet/kapsul/kaplet
131 Glipizid tab 5 mg tablet/kapsul/kaplet
132 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet
133 Gliserin tts 100 mg/ml Botol
134 Glukosa Larutan Infus 10% steril 100 ml Botol
137 Glukosa Larutan Infus 40% Ampul @25 ml
141 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet
142 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet
143 Gutta percha dan paper points 15 - 40 mm Roll
145 Haloperidol inj 5 mg/ml (i.m.) Vial
146 Haloperidol tab 0,5 mg tablet/kapsul/kaplet
148 Haloperidol tab 2 mg tablet/kapsul/kaplet
150 Haloperidol tts 2 mg/ml botol
151 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml Ampul
152 Hidrogen peroksida cairan 3% Botol
153 Hidrogen peroksida lar. Konsentrat 3% Botol
154 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet
155 Hidrokortison krim 2,5% tube @ 5 g
156 Hidrokortison serb inj 100 mg Vial
157 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet
158 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
160 Ibuprofen sir 100 mg/5 ml botol @ 60 ml
162 Ibuprofen tab 200 mg tablet/kapsul/kaplet
164 Ipratropium bromida aerosol 20 mcg/semprot Botol
165 Ipratropium bromida cairan ih 0,025% Botol
166 Ipratropium bromida ih 20mcg/puff Botol
167 Isoniazid tab 100 mg Tab
169 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet
170 IUD Cu T 380 A Set
171 IUD Levonorgestrel Set
172 Kalamin Tube
173 Kalsium glukonat inj 100 mg/ml ampul/vial
174 Kalsium hidroksida bubuk, pasta Tube
175 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet
176 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet
177 Kaptopril tab 12,5 mg tablet/kaplet
178 Kaptopril tab 25 mg tablet/kaplet
180 Karbamazepin sir 100 mg/5 ml Botol
181 Karbamazepin tab 100 mg Tab
182 Karbamazepin Tab 200 mg Tablet
183 Karbo adsorben tab 0,5 g Tab
184 Karbogliserin tts telinga 10 % Botol
185 Ketokonazol tab 200 mg tablet/kapsul/kaplet
186 Klindamisin kaps 150 mg Kaps
187 Klindamisin kaps 300 mg tablet/kapsul/kaplet
188 Klofazimin, micronized kaps 50 mg Kapsul
189 Klofazimin, micronizedkaps 100 mg kapsul
190 Klonidin tab 0,15 mg tablet/kapsul/kaplet
191 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet
192 Kloramfenikol salep kulit 2% tube 15g
193 Kloramfenikol salep mata 1% tube @ 5 gram
194 Kloramfenikol susp 125 mg/5 ml botol 60 ml
195 Kloramfenikol tetes telinga 3% Botol
196 Kloramfenikol tts mata 0,5% botol
197 Kloramfenikol tts mata 1% Botol
198 Klorfeniramin tab 4 mg tablet/kapsul/kaplet
199 Klorfenol kamfer mentol (CHKM) Botol
200 Klorheksidin lar 0,2% Botol
201 Klorheksidin lar 15% Botol
202 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
204 Klorpromazin tab sal 100 mg tablet salut selaput/kap
205 Klorpromazin tab sal 25 mg Tab sal
206 Klortalidon tab 50 mg Tab
207 Klozapin tab 100 mg tablet
209 Kodein tab 10 mg tablet/kapsul/kaplet
210 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 tablet salut selaput/kap
mg tab sal selaput
211 Kombinasi : artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kaplet
212 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
213 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
214 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet
215 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab tablet salut gula
salut
216 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg tab salut gula
217 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab

218 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Tab
Efavirenz 600 mg
219 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg ampul/vial
nebules
220 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
221 Komposit resin Set
222 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 tab/kaptab
mg+ trimetoprim 80 mg
223 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 tab/kaptab
224 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol botol 60 mL
200 mg + trimetoprim 40 mg
225 Kuinin inj 25% (i.v.) Vial
226 Kuinin tab 200 mg tablet/kapsul/kaplet
227 Laktulosa sir 3,335 g/5 ml botol @ 60 mL
228 Larutan mengandung Elektrolit (Kalium Klorida) Botol
229 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) Botol
(KN1)
230 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
231 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl Botol plastik @ 500 ml
109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
232 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl Softbag @ 500 ml
233 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa Botol
18.75 gr) (KA EN 1B)
234 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) Botol
113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2
gr/L, elektrolit)
235 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung Botol
electrolit: Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium
2.5 mmol/l, Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)
236 Larutan mengandung Karbohidrat (Fructose 120 g, glucose Botol

66 g, Xylitol 60 g/ L)
237 Larutan mengandung Karbohidrat (Fructose 200 g, glucose Botol
238 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 Botol
g, Xylitol 30 g/ L)
239 Larutan mengandung Karbohidrat (Maltose 10%) Botol
240 Larutan mengandung Karbohidrat + Elektrolit (25.00g Botol
maltose, 3.00 g sodium chloride, 0.15 g potassium chloride,
0.10 g calcium chloride dihydrate dan 1.55 g sodium lactate)
241 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Botol

Cl, Ca, Mg, Sorbitol 50 gr/L)
242 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, Botol
NaCL 0,45%, KCl) (HSD)
243 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, Botol
glucose 66 g, Xylitol 60 g/ L + elektrolit)
244 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, Botol
NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi
ad 1000 ml)
245 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Botol
246 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 Botol

g; NaCl: 4,5 g)
247 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 Botol
g; NaCl: 2.25 g) (D5-1/4NS)
248 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 Botol
g; NaCl: 4.5 g) (D5-1/2NS)
249 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi Botol
kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ,
Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
250 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer Botol

& Glukosa 5%)
251 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, Botol
KCL 1.5g, Glukosa 100 gr)
252 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, Botol
KCL 1.5g, Na Lactate 2.24 g, Glukosa 100 gr)
253 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, Botol
KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
254 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Botol

Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
255 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set

256 Lidokain gel 2% syringe/syringe plastik
257 Lidokain inj 2% (infiltr/p.v.) ampul/vial
258 Lidokain spray oral 10% botol
259 Linestrenol tab 0,5 mg tablet/kapsul/kaplet
260 Loperamid tab 2 mg Tab
261 Loratadin tab 10 mg tablet/kapsul/kaplet
262 Lorazepam tab 0,5 mg tablet/kapsul/kaplet
263 Lorazepam tab 1 mg tablet/kapsul/kaplet
264 Lorazepam tab sal 2 mg Tab sal
265 Lugol Botol
266 Magnesium sulfat inj 20% ampul/vial
267 Magnesium sulfat inj 20% ampul/vial @25 ml
270 Magnesium sulfat serb, ktg 30 g Sachet
271 Mebendazol sir 100 mg/5 ml Botol
272 Mebendazol tab 100 mg Tan
273 Mebendazol tab 500 mg tablet/kapsul/kaplet
274 Medroksi progesteron asetat inj 150 mg/ml ampul/vial
275 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial
276 Metenamin mandelat (heksamin mandelat) tab salut enterik Tab salut
500 mg
277 Metformin tab 500 mg tablet/kapsul/kaplet
279 Metilergometrin inj 0,2 mg/ml ampul/vial
280 Metilergometrin tab salut 0,125 mg tablet/kaplet salut sela
281 Metilprednisolon tab 4 mg tablet/kapsul/kaplet
282 Metoklopramid inj 5 mg/ml ampul/vial
283 Metoklopramid tab 10 mg tablet/kapsul/kaplet
285 Metronidazol lar inf 5 mg/ml botol
286 Metronidazol susp 125 mg/5 ml Botol @ 60 ml
288 Metronidazol tab 250 mg tablet/kapsul/kaplet
290 Mikonazol krim 2% tube
291 Mikonazol serb 2% botol / sachet
292 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Sachet
Magnesium Chloride Anhydrous, Potassium Chloride, Zinc
Acetate)
293 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet
294 NaCl 0,9% Larutan Botol plastik/botol plast
295 NaCl 0,9% Larutan Botol
296 NaCl 0,9% Larutan ampul/botol plastik/bot
297 Natrium diklofenak tab 25 mg tablet salut enterik/kap
298 Natrium diklofenak tab 50 mg tablet salut enterik/kap
299 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL
300 Natrium hipoklorit cairan konsentrat 5% Botol
301 Natrium tiosulfat inj 25% (i.v.) Ampul
302 Nifedipin kaps 10 mg tablet/kapsul/kaplet
303 Nikotinamid tab 100 mg Tab
305 Nistatin susp 100.000 UI/ml botol/vial
306 Nistatin tab salut 500.000 UI tablet salut gula/kaplet
307 Nistatin tab vaginal 100.000 UI tablet/kaplet
308 Nitrofurantoin tab 50 mg Tab
309 Norepinefrin inj 1 mg/ml ampul/vial
310 Obat Anti Tuberculosis FDC Kategori Anak paket
311 Obat Anti Tuberculosis FDC Kategori I paket
312 Obat Anti Tuberculosis FDC Kategori II paket
313 Obat Anti Tuberculosis FDC Kategori Sisipan paket
314 Obat Anti Tuberculosis Kombipak Anak Paket
315 Obat Anti Tuberculosis Kombipak Dewasa paket
316 Oksigen ih, gas dlm tabung Botol
317 Oksimetazolin tts hidung 0,025% botol @ 10 mL
319 Oksitetrasiklin 1% Salep Mata tube
320 Oksitosin inj 10 UI/ml ampul/vial
321 Olopatadin tts mata 0,1% Botol
322 Omeprazol inj 40 mg/10 ml ampul/vial
323 Omeprazol kaps 20 mg tablet/kapsul/kaplet
324 Paraformaldehid tab 1 g Tab
325 Parasetamol sir 120 mg/5 ml botol @ 60 mL
326 Parasetamol tab 500 mg tablet/kapsul/kaplet
327 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL
328 Pasta devitalisasi (non arsen) Tube
329 Pasta pengisi saluran akar (pasta) Tube
330 Perak nitrat lar 20% Botol
331 Perak sulfadiazin krim 1% Tube
332 Permetrin krim 5 % Tube
333 Pirantel pamoat susp 125 mg/5 ml Botol
334 Pirantel pamoat tab 500 mg Tab
335 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet
336 Pirantel pamoat tab scored 250 mg Tab
337 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
338 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl
339 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet
340 Povidon iodin lar 100 mg/ml botol @ 60 mL
341 Povidon iodin lar 100 mg/ml Botol 300 ml
342 Povidon iodin lar 100 mg/ml botol @ 1.000 mL
343 Povidon iodin lar 100 mg/ml botol 30 mL
344 Prednison tab 5 mg tablet/kapsul/kaplet
345 Primakuin tab 15 mg Tab
346 Probenesid tab 500 mg tablet/kapsul/kaplet
347 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial
348 Propiltiourasil tab 100 mg tablet/kapsul/kaplet
349 Propranolol tab 10 mg tablet/kapsul/kaplet
350 Ranitidin tab 150 mg tablet/kapsul/kaplet
351 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
353 Rifampisin kaps 300 mg tablet/kapsul/kaplet
354 Ringer Laktat Larutan Botol
355 Risperidon tab sal 1 mg tablet/kapsul/kaplet
357 Salbutamol cairan ih 0,1% ampul/vial/botol
358 Salbutamol lar ih 0,5 % Botol
359 Salbutamol sir 2 mg/5 ml Botol
360 Salbutamol tab 2 mg tablet/kapsul/kaplet
362 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 pot 15 gram
%
363 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 pot 30 gram
%
364 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj Vial
(i.m./i.v.)
365 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj Vial
(i.m./i.v.)
366 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
367 Serum antirabies inj 100 UI/ml Vial
369 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
370 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
371 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
372 Setirizin sir 5 mg/5 ml. botol @ 60 mL
373 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial
374 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet
375 Simvastatin tab sal 10 mg tablet/kapsul/kaplet/tab
376 Simvastatin tab sal 20 mg tablet/kapsul/kaplet/tab
377 Simvastatin tab sal selaput 40 mg Tab sal
378 Siprofloksasin tab scored 500 mg tablet salut selaput/kap
379 Siprofloksasin tetes mata 3 mg/ml Catchcover, botol 0,6
380 Spironolakton tab 25 mg tablet/kapsul/kaplet
381 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
382 Streptomisin serb inj 1.000 mg/vial ampul/vial

383 Surgical ginggival pack Tube
384 Tenofovir tab 300 mg tablet salut selaput/kap
385 Tetanus toxoid inj Ampul
386 Tetrakain tts mata 0,5% Botol
387 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet
389 Tetrasiklin Salep Mata 1% Tube
390 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet
391 Timolol tts mata 0,25% botol @ 5 mL
393 Triheksifenidil tab 2 mg tablet/kapsul/kaplet
394 Urea krim 10 % pot
395 Vaksin BCG inj (i.k) Vial
396 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
397 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device Vial
(Uniject) 0,5 ml (i.m)
398 Vaksin Influenza Vial
399 Vaksin Japanese Enchepalitis (J.E) Vial
400 Vaksin jerap difteri tetanus (DT) Vial
401 Vaksin jerap difteri tetanus (Td) Vial
402 Vaksin kombinasi DPT-HB-Hib Vial
403 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
404 Vaksin Meningitis Meningokokus Vial
405 Vaksin polio IPV inj 0,5 ml Vial
406 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
407 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
408 Vaksin Yellow Fever Vial
409 Valproat sir 250 mg/5 ml botol @ 120 ml
410 Valproat tab sal 250 mg tablet salut enterik/ kap
411 Valproat tab sal 500 mg Tab sal
412 Vitamin B kompleks tablet
413 Zinc drops 10 mg/ml Botol
414 Zinc serb 10 mg Sachet
415 Zinc sir 10 mg/ml Botol
416 Zinc sir 20 mg/5 ml botol
417 Zinc tab disp 20 mg tablet dispersible
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
Jumlah Kebutuhan Obat
BAHAN MEDIS HABIS PAKAI

1 ADS 0.05 ml Buah
2 ADS 0.5 ml Buah
3 ADS 5 ml Buah
7 Alkohol Swab Buah
8 Bisturi Buah
9 Blood set Buah
19 Jarum kulit Buah
20 Jarum otot Buah
21 Kaca Slide Buah
30 Masker N-95 Buah
35 Pot Dahak Buah
36 Safety box Buah
43 Sendok Obat Buah
45 Urin Bag Buah
46 - -
47 - -
48 - -
49 - -
50 - -
51 - -
52 - -
53 - -
54 - -
55 - -
56 - -
57 - -
58 - -
59 - -
60 - -
61 - -
62 - -
63 - -
64 - -
65 - -
Jumlah Kebutuhan BMHP
REAGEN
5 Humasens Plus Set
9 Iodin test Botol
36 SD HCV Sachet
37 - -
38 - -
39 - -
40 - -
41 - -
42 - -
43 - -
44 - -
45 - -
46 - -
47 - -
48 - -
49 - -
50 - -
51 - -
Jumlah Kebutuhan Reagen
Jumlah Total
RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN
PUSKESMAS LEMBANG
TAHUN 2021
KEBUTUHAN OBAT 1 TAHUN DENGAN METODA

PERKIRAAN PEMAKAIAN KONSUMSI
HARGA SATUAN RATA-RATA
(Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH
(4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7)
2,449.00 5 60 6 66
2,449.00 - - - -
4,000.00 - - - -
430.00 640 7,680 768 8,448
105.00 10 120 12 132
105.00 - - - -
2,789.00 - - - -
95.00 - - - -
95.00 7 84 8 92
167.00 40 480 48 528
99.00 - - - -
75.00 17 204 20 224
26,620.00 - - - -
3,628.00 - - - -
2,000.00 7 84 8 92
195.00 - - - -
249.00 55 660 66 726
8,237.00 #VALUE! #VALUE! #VALUE!
8,237.00 - - - -
1,152.00 20 240 24 264
58.00 65 780 78 858
2,129.00 5 60 6 66
1,298.00 - - - -
4,798.00 12 144 14 158
3,167.00 14 168 17 185
312,000.00 - - - -
38,999.00 - - - -
80,000.00 - - - -
105.00 18 216 22 238
105.00 - - - -
105.00 28 336 34 370
55.00 22 264 26 290
55.00 - - - -
55.00 - - - -
64.00 - - - -
103.00 27 324 32 356
103.00 - - - -
5,000.00 - - - -
3,000.00 - - - -
1,500.00 - - - -
200.00 - - - -
380.00 15 180 18 198
145.00 15 180 18 198
145.00 - - - -
145.00 - - - -
145.00 - - - -
529.00 - - - -
748.00 - - - -
1,639.00 - - - -
1,595.00 - - - -
52,833.00 - - - -
1,774.30 3 36 4 40
1,340.00 5 60 6 66
1,340.00 - - - -
1,380.00 - - - -
2,500.00 - - - -
5,730.00 - - - -
5,800.00 - - - -
319.00 - - - -
10,378.00 - - - -
10,378.00 - - - -
10,378.00 - - - -
14,000.00 - - - -
140,000.00 - - - -
140,000.00 - - - -
140,000.00 - - - -
141,600.00 - - - -
500,000.00 - - - -
1,097.00 5 60 6 66
32.00 20 240 24 264
18,279.00 - - - -
12,573.00 1 12 1 13
1,735.00 6 72 7 79
86.00 30 360 36 396
114.00 - - - -
312.00 - - - -
1,095.00 30 360 36 396
104.00 15 180 18 198
127.00 - - - -
4,290.00 - - - -
4,650.00 - - - -
127.00 - - - -
99.00 15 180 18 198
280.00 - - - -
2,700.00 35 420 42 462
91.00 22 264 26 290
1,408.00 - - - -
1,408.00 - - - -
135.00 - - - -
546.00 - - - -
6,090.00 - - - -
750.00 - - - -
92,100.00 - - - -
26,250.00 - - - -
99,000.00 - - - -
230,000.00 - - - -
18,824.00 - - - -
7,980.00 - - - -
158.00 60 720 72 792
158.00 - - - -
171.00 - - - -
171.00 35 420 42 462
629.00 - - - -
629.00 - - - -
50.00 - - - -
2,000.00 - - - -
50.00 - - - -
3,682.00 15 180 18 198
710.00 60 720 72 792
2,349.00 - - - -
150.00 - - - -
2,000.00 - - - -
150.00 - - - -
2,500.00 - - - -
116,000.00 - - - -
10,000.00 - - - -
2,500.00 - - - -
82.00 15 180 18 198
5,000.00 - - - -
274.00 5 60 6 66
5,000.00 - - - -
6,000.00 - - - -
270,583.00 - - - -
270,583.00 - - - -
270,583.00 - - - -
119.00 - - - -
119.00 20 240 24 264
1,000.00 - - - -
218.00 - - - -
289.00 - - - -
300.00 - - - -
1,500.00 - - - -
4,000.00 - - - -
4,000.00 - - - -
5,000.00 - - - -
7,500.00 - - - -
4,000.00 - - - -
4,000.00 - - - -
5,000.00 - - - -
6,900.00 3 36 4 40
224.00 13 156 16 172
224.00 - - - -
400,000.00 - - - -
400,000.00 - - - -
4,000.00 30 360 36 396
59.00 - - - -
59.00 30 360 36 396
59.00 - - - -
60.00 30 360 36 396
17,099.00 - - - -
1,325,000.00 - - - -
15,000.00 - - - -
15,000.00 - - - -
149.00 - - - -
2,475.00 4 48 5 53
2,000.00 - - - -
1,100.00 10 120 12 132
176,800.00 - - - -
200,000.00 - - - -
2,475.00 - - - -
3,000.00 - - - -
105.00 - - - -
220.00 15 180 18 198
83,500.00 - - - -
98,000.00 - - - -
90,000.00 - - - -
74.00 10 120 12 132
173.00 - - - -
89.00 20 240 24 264
500,000.00 - - - -
350,000.00 - - - -
11,000.00 - - - -
10,351.00 12 144 14 158
227,700.00 - - - -
400.00 - - - -
63.00 40 480 48 528
75.00 - - - -
75.00 25 300 30 330
75.00 - - - -
3,500.00 - - - -
200.00 - - - -
245.00 30 360 36 396
300.00 - - - -
2,590.00 12 144 14 158
288.00 15 180 18 198
578.00 - - - -
578.00 - - - -
300.00 - - - -
350.00 - - - -
200.00 - - - -
310.00 10 120 12 132
3,242.00 - - - -
2,007.00 5 60 6 66
5,015.00 5 60 6 66
7,480.00 3 36 4 40
7,260.00 4 48 5 53
7,260.00 - - - -
23.00 65 780 78 858
65,429.00 - - - -
90,000.00 - - - -
150,000.00 - - - -
1,500.00 - - - -
1,000.00 - - - -
157.00 30 360 36 396
147.00 - - - -
300.00 - - - -
2,000.00 - - - -
1,121.00 - - - -
100.00 - - - -
2,000.00 - - - -
3,498.00 - - - -
1,000.00 - - - -
5,000.00 - - - -
185.00 17 204 20 224
353.00 75 900 90 990
9,000.00 - - - -
10,000.00 - - - -
3,276.00 - - - -
4,550.00 - - - -
200.00 - - - -
100,000.00 - - - -
133.00 12 144 14 158
300.00 - - - -
2,190.00 7 84 8 92
6,200.00 - - - -
670.00 - - - -
10,000.00 - - - -
7,000.00 - - - -
10,000.00 - - - -
10,000.00 - - - -
10,000.00 - - - -
10,000.00 - - - -
57,750.00 - - - -
57,750.00 - - - -
60,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
47,000.00 - - - -
50,000.00 - - - -
8,025.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
9,350.00 - - - -
9,400.00 - - - -
39,325.00 - - - -
50,000.00 - - - -
50,000.00 - - - -
10,050.00 - - - -
10,050.00 - - - -
50,000.00 - - - -
41,600.00 - - - -
2,000.00 - - - -
177,216.00 - - - -
500.00 - - - -
85.00 - - - -
131.00 24 288 29 317
200.00 - - - -
250.00 - - - -
300.00 - - - -
50,000.00 - - - -
3,328.00 - - - -
3,328.00 2 24 2 26
3,796.00 - - - -
3,796.00 2 24 2 26
2,000.00 - - - -
10,000.00 - - - -
5,000.00 - - - -
8,800.00 - - - -
6,100.00 - - - -
6,100.00 - - - -
10,000.00 - - - -
102.00 20 240 24 264

102.00 - - - -
2,959.00 30 360 36 396
224.00 10 120 12 132
143.00 20 240 24 264
3,960.00 - - - -
90.00 - - - -
115.00 - - - -
8,110.00 - - - -
3,800.00 - - - -
94.00 - - - -
113.00 - - - -
220.00 15 180 18 198
3,414.00 3 36 4 40
3,414.00 - - - -
2,920.00 - - - -
382.00 30 360 36 396

6,410.00 4 48 5 53
6,410.00 - - - -
6,410.00 - - - -
123.00 - - - -
123.00 30 360 36 396
3,000.00 - - - -
64,800.00 - - - -
2,000.00 - - - -
99.00 - - - -
500.00 - - - -
400.00 - - - -
5,000.00 - - - -
790.00 5 60 6 66
560.00 4 48 5 53
300.00 - - - -
2,000.00 - - - -
232,518.00 - - - -
389,344.00 1 12 1 13
1,297,889.00 1 12 1 13
173,030.00 - - - -
232,200.00 - - - -
288,200.00 - - - -
25,000.00 - - - -
30,000.00 - - - -
31,000.00 - - - -
2,500.00 - - - -
1,199.00 10 120 12 132
16,997.00 - - - -
10,393.00 - - - -
139.00 10 120 12 132
150.00 - - - -
1,181.00 12 144 14 158
53.00 75 900 90 990
246,400.00 - - - -
217,429.00 - - - -
167,667.00 - - - -
50,000.00 - - - -
20,700.00 - - - -
11,825.00 4 48 5 53
2,500.00 - - - -
500.00 - - - -
291.00 - - - -
350.00 - - - -
3,000.00 - - - -
131.00 30 360 36 396
60.00 - - - -
18,900.00 - - - -
18,900.00 1 12 1 13
18,900.00 - - - -
3,045.00 - - - -
73.00 25 300 30 330
253.00 - - - -
1,780.00 - - - -
8,615.00 - - - -
550.00 - - - -
81.00 - - - -
112.00 15 180 18 198
307.00 2 24 2 26
517.00 4 48 5 53
683.00 - - - -
7,630.00 4 48 5 53
287.00 - - - -
287.00 15 180 18 198
3,999.60 - - - -
3,000.00 - - - -
4,750.00 - - - -
66.00 - - - -
70.00 10 120 12 132
2,797.00 - - - -
2,797.00 2 24 2 26
512,204.00 - - - -
512,204.00 - - - -
2,480,000.00 - - - -
150,000.00 - - - -
200,000.00 - - - -
250,000.00 - - - -
130,999.00 - - - -
250,000.00 - - - -
2,915.00 5 60 6 66
1,104.00 2 24 2 26
1,104.00 - - - -
117.00 15 180 18 198
117.00 - - - -
117.00 - - - -
265.00 20 240 24 264
5,000.00 - - - -
294.00 - - - -
20,000.00 - - - -
5,000.00 - - - -
- - - - -
8,100.00 - - - -
170,000.00 - - - -
5,000.00 - - - -
163.00 - - - -
323.00 10 120 12 132
3,000.00 - - - -
91.00 40 480 48 528
3,000.00 - - - -
4,000.00 - - - -
91.00 30 360 36 396
5,000.00 - - - -
61,996.00 5 60 6 66
19,954.00 10 120 12 132
23,991.00 8 96 10 106
82,005.00 - - - -
100,000.00 - - - -
17,996.00 - - - -
16,995.00 10 120 12 132
78,991.00 20 240 24 264
155,813.00 - - - -
135,000.00 - - - -
158,994.00 5 60 6 66
165,000.00 - - - -
165,000.00 - - - -
296,000.00 - - - -
189,607.00 - - - -
1,750.00 - - - -
6,000.00 - - - -
89.00 50 600 60 660
20,000.00 - - - -
500.00 - - - -
14,980.00 - - - -
6,290.00 - - - -
524.00 25 300 30 330
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
1,458.00 15 180 18 198

1,348.00 2 24 2 26
1,458.00 3 36 4 40
865.00 25 300 30 330
879.00 15 180 18 198
928.00 25 300 30 330
110.00 5 60 6 66
770.00 1 12 1 13
4,760.00 3 36 4 40
8,208.33 6 72 7 79
8,208.33 5 60 6 66
9,590.00 - - - -
3,030.00 2 24 2 26
2,880.00 2 24 2 26
6,280.00 1 12 1 13
6,280.00 1 12 1 13
6,250.00 2 24 2 26
6,250.00 - - - -
2,300.00 - - - -
2,300.00 - - - -
296.49 - - - -
200,000.00 - - - -
20,600.00 - - - -
9,870.00 5 60 6 66
461.00 5 60 6 66
2,415.00 - - - -
1,100.00 - - - -
- - - - -
330.00 50 600 60 660
6,707.00 - - - -
37,371.00 2 24 2 26
- - - - -
- - - - -
- - - - -
5,800.00 - - - -
22,433.00 3 36 4 40
470.00 25 300 30 330
530.00 20 240 24 264
530.00 22 264 26 290
3,674.00 - - - -
3,674.00 7 84 8 92
3,674.00 8 96 10 106
250.00 8 96 10 106
3,958.33 2 24 2 26
3,820.00 4 48 5 53
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
138,950.00 - - - -
81,000.00 - - - -
81,000.00 - - - -
103,000.00 - - - -
- - - - -
550,800.00 - - - -
252,300.00 - - - -
544,400.00 - - - -
5,000.00 - - - -
- - - - -
32,950.00 - - - -
87,100.00 - - - -
32,950.00 - - - -
32,475.00 - - - -
59,550.00 - - - -
36,750.00 - - - -
168,200.00 - - - -
13,235.00 - - - -
13,235.00 2 24 2 26
22,475.00 - - - -
22,475.00 2 24 2 26
14,340.00 - - - -
22,385.00 - - - -
14,340.00 3 36 4 40
26,527.00 - - - -
26,527.00 - - - -
823,000.00 - - - -
158,400.00 - - - -
4,150.00 4 48 5 53
43,000.00 - - - -
43,000.00 - - - -
7,251.00 - - - -
9,870.00 - - - -
625,900.00 - - - -
487,000.00 - - - -
13,252.00 - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
RENCANA
JUMLAH HARGA
KEBUTUHAN KETERANGAN
(Rp)
TAHUN 2020
(9) (10) (11)
100 244,900
-
-
1200 516,000
5000 525,000
-
-
-
500 47,500
5000 835,000
-
10000 750,000
-
-
1000 2,000,000
-
50000 12,450,000
-
-
400 460,800
60000 3,480,000
600 1,277,400
500 2,399,000
200 633,400
-
-
-
5000 525,000
-
20000 2,100,000
1000 55,000
-
-
-
30000 3,090,000
-
-
-
-
-
1000 380,000
6000 870,000
-
-
-
-
-
-
-
-
500 887,150
700 938,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
600 658,200
40000 1,280,000
-
70 880,110
1000 1,735,000
5000 430,000
-
-
500 547,500
1000 104,000
-
-
-
-
10000 990,000
-
500 1,350,000
20000 1,820,000
-
-
-
-
-
-
-
-
-
-
-
-
1000 158,000
-
-
5000 855,000
-
-
-
-
-
600 2,209,200
1000 710,000
-
-
-
-
-
-
-
-
3000 246,000
-
3000 822,000
-
-
-
-
5000 595,000
-
-
-
-
-
-
-
-
-
-
-
-
200 1,380,000
3000 672,000
-
-
-
200 800,000
-
5000 295,000
-
8000 480,000
-
-
-
-
-
1000 2,475,000
-
1000 1,100,000
-
-
-
-
-
20000 4,400,000
-
-
-
3000 222,000
-
2000 178,000
-
-
-
100 1,035,100
-
-
30000 1,890,000
-
6000 450,000
-
-
-
4000 980,000
-
300 777,000
2000 576,000
-
-
-
-
-
3000 930,000
-
400 802,800
200 1,003,000
300 2,244,000
300 2,178,000
-
40000 920,000
-
-
-
-
-
1000 157,000
-
-
-
-
-
-
-
-
-
1000 185,000
1000 353,000
-
-
-
-
50000 6,650,000
500 1,095,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
20000 2,620,000
-
-
-
-
-
400 1,331,200
-
400 1,518,400
-
-
-
-
-
-
-
10200 1,040,400
-
600 1,775,400
3000 672,000
-
-
-
-
-
-
-
-
10000 2,200,000
500 1,707,000
-
-
10000 3,820,000
300 1,923,000
-
-
-
20000 2,460,000
-
-
-
-
-
-
-
2000 1,580,000
500 280,000
-
-
-
48 18,688,512
20 25,957,780
-
-
-
-
-
-
-
800 959,200
-
-
9000 1,251,000
-
1000 1,181,000
80000 4,240,000
-
-
-
-
-
200 2,365,000
-
-
-
-
-
30000 3,930,000
-
-
50 945,000
-
-
20000 1,460,000
-
-
-
-
-
20000 2,240,000
1000 307,000
500 258,500
-
1000 7,630,000
-
3000 861,000
-
-
-
-
30500 2,135,000
-
1000 2,797,000
-
-
-
-
-
-
1000 2,915,000
800 883,200
-
10000 1,170,000
-
-
9000 2,385,000
-
-
-
-
-
-
-
-
-
5000 1,615,000
-
30500 2,775,500
-
-
10000 910,000
-
200 12,399,200
200 3,990,800
500 11,995,500
-
-
-
600 10,197,000
200 15,798,200
-
-
200 31,798,800
-
-
-
-
-
-
50000 4,450,000
-
-
-
-
20000 10,480,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
297,978,652
5000 7,290,000
3000 4,044,000
1000 1,458,000
7000 6,055,000
6000 5,274,000
4000 3,712,000
10000 1,100,000
1000 770,000
500 2,380,000
500 4,104,167
500 4,104,167
-
300 909,000
500 1,440,000
1000 6,280,000
1000 6,280,000
1000 6,250,000
-
-
-
-
-
-
1000 9,870,000
3000 1,383,000
-
-
-
50000 16,500,000
-
150 5,605,650
-
-
-
-
200 4,486,600
10000 4,700,000
20000 10,600,000
40000 21,200,000
-
5000 18,370,000
5000 18,370,000
10000 2,500,000
1000 3,958,333
900 3,438,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
182,431,917
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
200 2,647,000
-
200 4,495,000
-
-
200 2,868,000
-
-
-
-
400 1,660,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
11,670,000
492,080,569
RENCAN
NO NAMA OBAT SATUAN
(1) (2) (3)

- OBAT -
ampul/vial/botol 25
2 Air untuk injeksi amp 25 ml
mL
Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 :
20 ampul/vial
80.000 inj 2 ml
Antasida, kombinasi : aluminium hidroksida 200 mg +
21 tablet/kapsul/kaplet
22 botol 60 ml
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100
23 Kaps
mg
Antifungi salep, kombinasi : asam benzoat 6%+ asam
24 pot 30 g
salisilat 3%
Antihemoroid, kombinasi: bismut subgalat 150 mg +
25 heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida Suppositoria
120 mg + sup ad 2 g
Kertas warna
27 Articulating paper kertas warna penanda oklusi
penanda oklusi
36 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/k

aptab

tablet salut
93 Estrogen terkonjugasi tab sal 0,625 mg
gula/kaplet salut gula
97 Eugenol Botol
tablet salut
110 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m)
Garam oralit kombinasi : natrium klorida 0,52 g + kalium
120 klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 sachet
g
Glass ionomer ART (Atraumatic Restorative Treatment)
123 Sachet
cocoa butter 5 g

172 Kalamin Tube

tablet salut
204 Klorpromazin tab sal 100 mg selaput/kaplet salut
selaput
tablet salut
Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320
210 selaput/kaplet salut
mg tab sal selaput
selaput
Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab
215 tablet salut gula
salut
Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg +
218 Tab
Efavirenz 600 mg
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg ampul/vial
219
nebules
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400
222 tab/kaptab
223 tab/kaptab
Kotrimoksazol kombinasi tiap 5 ml suspensi :
224 botol 60 mL
sulfametoksazol 200 mg + trimetoprim 40 mg
Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%)
229 Botol
(KN1)
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl Botol plastik @ 500
231
109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat ml
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl
232 Softbag @ 500 ml
Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa
233 Botol
18.75 gr) (KA EN 1B)
Larutan mengandung Elektrolit (Sodium Lactate sol (50%)
234 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 Botol
gr/L, elektrolit)
Larutan mengandung Elektrolit (Tiap 1000 ml mengandung

235 Botol
Larutan mengandung Karbohidrat (Fructose 120 g, glucose

236 Botol
237 Botol
Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33
238 Botol
g, Xylitol 30 g/ L)
Larutan mengandung Karbohidrat + Elektrolit (25.00g
240 maltose, 3.00 g sodium chloride, 0.15 g potassium chloride, Botol
Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K,

241 Botol
Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%,
242 Botol
Larutan mengandung Karbohidrat + Elektrolit (Fructose 120
243 Botol
g, glucose 66 g, Xylitol 60 g/ L + elektrolit)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g,
244 NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi Botol
ad 1000 ml)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ;

245 Botol
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0

246 Botol
g; NaCl: 4,5 g)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0
247 Botol
g; NaCl: 2.25 g) (D5-1/4NS)
248 Botol
g; NaCl: 4.5 g) (D5-1/2NS)
Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi

249 kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Botol
Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer

250 Botol
& Glukosa 5%)
Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g,
251 Botol
252 Botol
Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr,

253 Botol

254 Botol
syringe/syringe
256 Lidokain gel 2%
plastik
265 Lugol Botol
Metenamin mandelat (heksamin mandelat) tab salut enterik
276 Tab salut
500 mg
tablet/kaplet salut
280 Metilergometrin tab salut 0,125 mg
selaput
Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate,
292 Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Sachet
Acetate)

Botol plastik/botol
294 NaCl 0,9% Larutan
plastik pi
ampul/botol
plastik/botol plas
tablet salut
297 Natrium diklofenak tab 25 mg enterik/kaplet salut
enterik
tablet salut
enterik
tablet salut
306 Nistatin tab salut 500.000 UI
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4
362 pot 15 gram
%
363 pot 30 gram
%
Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua)
364 Vial
inj (i.m./i.v.)
Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj
365 Vial
(i.m./i.v.)
tablet/kapsul/kaplet/ta
375 Simvastatin tab sal 10 mg blet salut
selaput/kaplet salut
selaput
selaput
tablet salut
378 Siprofloksasin tab scored 500 mg selaput/kaplet salut
selaput
Catchcover, botol 0,6
379 Siprofloksasin tetes mata 3 mg/ml
ml
tablet salut
384 Tenofovir tab 300 mg selaput/kaplet salut
selaput

Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device
397 Vial
tablet salut enterik/
410 Valproat tab sal 250 mg
kaplet salut enterik
- Jumlah Kebutuhan Obat Emonev
RENCANA KEBUTUHAN OBAT EMONEV
PUSKESMAS …...........
TAHUN 2021
KEBUTUHAN OBAT 1 TAHUN DENGAN

PERKIRAAN PEMAKAIAN METODA KONSUMSI RENCANA
HARGA RATA-RATA KEBUTUHAN
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9)
2,449.00 5.00 60.00 6.00 66.00 100.00

2,449.00 - - - - -
4,000.00 - - - - -
430.00 640.00 7,680.00 768.00 8,448.00 1,200.00
105.00 10.00 120.00 12.00 132.00 5,000.00
105.00 - - - - -
2,789.00 - - - - -
95.00 - - - - -
95.00 7.00 84.00 8.40 92.40 500.00
167.00 40.00 480.00 48.00 528.00 5,000.00
99.00 - - - - -
75.00 17.00 204.00 20.40 224.40 10,000.00
26,620.00 - - - - -
3,628.00 - - - - -
2,000.00 7.00 84.00 8.40 92.40 1,000.00
195.00 - - - - -
249.00 55.00 660.00 66.00 726.00 50,000.00
8,237.00 #VALUE! #VALUE! #VALUE! -
8,237.00 - - - - -
1,152.00 20.00 240.00 24.00 264.00 400.00
58.00 65.00 780.00 78.00 858.00 60,000.00
2,129.00 5.00 60.00 6.00 66.00 600.00
1,298.00 - - - - -
4,798.00 12.00 144.00 14.40 158.40 500.00
3,167.00 14.00 168.00 16.80 184.80 200.00
312,000.00 - - - - -
38,999.00 - - - - -
80,000.00 - - - - -
105.00 18.00 216.00 21.60 237.60 5,000.00
105.00 - - - - -
105.00 28.00 336.00 33.60 369.60 20,000.00
55.00 22.00 264.00 26.40 290.40 1,000.00
55.00 - - - - -
55.00 - - - - -
64.00 - - - - -
103.00 27.00 324.00 32.40 356.40 30,000.00
103.00 - - - - -
5,000.00 - - - - -
3,000.00 - - - - -
1,500.00 - - - - -
200.00 - - - - -
380.00 15.00 180.00 18.00 198.00 1,000.00
145.00 15.00 180.00 18.00 198.00 6,000.00
145.00 - - - - -
145.00 - - - - -
145.00 - - - - -
529.00 - - - - -
748.00 - - - - -
1,639.00 - - - - -
1,595.00 - - - - -
52,833.00 - - - - -
1,774.30 3.00 36.00 3.60 39.60 500.00
1,340.00 5.00 60.00 6.00 66.00 700.00
1,340.00 - - - - -
1,380.00 - - - - -
2,500.00 - - - - -
5,730.00 - - - - -
5,800.00 - - - - -
319.00 - - - - -
10,378.00 - - - - -
10,378.00 - - - - -
10,378.00 - - - - -
14,000.00 - - - - -
140,000.00 - - - - -
140,000.00 - - - - -
140,000.00 - - - - -
141,600.00 - - - - -
500,000.00 - - - - -
1,097.00 5.00 60.00 6.00 66.00 600.00
32.00 20.00 240.00 24.00 264.00 40,000.00
18,279.00 - - - - -
12,573.00 1.00 12.00 1.20 13.20 70.00
1,735.00 6.00 72.00 7.20 79.20 1,000.00
86.00 30.00 360.00 36.00 396.00 5,000.00
114.00 - - - - -
312.00 - - - - -
1,095.00 30.00 360.00 36.00 396.00 500.00
104.00 15.00 180.00 18.00 198.00 1,000.00
127.00 - - - - -
4,290.00 - - - - -
4,650.00 - - - - -
127.00 - - - - -
99.00 15.00 180.00 18.00 198.00 10,000.00
280.00 - - - - -
2,700.00 35.00 420.00 42.00 462.00 500.00
91.00 22.00 264.00 26.40 290.40 20,000.00
1,408.00 - - - - -
1,408.00 - - - - -
135.00 - - - - -
546.00 - - - - -
6,090.00 - - - - -
750.00 - - - - -
92,100.00 - - - - -
26,250.00 - - - - -
99,000.00 - - - - -
230,000.00 - - - - -
18,824.00 - - - - -
7,980.00 - - - - -
158.00 60.00 720.00 72.00 792.00 1,000.00
158.00 - - - - -
171.00 - - - - -
171.00 35.00 420.00 42.00 462.00 5,000.00
629.00 - - - - -
629.00 - - - - -
50.00 - - - - -
2,000.00 - - - - -
50.00 - - - - -
3,682.00 15.00 180.00 18.00 198.00 600.00
710.00 60.00 720.00 72.00 792.00 1,000.00
2,349.00 - - - - -
150.00 - - - - -
2,000.00 - - - - -
150.00 - - - - -
2,500.00 - - - - -
116,000.00 - - - - -
10,000.00 - - - - -
2,500.00 - - - - -
82.00 15.00 180.00 18.00 198.00 3,000.00
5,000.00 - - - - -
274.00 5.00 60.00 6.00 66.00 3,000.00
5,000.00 - - - - -
6,000.00 - - - - -
270,583.00 - - - - -
270,583.00 - - - - -
270,583.00 - - - - -
119.00 - - - - -
119.00 20.00 240.00 24.00 264.00 5,000.00
1,000.00 - - - - -
218.00 - - - - -
289.00 - - - - -
300.00 - - - - -
1,500.00 - - - - -
4,000.00 - - - - -
4,000.00 - - - - -
5,000.00 - - - - -
7,500.00 - - - - -
4,000.00 - - - - -
4,000.00 - - - - -
5,000.00 - - - - -
6,900.00 3.00 36.00 3.60 39.60 200.00
224.00 13.00 156.00 15.60 171.60 3,000.00
224.00 - - - - -
400,000.00 - - - - -
400,000.00 - - - - -
4,000.00 30.00 360.00 36.00 396.00 200.00
59.00 - - - - -
59.00 30.00 360.00 36.00 396.00 5,000.00
59.00 - - - - -
60.00 30.00 360.00 36.00 396.00 8,000.00
17,099.00 - - - - -
1,325,000.00 - - - - -
15,000.00 - - - - -
15,000.00 - - - - -
149.00 - - - - -
2,475.00 4.00 48.00 4.80 52.80 1,000.00
2,000.00 - - - - -
1,100.00 10.00 120.00 12.00 132.00 1,000.00
176,800.00 - - - - -
200,000.00 - - - - -
2,475.00 - - - - -
3,000.00 - - - - -
105.00 - - - - -
220.00 15.00 180.00 18.00 198.00 20,000.00

83,500.00 - - - - -
98,000.00 - - - - -
90,000.00 - - - - -
74.00 10.00 120.00 12.00 132.00 3,000.00
173.00 - - - - -
89.00 20.00 240.00 24.00 264.00 2,000.00
500,000.00 - - - - -
350,000.00 - - - - -
11,000.00 - - - - -
10,351.00 12.00 144.00 14.40 158.40 100.00
227,700.00 - - - - -
400.00 - - - - -
63.00 40.00 480.00 48.00 528.00 30,000.00
75.00 - - - - -
75.00 25.00 300.00 30.00 330.00 6,000.00
75.00 - - - - -
3,500.00 - - - - -
200.00 - - - - -
245.00 30.00 360.00 36.00 396.00 4,000.00
300.00 - - - - -
2,590.00 12.00 144.00 14.40 158.40 300.00
288.00 15.00 180.00 18.00 198.00 2,000.00
578.00 - - - - -
578.00 - - - - -
300.00 - - - - -
350.00 - - - - -
200.00 - - - - -
310.00 10.00 120.00 12.00 132.00 3,000.00
3,242.00 - - - - -
2,007.00 5.00 60.00 6.00 66.00 400.00
5,015.00 5.00 60.00 6.00 66.00 200.00
7,480.00 3.00 36.00 3.60 39.60 300.00
7,260.00 4.00 48.00 4.80 52.80 300.00
7,260.00 - - - - -
23.00 65.00 780.00 78.00 858.00 40,000.00
65,429.00 - - - - -
90,000.00 - - - - -
150,000.00 - - - - -
1,500.00 - - - - -
1,000.00 - - - - -
157.00 30.00 360.00 36.00 396.00 1,000.00
147.00 - - - - -
300.00 - - - - -
2,000.00 - - - - -
1,121.00 - - - - -
100.00 - - - - -
2,000.00 - - - - -
3,498.00 - - - - -
1,000.00 - - - - -
5,000.00 - - - - -
185.00 17.00 204.00 20.40 224.40 1,000.00
353.00 75.00 900.00 90.00 990.00 1,000.00
9,000.00 - - - - -
10,000.00 - - - - -
3,276.00 - - - - -
4,550.00 - - - - -
200.00 - - - - -
100,000.00 - - - - -
133.00 12.00 144.00 14.40 158.40 50,000.00
300.00 - - - - -
2,190.00 7.00 84.00 8.40 92.40 500.00
6,200.00 - - - - -
670.00 - - - - -
10,000.00 - - - - -
7,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
57,750.00 - - - - -
57,750.00 - - - - -
60,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
47,000.00 - - - - -
50,000.00 - - - - -
8,025.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
9,350.00 - - - - -
9,400.00 - - - - -
39,325.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
10,050.00 - - - - -
10,050.00 - - - - -
50,000.00 - - - - -
41,600.00 - - - - -
2,000.00 - - - - -
177,216.00 - - - - -
500.00 - - - - -
85.00 - - - - -
131.00 24.00 288.00 28.80 316.80 20,000.00
200.00 - - - - -
250.00 - - - - -
300.00 - - - - -
50,000.00 - - - - -
3,328.00 - - - - -
3,328.00 2.00 24.00 2.40 26.40 400.00
3,796.00 - - - - -
3,796.00 2.00 24.00 2.40 26.40 400.00
2,000.00 - - - - -
10,000.00 - - - - -
5,000.00 - - - - -
8,800.00 - - - - -
6,100.00 - - - - -
6,100.00 - - - - -
10,000.00 - - - - -
102.00 20.00 240.00 24.00 264.00 10,200.00

102.00 - - - - -
2,959.00 30.00 360.00 36.00 396.00 600.00
224.00 10.00 120.00 12.00 132.00 3,000.00
143.00 20.00 240.00 24.00 264.00 -

3,960.00 - - - - -
90.00 - - - - -
115.00 - - - - -
8,110.00 - - - - -
3,800.00 - - - - -
94.00 - - - - -
113.00 - - - - -
220.00 15.00 180.00 18.00 198.00 10,000.00
3,414.00 3.00 36.00 3.60 39.60 500.00
3,414.00 - - - - -
2,920.00 - - - - -
382.00 30.00 360.00 36.00 396.00 10,000.00
6,410.00 4.00 48.00 4.80 52.80 300.00
6,410.00 - - - - -
6,410.00 - - - - -
123.00 - - - - -
123.00 30.00 360.00 36.00 396.00 20,000.00
3,000.00 - - - - -
64,800.00 - - - - -
2,000.00 - - - - -
99.00 - - - - -
500.00 - - - - -
400.00 - - - - -
5,000.00 - - - - -
790.00 5.00 60.00 6.00 66.00 2,000.00
560.00 4.00 48.00 4.80 52.80 500.00

300.00 - - - - -
2,000.00 - - - - -
232,518.00 - - - - -
389,344.00 1.00 12.00 1.20 13.20 48.00
1,297,889.00 1.00 12.00 1.20 13.20 20.00
173,030.00 - - - - -
232,200.00 - - - - -
288,200.00 - - - - -
25,000.00 - - - - -
30,000.00 - - - - -
31,000.00 - - - - -
2,500.00 - - - - -
1,199.00 10.00 120.00 12.00 132.00 800.00
16,997.00 - - - - -
10,393.00 - - - - -
139.00 10.00 120.00 12.00 132.00 9,000.00
150.00 - - - - -
1,181.00 12.00 144.00 14.40 158.40 1,000.00
53.00 75.00 900.00 90.00 990.00 80,000.00
246,400.00 - - - - -
217,429.00 - - - - -
167,667.00 - - - - -
50,000.00 - - - - -
20,700.00 - - - - -
11,825.00 4.00 48.00 4.80 52.80 200.00
2,500.00 - - - - -
500.00 - - - - -
291.00 - - - - -
350.00 - - - - -
3,000.00 - - - - -
131.00 30.00 360.00 36.00 396.00 30,000.00
60.00 - - - - -
18,900.00 - - - - -
18,900.00 1.00 12.00 1.20 13.20 50.00
18,900.00 - - - - -
3,045.00 - - - - -
73.00 25.00 300.00 30.00 330.00 20,000.00
253.00 - - - - -
1,780.00 - - - - -
8,615.00 - - - - -
550.00 - - - - -
81.00 - - - - -
112.00 15.00 180.00 18.00 198.00 20,000.00
307.00 2.00 24.00 2.40 26.40 1,000.00
517.00 4.00 48.00 4.80 52.80 500.00
683.00 - - - - -
7,630.00 4.00 48.00 4.80 52.80 1,000.00
287.00 - - - - -
287.00 15.00 180.00 18.00 198.00 3,000.00
3,999.60 - - - - -
3,000.00 - - - - -
4,750.00 - - - - -
66.00 - - - - -
70.00 10.00 120.00 12.00 132.00 30,500.00
2,797.00 - - - - -
2,797.00 2.00 24.00 2.40 26.40 1,000.00
512,204.00 - - - - -
512,204.00 - - - - -
2,480,000.00 - - - - -
150,000.00 - - - - -
200,000.00 - - - - -
250,000.00 - - - - -
130,999.00 - - - - -
250,000.00 - - - - -
2,915.00 5.00 60.00 6.00 66.00 1,000.00
1,104.00 2.00 24.00 2.40 26.40 800.00
1,104.00 - - - - -
117.00 15.00 180.00 18.00 198.00 10,000.00
117.00 - - - - -
117.00 - - - - -
265.00 20.00 240.00 24.00 264.00 9,000.00
5,000.00 - - - - -
294.00 - - - - -
20,000.00 - - - - -
5,000.00 - - - - -
- - - - - -
8,100.00 - - - - -
170,000.00 - - - - -
5,000.00 - - - - -
163.00 - - - - -
323.00 10.00 120.00 12.00 132.00 5,000.00
3,000.00 - - - - -
91.00 40.00 480.00 48.00 528.00 30,500.00
3,000.00 - - - - -
4,000.00 - - - - -
91.00 30.00 360.00 36.00 396.00 10,000.00
5,000.00 - - - - -
61,996.00 5.00 60.00 6.00 66.00 200.00
19,954.00 10.00 120.00 12.00 132.00 200.00
23,991.00 8.00 96.00 9.60 105.60 500.00
82,005.00 - - - - -
100,000.00 - - - - -
17,996.00 - - - - -
16,995.00 10.00 120.00 12.00 132.00 600.00
78,991.00 20.00 240.00 24.00 264.00 200.00
155,813.00 - - - - -
135,000.00 - - - - -
158,994.00 5.00 60.00 6.00 66.00 200.00
165,000.00 - - - - -
165,000.00 - - - - -
296,000.00 - - - - -
189,607.00 - - - - -
1,750.00 - - - - -
6,000.00 - - - - -
89.00 50.00 600.00 60.00 660.00 50,000.00
20,000.00 - - - - -
500.00 - - - - -
14,980.00 - - - - -
6,290.00 - - - - -
524.00 25.00 300.00 30.00 330.00 20,000.00
#REF!
JUMLAH HARGA
KETERANGAN
(Rp)
(10) (11)
244,900.00 -
- -
- -
516,000.00 -
525,000.00 -
- -
- -
- -
47,500.00 -
835,000.00 -
- -
750,000.00 -
- -
- -
2,000,000.00 -
- -
12,450,000.00 -
- -
- -
460,800.00 -
3,480,000.00 -
1,277,400.00 -
- -
2,399,000.00 -
633,400.00 -
- -
- -
- -
525,000.00 -
- -
2,100,000.00 -
55,000.00 -
- -
- -
- -
3,090,000.00 -
- -
- -
- -
- -
- -
380,000.00 -
870,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
887,150.00 -
938,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
658,200.00 -
1,280,000.00 -
- -
880,110.00 -
1,735,000.00 -
430,000.00 -
- -
- -
547,500.00 -
104,000.00 -
- -
- -
- -
- -
990,000.00 -
- -
1,350,000.00 -
1,820,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
158,000.00 -
- -
- -
855,000.00 -
- -
- -
- -
- -
- -
2,209,200.00 -
710,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
246,000.00 -
- -
822,000.00 -
- -
- -
- -
- -
- -
- -
595,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,380,000.00 -
672,000.00 -
- -
- -
- -
800,000.00 -
- -
295,000.00 -
- -
480,000.00 -
- -
- -
- -
- -
- -
2,475,000.00 -
- -
1,100,000.00 -
- -
- -
- -
- -
- -
4,400,000.00 -
- -
- -
- -
222,000.00 -
- -
178,000.00 -
- -
- -
- -
1,035,100.00 -
- -
- -
1,890,000.00 -
- -
450,000.00 -
- -
- -
- -
980,000.00 -
- -
777,000.00 -
576,000.00 -
- -
- -
- -
- -
- -
930,000.00 -
- -
802,800.00 -
1,003,000.00 -
2,244,000.00 -
2,178,000.00 -
- -
920,000.00 -
- -
- -
- -
- -
- -
157,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
185,000.00 -
353,000.00 -
- -
- -
- -
- -
- -
- -
6,650,000.00 -
- -
1,095,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2,620,000.00 -
- -
- -
- -
- -
- -
1,331,200.00 -
- -
1,518,400.00 -
- -
- -
- -
- -
- -
- -
- -
1,040,400.00 -
- -
1,775,400.00 -
672,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
2,200,000.00 -
1,707,000.00 -
- -
- -
3,820,000.00 -
1,923,000.00 -
- -
- -
- -
2,460,000.00 -
- -
- -
- -
- -
- -
- -
- -
1,580,000.00 -
280,000.00 -
- -
- -
- -
18,688,512.00 -
25,957,780.00 -
- -
- -
- -
- -
- -
- -
- -
959,200.00 -
- -
- -
1,251,000.00 -
- -
1,181,000.00 -
4,240,000.00 -
- -
- -
- -
- -
- -
2,365,000.00 -
- -
- -
- -
- -
- -
3,930,000.00 -
- -
- -
945,000.00 -
- -
- -
1,460,000.00 -
- -
- -
- -
- -
- -
2,240,000.00 -
307,000.00 -
258,500.00 -
- -
7,630,000.00 -
- -
861,000.00 -
- -
- -
- -
- -
2,135,000.00 -
- -
2,797,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
2,915,000.00 -
883,200.00 -
- -
1,170,000.00 -
- -
- -
2,385,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,615,000.00 -
- -
2,775,500.00 -
- -
- -
910,000.00 -
- -
12,399,200.00 -
3,990,800.00 -
11,995,500.00 -
- -
- -
- -
10,197,000.00 -
15,798,200.00 -
- -
- -
31,798,800.00 -
- -
- -
- -
- -
- -
- -
4,450,000.00 -
- -
- -
- -
- -
10,480,000.00 -
297,978,652.00 -
REN
NO NAMA OBAT SATUAN
(1) (2) (3)

- OBAT -
ampul/vial/botol 25
2 Air untuk injeksi amp 25 ml
mL
Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 :
20 ampul/vial
80.000 inj 2 ml
21 tablet/kapsul/kaplet
22 botol 60 ml
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100
23 Kaps
mg
Antifungi salep, kombinasi : asam benzoat 6%+ asam
24 pot 30 g
salisilat 3%
Antihemoroid, kombinasi: bismut subgalat 150 mg +
25 heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida Suppositoria
120 mg + sup ad 2 g
Kertas warna
27 Articulating paper kertas warna penanda oklusi
penanda oklusi
36 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/k

aptab

tablet salut
93 Estrogen terkonjugasi tab sal 0,625 mg

97 Eugenol Botol
tablet salut
110 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m)

Garam oralit kombinasi : natrium klorida 0,52 g + kalium
120 klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 sachet
g
Glass ionomer ART (Atraumatic Restorative Treatment)
123 Sachet
cocoa butter 5 g
172 Kalamin Tube
tablet salut
204 Klorpromazin tab sal 100 mg selaput/kaplet salut
selaput
tablet salut
Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320
210 selaput/kaplet salut
mg tab sal selaput
selaput
Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab
215 tablet salut gula
salut
Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg +
218 Tab
Efavirenz 600 mg
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg ampul/vial
219
nebules
222 tab/kaptab
223 tab/kaptab
Kotrimoksazol kombinasi tiap 5 ml suspensi :
224 botol 60 mL
sulfametoksazol 200 mg + trimetoprim 40 mg
Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%)
229 Botol
(KN1)
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl Botol plastik @ 500
231
109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat ml
Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl
232 Softbag @ 500 ml
Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa
233 Botol
18.75 gr) (KA EN 1B)
Larutan mengandung Elektrolit (Sodium Lactate sol (50%)
234 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 Botol
gr/L, elektrolit)
Larutan mengandung Elektrolit (Tiap 1000 ml mengandung
235 Botol
236 Botol
237 Botol
Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33
238 Botol
g, Xylitol 30 g/ L)
Larutan mengandung Karbohidrat + Elektrolit (25.00g

240 maltose, 3.00 g sodium chloride, 0.15 g potassium chloride, Botol
Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K,

241 Botol
Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%,
242 Botol
Larutan mengandung Karbohidrat + Elektrolit (Fructose 120
243 Botol
g, glucose 66 g, Xylitol 60 g/ L + elektrolit)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g,
244 NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi Botol
ad 1000 ml)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ;

245 Botol
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0

246 Botol
g; NaCl: 4,5 g)
247 Botol
g; NaCl: 2.25 g) (D5-1/4NS)
248 Botol
g; NaCl: 4.5 g) (D5-1/2NS)
Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi
249 kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Botol
Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer
250 Botol
& Glukosa 5%)
251 Botol
252 Botol

253 Botol

254 Botol

syringe/syringe
256 Lidokain gel 2%
plastik
265 Lugol Botol
Metenamin mandelat (heksamin mandelat) tab salut enterik
276 Tab salut
500 mg
tablet/kaplet salut
280 Metilergometrin tab salut 0,125 mg
selaput
Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate,
292 Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Sachet
Acetate)
Botol plastik/botol
plastik pi
ampul/botol
plastik/botol plas
tablet salut
enterik
tablet salut
enterik
tablet salut
306 Nistatin tab salut 500.000 UI

362 pot 15 gram
%
363 pot 30 gram
%
Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua)
364 Vial
inj (i.m./i.v.)
Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj
365 Vial
(i.m./i.v.)
selaput
selaput
tablet salut
378 Siprofloksasin tab scored 500 mg selaput/kaplet salut
selaput
Catchcover, botol 0,6
379 Siprofloksasin tetes mata 3 mg/ml
ml
tablet salut
384 Tenofovir tab 300 mg selaput/kaplet salut
selaput
Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device
397 Vial
tablet salut enterik/
410 Valproat tab sal 250 mg
kaplet salut enterik
418 - -
419 - -
420 - -
421 - -
422 - -
423 - -
424 - -
425 - -
426 - -
427 - -
428 - -
429 - -
430 - -
431 - -
432 - -
433 - -
434 - -
435 - -
436 - -
437 - -
438 - -
439 - -
440 - -
441 - -
442 - -
443 - -
444 - -
445 - -
446 - -
447 - -
448 - -
449 - -
450 - -
451 - -
452 - -
453 - -
454 - -
455 - -
456 - -
457 - -
458 - -
459 - -
460 - -
461 - -
462 - -
463 - -
464 - -
465 - -
466 - -
467 - -
468 - -
469 - -
470 - -
471 - -
472 - -
473 - -
474 - -
475 - -
476 - -
477 - -
478 - -
479 - -
480 - -
481 - -
482 - -
483 - -
484 - -
485 - -
486 - -
- Jumlah Kebutuhan Obat -
RENCANA KEBUTUHAN OBAT
TAHUN 2021

(4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9)
2,449.00 5.00 60.00 6.00 66.00 100.00

2,449.00 - - - - -
4,000.00 - - - - -
430.00 640.00 7,680.00 768.00 8,448.00 1,200.00
105.00 10.00 120.00 12.00 132.00 5,000.00
105.00 - - - - -
2,789.00 - - - - -
95.00 - - - - -
95.00 7.00 84.00 8.40 92.40 500.00
167.00 40.00 480.00 48.00 528.00 5,000.00
99.00 - - - - -
75.00 17.00 204.00 20.40 224.40 10,000.00
26,620.00 - - - - -
3,628.00 - - - - -
2,000.00 7.00 84.00 8.40 92.40 1,000.00
195.00 - - - - -
249.00 55.00 660.00 66.00 726.00 50,000.00
8,237.00 #VALUE! #VALUE! #VALUE! -
8,237.00 - - - - -
1,152.00 20.00 240.00 24.00 264.00 400.00
58.00 65.00 780.00 78.00 858.00 60,000.00
2,129.00 5.00 60.00 6.00 66.00 600.00
1,298.00 - - - - -
4,798.00 12.00 144.00 14.40 158.40 500.00
3,167.00 14.00 168.00 16.80 184.80 200.00
312,000.00 - - - - -
38,999.00 - - - - -
80,000.00 - - - - -
105.00 18.00 216.00 21.60 237.60 5,000.00
105.00 - - - - -
105.00 28.00 336.00 33.60 369.60 20,000.00
55.00 22.00 264.00 26.40 290.40 1,000.00
55.00 - - - - -
55.00 - - - - -
64.00 - - - - -
103.00 27.00 324.00 32.40 356.40 30,000.00
103.00 - - - - -
5,000.00 - - - - -
3,000.00 - - - - -
1,500.00 - - - - -
200.00 - - - - -
380.00 15.00 180.00 18.00 198.00 1,000.00
145.00 15.00 180.00 18.00 198.00 6,000.00
145.00 - - - - -
145.00 - - - - -
145.00 - - - - -
529.00 - - - - -
748.00 - - - - -
1,639.00 - - - - -
1,595.00 - - - - -
52,833.00 - - - - -
1,774.30 3.00 36.00 3.60 39.60 500.00
1,340.00 5.00 60.00 6.00 66.00 700.00
1,340.00 - - - - -
1,380.00 - - - - -
2,500.00 - - - - -
5,730.00 - - - - -
5,800.00 - - - - -
319.00 - - - - -
10,378.00 - - - - -
10,378.00 - - - - -
10,378.00 - - - - -
14,000.00 - - - - -
140,000.00 - - - - -
140,000.00 - - - - -
140,000.00 - - - - -
141,600.00 - - - - -
500,000.00 - - - - -
1,097.00 5.00 60.00 6.00 66.00 600.00
32.00 20.00 240.00 24.00 264.00 40,000.00
18,279.00 - - - - -
12,573.00 1.00 12.00 1.20 13.20 70.00
1,735.00 6.00 72.00 7.20 79.20 1,000.00
86.00 30.00 360.00 36.00 396.00 5,000.00
114.00 - - - - -
312.00 - - - - -
1,095.00 30.00 360.00 36.00 396.00 500.00
104.00 15.00 180.00 18.00 198.00 1,000.00
127.00 - - - - -
4,290.00 - - - - -
4,650.00 - - - - -
127.00 - - - - -
99.00 15.00 180.00 18.00 198.00 10,000.00
280.00 - - - - -
2,700.00 35.00 420.00 42.00 462.00 500.00
91.00 22.00 264.00 26.40 290.40 20,000.00
1,408.00 - - - - -
1,408.00 - - - - -
135.00 - - - - -
546.00 - - - - -
6,090.00 - - - - -
750.00 - - - - -
92,100.00 - - - - -
26,250.00 - - - - -
99,000.00 - - - - -
230,000.00 - - - - -
18,824.00 - - - - -
7,980.00 - - - - -
158.00 60.00 720.00 72.00 792.00 1,000.00
158.00 - - - - -
171.00 - - - - -
171.00 35.00 420.00 42.00 462.00 5,000.00
629.00 - - - - -
629.00 - - - - -
50.00 - - - - -
2,000.00 - - - - -
50.00 - - - - -
3,682.00 15.00 180.00 18.00 198.00 600.00
710.00 60.00 720.00 72.00 792.00 1,000.00
2,349.00 - - - - -
150.00 - - - - -
2,000.00 - - - - -
150.00 - - - - -
2,500.00 - - - - -
116,000.00 - - - - -
10,000.00 - - - - -
2,500.00 - - - - -
82.00 15.00 180.00 18.00 198.00 3,000.00
5,000.00 - - - - -
274.00 5.00 60.00 6.00 66.00 3,000.00
5,000.00 - - - - -
6,000.00 - - - - -
270,583.00 - - - - -
270,583.00 - - - - -
270,583.00 - - - - -
119.00 - - - - -
119.00 20.00 240.00 24.00 264.00 5,000.00
1,000.00 - - - - -
218.00 - - - - -
289.00 - - - - -
300.00 - - - - -
1,500.00 - - - - -
4,000.00 - - - - -
4,000.00 - - - - -
5,000.00 - - - - -
7,500.00 - - - - -
4,000.00 - - - - -
4,000.00 - - - - -
5,000.00 - - - - -
6,900.00 3.00 36.00 3.60 39.60 200.00
224.00 13.00 156.00 15.60 171.60 3,000.00
224.00 - - - - -
400,000.00 - - - - -
400,000.00 - - - - -
4,000.00 30.00 360.00 36.00 396.00 200.00
59.00 - - - - -
59.00 30.00 360.00 36.00 396.00 5,000.00
59.00 - - - - -
60.00 30.00 360.00 36.00 396.00 8,000.00
17,099.00 - - - - -
1,325,000.00 - - - - -
15,000.00 - - - - -
15,000.00 - - - - -
149.00 - - - - -
2,475.00 4.00 48.00 4.80 52.80 1,000.00
2,000.00 - - - - -
1,100.00 10.00 120.00 12.00 132.00 1,000.00
176,800.00 - - - - -
200,000.00 - - - - -
2,475.00 - - - - -
3,000.00 - - - - -
105.00 - - - - -
220.00 15.00 180.00 18.00 198.00 20,000.00
83,500.00 - - - - -
98,000.00 - - - - -
90,000.00 - - - - -
74.00 10.00 120.00 12.00 132.00 3,000.00
173.00 - - - - -
89.00 20.00 240.00 24.00 264.00 2,000.00
500,000.00 - - - - -
350,000.00 - - - - -
11,000.00 - - - - -
10,351.00 12.00 144.00 14.40 158.40 100.00
227,700.00 - - - - -
400.00 - - - - -
63.00 40.00 480.00 48.00 528.00 30,000.00
75.00 - - - - -
75.00 25.00 300.00 30.00 330.00 6,000.00
75.00 - - - - -
3,500.00 - - - - -
200.00 - - - - -
245.00 30.00 360.00 36.00 396.00 4,000.00
300.00 - - - - -
2,590.00 12.00 144.00 14.40 158.40 300.00
288.00 15.00 180.00 18.00 198.00 2,000.00
578.00 - - - - -
578.00 - - - - -
300.00 - - - - -
350.00 - - - - -
200.00 - - - - -
310.00 10.00 120.00 12.00 132.00 3,000.00
3,242.00 - - - - -
2,007.00 5.00 60.00 6.00 66.00 400.00
5,015.00 5.00 60.00 6.00 66.00 200.00
7,480.00 3.00 36.00 3.60 39.60 300.00
7,260.00 4.00 48.00 4.80 52.80 300.00
7,260.00 - - - - -
23.00 65.00 780.00 78.00 858.00 40,000.00
65,429.00 - - - - -
90,000.00 - - - - -
150,000.00 - - - - -
1,500.00 - - - - -
1,000.00 - - - - -
157.00 30.00 360.00 36.00 396.00 1,000.00
147.00 - - - - -
300.00 - - - - -
2,000.00 - - - - -
1,121.00 - - - - -
100.00 - - - - -
2,000.00 - - - - -
3,498.00 - - - - -
1,000.00 - - - - -
5,000.00 - - - - -
185.00 17.00 204.00 20.40 224.40 1,000.00
353.00 75.00 900.00 90.00 990.00 1,000.00
9,000.00 - - - - -
10,000.00 - - - - -
3,276.00 - - - - -
4,550.00 - - - - -
200.00 - - - - -
100,000.00 - - - - -
133.00 12.00 144.00 14.40 158.40 50,000.00
300.00 - - - - -
2,190.00 7.00 84.00 8.40 92.40 500.00
6,200.00 - - - - -
670.00 - - - - -
10,000.00 - - - - -
7,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
10,000.00 - - - - -
57,750.00 - - - - -
57,750.00 - - - - -
60,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
47,000.00 - - - - -
50,000.00 - - - - -
8,025.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
9,350.00 - - - - -
9,400.00 - - - - -
39,325.00 - - - - -
50,000.00 - - - - -
50,000.00 - - - - -
10,050.00 - - - - -
10,050.00 - - - - -
50,000.00 - - - - -
41,600.00 - - - - -
2,000.00 - - - - -
177,216.00 - - - - -
500.00 - - - - -
85.00 - - - - -
131.00 24.00 288.00 28.80 316.80 20,000.00
200.00 - - - - -
250.00 - - - - -
300.00 - - - - -
50,000.00 - - - - -
3,328.00 - - - - -
3,328.00 2.00 24.00 2.40 26.40 400.00
3,796.00 - - - - -
3,796.00 2.00 24.00 2.40 26.40 400.00
2,000.00 - - - - -
10,000.00 - - - - -
5,000.00 - - - - -
8,800.00 - - - - -
6,100.00 - - - - -
6,100.00 - - - - -
10,000.00 - - - - -
102.00 20.00 240.00 24.00 264.00 10,200.00

102.00 - - - - -
2,959.00 30.00 360.00 36.00 396.00 600.00
224.00 10.00 120.00 12.00 132.00 3,000.00
143.00 20.00 240.00 24.00 264.00 -

3,960.00 - - - - -
90.00 - - - - -
115.00 - - - - -
8,110.00 - - - - -
3,800.00 - - - - -
94.00 - - - - -
113.00 - - - - -
220.00 15.00 180.00 18.00 198.00 10,000.00
3,414.00 3.00 36.00 3.60 39.60 500.00
3,414.00 - - - - -
2,920.00 - - - - -
382.00 30.00 360.00 36.00 396.00 10,000.00

6,410.00 4.00 48.00 4.80 52.80 300.00
6,410.00 - - - - -
6,410.00 - - - - -
123.00 - - - - -
123.00 30.00 360.00 36.00 396.00 20,000.00
3,000.00 - - - - -
64,800.00 - - - - -
2,000.00 - - - - -
99.00 - - - - -
500.00 - - - - -
400.00 - - - - -
5,000.00 - - - - -
790.00 5.00 60.00 6.00 66.00 2,000.00
560.00 4.00 48.00 4.80 52.80 500.00

300.00 - - - - -
2,000.00 - - - - -
232,518.00 - - - - -
389,344.00 1.00 12.00 1.20 13.20 48.00
1,297,889.00 1.00 12.00 1.20 13.20 20.00
173,030.00 - - - - -
232,200.00 - - - - -
288,200.00 - - - - -
25,000.00 - - - - -
30,000.00 - - - - -
31,000.00 - - - - -
2,500.00 - - - - -
1,199.00 10.00 120.00 12.00 132.00 800.00
16,997.00 - - - - -
10,393.00 - - - - -
139.00 10.00 120.00 12.00 132.00 9,000.00
150.00 - - - - -
1,181.00 12.00 144.00 14.40 158.40 1,000.00
53.00 75.00 900.00 90.00 990.00 80,000.00
246,400.00 - - - - -
217,429.00 - - - - -
167,667.00 - - - - -
50,000.00 - - - - -
20,700.00 - - - - -
11,825.00 4.00 48.00 4.80 52.80 200.00
2,500.00 - - - - -
500.00 - - - - -
291.00 - - - - -
350.00 - - - - -
3,000.00 - - - - -
131.00 30.00 360.00 36.00 396.00 30,000.00
60.00 - - - - -
18,900.00 - - - - -
18,900.00 1.00 12.00 1.20 13.20 50.00
18,900.00 - - - - -
3,045.00 - - - - -
73.00 25.00 300.00 30.00 330.00 20,000.00
253.00 - - - - -
1,780.00 - - - - -
8,615.00 - - - - -
550.00 - - - - -
81.00 - - - - -
112.00 15.00 180.00 18.00 198.00 20,000.00
307.00 2.00 24.00 2.40 26.40 1,000.00
517.00 4.00 48.00 4.80 52.80 500.00
683.00 - - - - -
7,630.00 4.00 48.00 4.80 52.80 1,000.00
287.00 - - - - -
287.00 15.00 180.00 18.00 198.00 3,000.00
3,999.60 - - - - -
3,000.00 - - - - -
4,750.00 - - - - -
66.00 - - - - -
70.00 10.00 120.00 12.00 132.00 30,500.00
2,797.00 - - - - -
2,797.00 2.00 24.00 2.40 26.40 1,000.00
512,204.00 - - - - -
512,204.00 - - - - -
2,480,000.00 - - - - -
150,000.00 - - - - -
200,000.00 - - - - -
250,000.00 - - - - -
130,999.00 - - - - -
250,000.00 - - - - -
2,915.00 5.00 60.00 6.00 66.00 1,000.00
1,104.00 2.00 24.00 2.40 26.40 800.00
1,104.00 - - - - -
117.00 15.00 180.00 18.00 198.00 10,000.00
117.00 - - - - -
117.00 - - - - -
265.00 20.00 240.00 24.00 264.00 9,000.00
5,000.00 - - - - -
294.00 - - - - -
20,000.00 - - - - -
5,000.00 - - - - -
- - - - - -
8,100.00 - - - - -
170,000.00 - - - - -
5,000.00 - - - - -
163.00 - - - - -
323.00 10.00 120.00 12.00 132.00 5,000.00
3,000.00 - - - - -
91.00 40.00 480.00 48.00 528.00 30,500.00
3,000.00 - - - - -
4,000.00 - - - - -
91.00 30.00 360.00 36.00 396.00 10,000.00
5,000.00 - - - - -
61,996.00 5.00 60.00 6.00 66.00 200.00
19,954.00 10.00 120.00 12.00 132.00 200.00
23,991.00 8.00 96.00 9.60 105.60 500.00
82,005.00 - - - - -
100,000.00 - - - - -
17,996.00 - - - - -
16,995.00 10.00 120.00 12.00 132.00 600.00
78,991.00 20.00 240.00 24.00 264.00 200.00
155,813.00 - - - - -
135,000.00 - - - - -
158,994.00 5.00 60.00 6.00 66.00 200.00
165,000.00 - - - - -
165,000.00 - - - - -
296,000.00 - - - - -
189,607.00 - - - - -
1,750.00 - - - - -
6,000.00 - - - - -
89.00 50.00 600.00 60.00 660.00 50,000.00
20,000.00 - - - - -
500.00 - - - - -
14,980.00 - - - - -
6,290.00 - - - - -
524.00 25.00 300.00 30.00 330.00 20,000.00
- - - - - -
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- - - - - -
- - - - - -
#REF!
JUMLAH HARGA
KETERANGAN
(Rp)
(10) (11)
244,900.00 -
- -
- -
516,000.00 -
525,000.00 -
- -
- -
- -
47,500.00 -
835,000.00 -
- -
750,000.00 -
- -
- -
2,000,000.00 -
- -
12,450,000.00 -
- -
- -
460,800.00 -
3,480,000.00 -
1,277,400.00 -
- -
2,399,000.00 -
633,400.00 -
- -
- -
- -
525,000.00 -
- -
2,100,000.00 -
55,000.00 -
- -
- -
- -
3,090,000.00 -
- -
- -
- -
- -
- -
380,000.00 -
870,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
887,150.00 -
938,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
658,200.00 -
1,280,000.00 -
- -
880,110.00 -
1,735,000.00 -
430,000.00 -
- -
- -
547,500.00 -
104,000.00 -
- -
- -
- -
- -
990,000.00 -
- -
1,350,000.00 -
1,820,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
158,000.00 -
- -
- -
855,000.00 -
- -
- -
- -
- -
- -
2,209,200.00 -
710,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
246,000.00 -
- -
822,000.00 -
- -
- -
- -
- -
- -
- -
595,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,380,000.00 -
672,000.00 -
- -
- -
- -
800,000.00 -
- -
295,000.00 -
- -
480,000.00 -
- -
- -
- -
- -
- -
2,475,000.00 -
- -
1,100,000.00 -
- -
- -
- -
- -
- -
4,400,000.00 -
- -
- -
- -
222,000.00 -
- -
178,000.00 -
- -
- -
- -
1,035,100.00 -
- -
- -
1,890,000.00 -
- -
450,000.00 -
- -
- -
- -
980,000.00 -
- -
777,000.00 -
576,000.00 -
- -
- -
- -
- -
- -
930,000.00 -
- -
802,800.00 -
1,003,000.00 -
2,244,000.00 -
2,178,000.00 -
- -
920,000.00 -
- -
- -
- -
- -
- -
157,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
185,000.00 -
353,000.00 -
- -
- -
- -
- -
- -
- -
6,650,000.00 -
- -
1,095,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2,620,000.00 -
- -
- -
- -
- -
- -
1,331,200.00 -
- -
1,518,400.00 -
- -
- -
- -
- -
- -
- -
- -
1,040,400.00 -
- -
1,775,400.00 -
672,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
2,200,000.00 -
1,707,000.00 -
- -
- -
3,820,000.00 -
1,923,000.00 -
- -
- -
- -
2,460,000.00 -
- -
- -
- -
- -
- -
- -
- -
1,580,000.00 -
280,000.00 -
- -
- -
- -
18,688,512.00 -
25,957,780.00 -
- -
- -
- -
- -
- -
- -
- -
959,200.00 -
- -
- -
1,251,000.00 -
- -
1,181,000.00 -
4,240,000.00 -
- -
- -
- -
- -
- -
2,365,000.00 -
- -
- -
- -
- -
- -
3,930,000.00 -
- -
- -
945,000.00 -
- -
- -
1,460,000.00 -
- -
- -
- -
- -
- -
2,240,000.00 -
307,000.00 -
258,500.00 -
- -
7,630,000.00 -
- -
861,000.00 -
- -
- -
- -
- -
2,135,000.00 -
- -
2,797,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
2,915,000.00 -
883,200.00 -
- -
1,170,000.00 -
- -
- -
2,385,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,615,000.00 -
- -
2,775,500.00 -
- -
- -
910,000.00 -
- -
12,399,200.00 -
3,990,800.00 -
11,995,500.00 -
- -
- -
- -
10,197,000.00 -
15,798,200.00 -
- -
- -
31,798,800.00 -
- -
- -
- -
- -
- -
- -
4,450,000.00 -
- -
- -
- -
- -
10,480,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
297,978,652.00 -
RENCANA KEB
NO NAMA OBAT SATUAN
(1) (2) (3)

- BAHAN MEDIS HABIS PAKAI -
1 ADS 0.05 ml Buah
2 ADS 0.5 ml Buah
3 ADS 5 ml Buah
7 Alkohol Swab Buah
8 Bisturi Buah
9 Blood set Buah
19 Jarum kulit Buah
20 Jarum otot Buah
21 Kaca Slide Buah
30 Masker N-95 Buah
35 Pot Dahak Buah
36 Safety box Buah
43 Sendok Obat Buah
45 Urin Bag Buah
46 - -
47 - -
48 - -
49 - -
50 - -
51 - -
52 - -
53 - -
54 - -
55 - -
56 - -
57 - -
58 - -
59 - -
60 - -
61 - -
62 - -
63 - -
64 - -
65 - -
- Jumlah Kebutuhan BMHP -
RENCANA KEBUTUHAN BAHAN MEDIS HABIS PAKAI
TAHUN 2021

(4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9)
- - - - - -
1,458.00 15.00 180.00 18.00 198.00 5,000.00
1,348.00 2.00 24.00 2.40 26.40 3,000.00
1,458.00 3.00 36.00 3.60 39.60 1,000.00
865.00 25.00 300.00 30.00 330.00 7,000.00
879.00 15.00 180.00 18.00 198.00 6,000.00
928.00 25.00 300.00 30.00 330.00 4,000.00
110.00 5.00 60.00 6.00 66.00 10,000.00
770.00 1.00 12.00 1.20 13.20 1,000.00
4,760.00 3.00 36.00 3.60 39.60 500.00
8,208.33 6.00 72.00 7.20 79.20 500.00
8,208.33 5.00 60.00 6.00 66.00 500.00
9,590.00 - - - - -
3,030.00 2.00 24.00 2.40 26.40 300.00
2,880.00 2.00 24.00 2.40 26.40 500.00
6,280.00 1.00 12.00 1.20 13.20 1,000.00
6,280.00 1.00 12.00 1.20 13.20 1,000.00
6,250.00 2.00 24.00 2.40 26.40 1,000.00
6,250.00 - - - - -
2,300.00 - - - - -
2,300.00 - - - - -
296.49 - - - - -
200,000.00 - - - - -
20,600.00 - - - - -
9,870.00 5.00 60.00 6.00 66.00 1,000.00
461.00 5.00 60.00 6.00 66.00 3,000.00
2,415.00 - - - - -
1,100.00 - - - - -
- - - - - -
330.00 50.00 600.00 60.00 660.00 50,000.00
6,707.00 - - - - -
37,371.00 2.00 24.00 2.40 26.40 150.00
- - - - - -
- - - - - -
- - - - - -
5,800.00 - - - - -
22,433.00 3.00 36.00 3.60 39.60 200.00
470.00 25.00 300.00 30.00 330.00 10,000.00
530.00 20.00 240.00 24.00 264.00 20,000.00
530.00 22.00 264.00 26.40 290.40 40,000.00
3,674.00 - - - - -
3,674.00 7.00 84.00 8.40 92.40 5,000.00
3,674.00 8.00 96.00 9.60 105.60 5,000.00
250.00 8.00 96.00 9.60 105.60 10,000.00
3,958.33 2.00 24.00 2.40 26.40 1,000.00
3,820.00 4.00 48.00 4.80 52.80 900.00

- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
#REF!
JUMLAH HARGA
KETERANGAN
(Rp)
(10) (11)
- -
7,290,000.00 -
4,044,000.00 -
1,458,000.00 -
6,055,000.00 -
5,274,000.00 -
3,712,000.00 -
1,100,000.00 -
770,000.00 -
2,380,000.00 -
4,104,166.67 -
4,104,166.67 -
- -
909,000.00 -
1,440,000.00 -
6,280,000.00 -
6,280,000.00 -
6,250,000.00 -
- -
- -
- -
- -
- -
- -
9,870,000.00 -
1,383,000.00 -
- -
- -
- -
16,500,000.00 -
- -
5,605,650.00 -
- -
- -
- -
- -
4,486,600.00 -
4,700,000.00 -
10,600,000.00 -
21,200,000.00 -
- -
18,370,000.00 -
18,370,000.00 -
2,500,000.00 -
3,958,333.33 -
3,438,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
182,431,916.67 -
RENC
NO NAMA OBAT SATUAN
(1) (2) (3)

- REAGEN -
5 Humasens Plus Set
9 Iodin test Botol
36 SD HCV Sachet
37 - -
38 - -
39 - -
40 - -
41 - -
42 - -
43 - -
44 - -
45 - -
46 - -
47 - -
48 - -
49 - -
50 - -
51 - -
- Jumlah Kebutuhan Reagen -
RENCANA KEBUTUHAN REAGEN
TAHUN 2021

(4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9)
- - - - - -
138,950.00 - - - - -
81,000.00 - - - - -
81,000.00 - - - - -
103,000.00 - - - - -
- - - - - -
550,800.00 - - - - -
252,300.00 - - - - -
544,400.00 - - - - -
5,000.00 - - - - -
- - - - - -
32,950.00 - - - - -
87,100.00 - - - - -
32,950.00 - - - - -
32,475.00 - - - - -
59,550.00 - - - - -
36,750.00 - - - - -
168,200.00 - - - - -
13,235.00 - - - - -
13,235.00 2.00 24.00 2.40 26.40 200.00
22,475.00 - - - - -
22,475.00 2.00 24.00 2.40 26.40 200.00
14,340.00 - - - - -
22,385.00 - - - - -
14,340.00 3.00 36.00 3.60 39.60 200.00
26,527.00 - - - - -
26,527.00 - - - - -
823,000.00 - - - - -
158,400.00 - - - - -
4,150.00 4.00 48.00 4.80 52.80 400.00
43,000.00 - - - - -
43,000.00 - - - - -
7,251.00 - - - - -
9,870.00 - - - - -
625,900.00 - - - - -
487,000.00 - - - - -
13,252.00 - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
-
JUMLAH HARGA
KETERANGAN
(Rp)
(10) (11)
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2,647,000.00 -
- -
4,495,000.00 -
- -
- -
2,868,000.00 -
- -
- -
- -
- -
1,660,000.00 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
11,670,000.00 -
hati-hati amox forte
klorhexidin
amox drop
bisakodil
framisetin
glukosa 40%
hidrogen peroksida
ibuprofen syr
kalsium karbonat
kaolin pektin
metoklor inj
Catatan:
1 Pengisian RKO ini dilakukan oleh petugas obat dan harus melibatkan pihak penulis resep di IGD, KIA, BP, RAWAT IN
2 Petugas obat mengisi pemakaian obat perbulan selama 2018 (pada sheet "ISI DATA PEMAKAIAN") dan analisa pem
3 Jenis obat yang terdapat pada sheet "ISI RENCANA KEBUTUHAN" sampai dengan nomor urut 413 sesuai dengan je
4 Pengisian jenis obat pada data RKO:
- dapat menggunakan jenis obat yang sudah BIASA digunakan
- menggunakan jenis obat baru yang TERDAPAT dalam sheet "ISI RENCANA KEBUTUHAN" nomor urut 1-413, yang s
- menggunakan jenis obat baru yang TIDAK TERDAPAT dalam sheet "ISI RENCANA KEBUTUHAN" hasil diskusi denga
dan pelayanan kesehatan PPK1 dan dituangkan dalam Formularium puskesmas yang telah disetujui
5 Penambahan jenis obat dapat dilakukan pada sheet "ISI DATA PEMAKAIAN" mulai nomor urut 298
6 Isi dengan manual kolom I pada sheet "ISI RENCANA KEBUTUHAN" dengan mempertimbangkan data hasil perhitu
dan juga analisa ditambah atau dikurang
7 Cek rasionalitas nilai rupiah total RKO tahunan nya
sep di IGD, KIA, BP, RAWAT INAP, GIZI, LAB, BP GIGI, Program P2P Dll dan ditandatangani oleh Kapus
PEMAKAIAN") dan analisa pemakaian rata-rata pada kolom S nya
mor urut 413 sesuai dengan jenis obat yang terdapat di FORNAS untuk PPK1, tidak boleh diubah urutannya
HAN" nomor urut 1-413, yang sesuai dg fornas tkt.I

BUTUHAN" hasil diskusi dengan tim di Puskesmas, sepanjang sesuai dengan indikasi medis
telah disetujui
omor urut 298
timbangkan data hasil perhitungan di kolom H, pembulatan angka, peningkatan kasus/sasaran,

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1 Albendazol Tablet 400 mg Tablet

230 0 500 300 430 580 580 432 657 0

246 5 280 750 5 0 0 420 0 8

0 15 0 38 27 310 310 254 239 29

0 230 0 130 65 90 110 90 0 0

230 130 420 320 60 220 230 210 390 60

210 230 0 139 20 130 90 0 34 60

340 254 230 94 34 211 321 290 245 324

200 0 100 36 0 110 100 0 230 0

1 Albendazol Tablet 400 mg Tablet

3 Aminofilin Inj 24 mg/ml-10 ml Ampul

4 Aminofilin Tablet 200 mg Tablet

6 Amlodipin Tablet 5 mg Tablet

303 Amoxcicillin Forte Syr Botol

7 Amoksisilin Kaplet 500 mg Kaplet

115 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 8000 Ampul

9 Antasida DOEN I Tablet Kunyah Tablet

10 Antasida II Suspensi 60 ml Botol

13 Antifungi DOEN kombinasi Pot

11 Anti Hemmoroid DOEN Supp

304 Arte Sunat Inj 60 mg Ampul

24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet

25 Asam Askorbat (VIT C) Tablet 50 mg Tablet

29 Asiklovir Tablet 400 mg Tablet

31 Atropin Sulfat Inj 0,25 mg/ml Ampul

194 Temporary Restorative Material Botol

41 Deksametason Inj 5 mg/ml-1 ml Ampul

48 Diazepam Rectal 5 mg/2,5 ml tube

294 Diethyk karbamazin 100 mg Tablet

58 Eritromisin Kapsul 250 mg Kapsul

62 Etanol 70 %- 1000 ml Botol

64 Eugenol Cairan Botol

65 Fenitoin Natrium Kapsul 100 mg Kapsul

66 Fenobarbital Tablet 30 mg Tablet

67 Fenoksimetil Penisilin Tablet 500 mg Tablet

69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul

72 Formokresol Cair Botol

73 Furosemid Tablet 40 mg Tablet

74 Garam Oralit I Serbuk Sachet

78 Glibenklamid Tablet 5 mg Tablet

46 Dextrose Inj 40% Vial

80 Glukosa Larutan Infus 5% steril Fls

84 Haloperidol Inj 5 mg/ml Ampul

85 Haloperidol Tablet 1,5 mg Tablet

295 Hepatitis B Imunoglobulin vial

86 Hidrokortison Krim 2,5 % Tube

87 Hiosina butilbromida tab 10 mg Tablet

89 Ibuprofen Tablet 400 mg Tablet

90 Isoniazid Tablet 100 mg Tablet

92 Kalsium glukonat inj 100 mg/ml Ampul

94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet

95 Kaptropil Tablet 25 mg Tablet

96 Karbamazepin Tablet 200 mg Tablet

103 Klindanmisin Tablet 300 mg Tablet

104 Kloramfenikol Kapsul 250 mg Kapsul

111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet

112 Klorpropmazin HCl Tablet salut 100 mg Tablet

39 Clozapine Tablet 25 mg Tablet

40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket

20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet

175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul

114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet