Obat E-Katalog 2014 Pengadaan

DAFTAR OBAT E-KATALOG
No
Wilayah
1.
DKI Jakarta
2.
DKI Jakarta
3.
Spesifiaksi obat
ACT (Artesunate tablet 50 mg + Amodiaquine
anhydrida tablet 200 mg)
Pabrikan
Satuan
Harga
n/a
PT. Kimia Farma
1 blister@24 tablet
1,375.00
Adefovir Dipivoksil tablet/kaplet 10 mg
Hepsera
PT. SmithKline Beecham

Phamaceuticals
DKI Jakarta
Albendazol suspensi 200 mg/5 ml
n/a
PT. Indofarma
Dus, 3 Blister @ 10
kapsul
Dus, 10 dus @ 1 botol
@ 10 ml
4.
DKI Jakarta
Albendazol tablet/kapsul/kaplet 400 mg
n/a
PT. Holi Pharma
5.
DKI Jakarta
Alopurinol tablet/kapsul/kaplet 100 mg
n/a
PT. Pertiwi Agung
6.
DKI Jakarta
Alprazolam tablet/kapsul/kaplet 0,25 mg
n/a
PT. Dexa Medica
7.
8.
9.
DKI Jakarta
DKI Jakarta
DKI Jakarta
Alprazolam tablet/kapsul/kaplet 0,5 mg

Alprazolam tablet/kapsul/kaplet 1 mg
Amfoterisin B salep mata 1%
n/a
n/a
Fungicide
Glybotic 250
mg /ml
n/a
n/a
Cordarone
Kendaron
Tablet
PT. Otto Pharmaceuticals

PT. Kimia Farma
PT. Cendo Industri Farmasi
Box, 10 strips @ 10
tablets
Dus, 10 Strip @ 10
tablet
strip
Ktk 10x10 tablet
tube 3.5 gr
PT. Sanbe Farma
Vial 2 ml
50,500.00
PT. Phapros, Tbk

PT. Erela
PT. Aventis Pharma
Dus @ 30 Ampul
Botol @100 Tablet
Dus, 6 ampul @ 3 ml
3,818.00
80.00
12,480.00
PT. Darya Varia
strip
1,200.00
Dus, 10 strip @ 10 tss
112.00
10. DKI Jakarta
Amikasin injeksi 250 mg/ml
11. DKI Jakarta

12. DKI Jakarta
13. DKI Jakarta
Aminofilin injeksi 24 mg/ml

Aminofilin tablet scored 200 mg
Amiodaron injeksi 150 mg/3 ml
14. DKI Jakarta
Amiodaron tablet/kaplet 200 mg
15. DKI Jakarta
Amitriptilin tablet salut 25 mg (HCl)
n/a
PT. Indofarma
16. DKI Jakarta
Amlodipin tablet 10 mg
n/a
PT. Pertiwi Agung
17. DKI Jakarta
Amlodipin tablet 5 mg
n/a
PT. Pertiwi Agung
18. DKI Jakarta
Amoksisilin kapsul/kaplet 250 mg
n/a
PT. Novapharin
Page 1 of 31
27,500.00
3,849.00
Dus, 5 strip @ 6 tablet 344.00
Box, 3 strips @ 10
tablets
Box, 3 strips @ 10
tablets
strip
86.00
380.00
176.00
233.00
18,500.00
330.00
187.00
211.00
19. DKI Jakarta
Amoksisilin kapsul/kaplet/tablet scored 500 mg
n/a
20. DKI Jakarta

21. DKI Jakarta
Amoksisilin sirup kering forte 250 mg/5 ml

Amoksisilin sirup kering 125 mg/ 5 ml
n/a
n/a
22. DKI Jakarta
Analog insulin long acting inj 100 UI/ml,

vial/cartridge disposible/penfill cartridge (Insulin
glargine 100 IU/ml)
PT. Mersifarma Tirmaku

Mercusana
PT. Holi Pharma
PT. Novapharin
KOTAK @ 10 x 10 TAB
261.00
Dus, Botol 60 ml
btl @ 60 ml
4,070.00
2,445.00
Lantus Solostar
100IU/ml 5pens PT. Aventis Pharma
x3ml
dus, 5 solostar pen @

3ml
85,000.00
Novomix
Flexpen
PT. Ferron Par

Pharmaceuticals
Injeksi 100 IU/ml,

Flexpen disposible 3 ml
106,000.00
(1 box isi 5 flexpen
disposible)
Humalog Mix
25
PT. Tempo Scan Pacific
Penfill cartridge
25. DKI Jakarta
Analog insulin rapid acting inj 100 UI/ml,

Aspart (Analogue))
Novorapid
Flexpen
PT. Ferron Par

Pharmaceuticals
Injeksi 100 IU/ml,

Flexpen disposible 3 ml
85,345.00
(1 box isi 5 flexpen
disposible)
26. DKI Jakarta
Analog insulin rapid acting inj 100 UI/ml,

Aspart (Analogue))
Novorapid Vial
PT. Ferron Par

Pharmaceuticals
Dus, vial 10 ml
200,000.00
27. DKI Jakarta
Analog insulin rapid actinginj 100 UI/ml,

glulisine 100 IU/ml)
Apidra Solostar
100IU/ml 5pens PT. Aventis Pharma
x3ml
dus, 5 solostar pen @

3ml
79,165.00
28. DKI Jakarta
Analog insulin rapid actinginj 100 UI/ml,

lispro (rDNA origin))
Humalog
Penfill cartridge
79,167.00
29. DKI Jakarta
Anastrozol tablet/kapsul/kaplet 1 mg
Arimidex 1 mg
PT. AstraZeneca indonesia
Dus, 2 blister @ 14
Tablet
32,000.00
23. DKI Jakarta
24. DKI Jakarta
Analog insulin mix acting inj 100 UI/ml, Analog

insulin mix acting inj 100 UI/ml (Premix 30% Insulin
Aspart + 70% Protaminated Insulin Aspart
(Analogue))
Analog insulin mix insulininj 100 UI/ml,
vial/cartridge disposible/penfill cartridge (25%
insulin lispro, 75% insulin lispro protamine
suspension, (rDNA))
Page 2 of 31
97,500.00
30. DKI Jakarta
31. DKI Jakarta

32. DKI Jakarta
33. DKI Jakarta
34. DKI Jakarta
35. DKI Jakarta
36.
37.
38.
39.
DKI Jakarta
DKI Jakarta
DKI Jakarta
DKI Jakarta
Antasida DOEN I tablet kunyah, kombinasi :

Aluminium Hidroksida 200 mg Magnesium
Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
mg/5 ml
Anti Bakteri DOEN salep kombinasi: Basitrasin 500
IU/g Polimiksin 10.000 IU/g
Antimalaria DOEN kombinasi : Pirimetamin 25 mg
Sulfadoksin 500 mg
n/a
PT. Erela
Dus, 10 Strip @ 10
Tablet
72.00
n/a
PT. Lucas Djaja
btl 60 ml
2,140.00
n/a
PT. Indofarma
Dus, 25 tube @ 5 g
2,516.00
n/a
PT. Kimia Farma
ktk 10 x 10 tablet
518.00
Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a
PT. Kimia Farma
Btl 100 tablet
135.00
Antiparkinson DOEN tablet kombinasi : Benserazid

25 mg Levodopa 100 mg
Artemether injeksi 80 mg/ml
Asam Askorbat (Vitamin C) tablet 50 mg
Asam Folat tablet/kapsul/kaplet 1 mg
Asam Ibandronat injeksi 6mg/6ml
Levopar Tablet PT. Meprofarm
Dus, 5 strip @ 10 tablet 1,500.00
Artem
n/a
n/a
Bondronat
PT. Kimia Farma

PT. Kimia Farma
PT. Marin Liza Farmasi
PT. Boehringer Ingelheim
22,000.00
95.00
48.00
2,209,000.00
n/a
PT. Bernofarm
Dus 6 amp @ 1ml

Dus 10 strip x 10 tab
Botol @ 100 tablet
Boks, 1 ampul
Dus, 10 blister @ 10
kaptab ss
Strip
1,815.00
Dus, 10 ampul @ 5 ml
3,334.00
Tube 3,5 gram
24,750.00
40. DKI Jakarta
Asam Mefenamat kapsul/kaplet 500 mg
41. DKI Jakarta
Asam pipemidat kapsul 400 mg
42. DKI Jakarta
Asam traneksamat injeksi 100 mg/ml
43. DKI Jakarta
Asiklovir salep mata 3%
44. DKI Jakarta
Asiklovir tablet/kapsul/kaplet 200 mg
n/a
PT. Indofarma
45. DKI Jakarta
Asiklovir tablet/kapsul/kaplet 400 mg
n/a
PT. Indofarma
46. DKI Jakarta
Asparaginase serbuk injeksi 10.000 UI/vial
Leunase
PT. Widatra Bhakti
tablet
tablet
10.000 UI/Vial
47. DKI Jakarta
Atapulgit tablet 600 mg
Pularex
PT. Zenith Pharmaceuticals
Dus 5 strip @ 10 tablet 190.00
Urotractin 400
PT. Sanbe Farma
mg
PT. Hexpharm Jaya
n/a
Laboratories
Temiral Eye
PT. Sanbe Farma
Oint
Page 3 of 31
112.00
237.00
355.00
1,039,500.00
48. DKI Jakarta
Atrakurium injeksi 25 mg/2,5 ml
Tracrium
PT. Glaxo Wellcome Indonesia Dus, 5 ampul @ 2.5 ml 20,000.00
49. DKI Jakarta
Atropin Sulfat tablet 0,5 mg
n/a
PT. Indofarma
50. DKI Jakarta

51. DKI Jakarta
52. DKI Jakarta
Azitromisin sir kering 200 mg/ 5 mL

Azitromisin tablet 500 mg
Azitromisin tablet 250 mg
n/a
n/a
n/a
53. DKI Jakarta
Bedak salisil serbuk 2%
n/a
54. DKI Jakarta

55. DKI Jakarta
56. DKI Jakarta
Benzatin Benzil Penisilin 1,2 juta IU/ vial

Benzatin Benzil Penisilin 2,4 juta IU/vial
Beractant injeksi / suspensi 25 mg/mL
n/a
n/a
Survanta
PT. Soho Industri Pharmasi

PT. Kimia Farma
PT. Rama Emerald Multi
Sukses
PT. Phapros, Tbk
PT. Phapros, Tbk
PT. Abbott Indonesia
57. DKI Jakarta
Beraprost sodium tablet 20 mcg
Dorner
PT. Combiphar
58. DKI Jakarta
Beraprost sodium tablet 20 mcg
Dorner 20 g
PT. Combiphar
59. DKI Jakarta
Betametason krim 0,1% (sebagai Valerat)
PT. Kimia Farma
60. DKI Jakarta
Bikalutamid tablet salut 150 mg
n/a
Casodex 150
mg
61. DKI Jakarta
Bikalutamid tablet salut 50 mg
Casodex 50 mg PT. AstraZeneca indonesia
62. DKI Jakarta

63. DKI Jakarta
64. DKI Jakarta
Bisakodil suppositoria 10 mg
Bisoprolol tablet 5 mg
Bromokriptin tablet 2,5 mg
65. DKI Jakarta
Budesonid inhaler 200 mcg/puff, 100 dosis
66. DKI Jakarta
Budesonid respules / cairan inhaler 0,25mg/mL
67. DKI Jakarta
Budesonid-formoterol (fixed combination) inhaler

160/4,5 mcg
68. DKI Jakarta
Budesonid-formoterol (fixed combination) inhaler

80/4,5 mcg
Stolax supp
n/a
Cripsa tab
Pulmicort
Turbuhaler
Pulmicort
Respules
Symbicort
Turbuhaler
160/4.5 mcg
Symbicort
80/4.5 mcg
Page 4 of 31
PT. Sanbe Farma

PT. Pratapa Nirmala
PT. Caprifarmindo
Dus, 10 strip @ 10
tablet
botol @ 60 ml
ktk 2x10 tablet
Strip
74.00
34,400.00
4,500.00
3,333.00
Dus @ 50 gram
1,250.00
Dus @ 10 Vial
Dus @ 10 Vial
Vial
Box @ 3 blister @ 10
Tablet
Box/ 3 blister @ 10
Tablet
Tube 5 gr
Dus, 2 blister @ 14
Tablet
Dus, 2 blister @ 14
Tablet
Supp
Box 3 X 10 tab
Box 3 x 10'S
Dus, 1 Turbuhaler @
100 dosis
Dus, 4 pak @ 5
respules @ 2 ml
9,800.00
13,400.00
3,200,000.00
3,600.00
3,600.00
1,520.00
72,400.00
45,000.00
6,045.00
645.00
247,089.00
93,000.00
8,900.00
Dus, 1 Turbuhaler @
120 dosis
Dus, 1 Turbuhaler @ 60
110,500.00
dosis
117,600.00
Exjade 250 mg
Tab
Exjade 500 mg
Tab
Deferasiroks tablet disp/ eff 250 mg
70. DKI Jakarta
Deferasiroks tablet disp/ eff 500 mg
71. DKI Jakarta
Deferoksamin Mesilat serbuk injeksi 500 mg
Desferal
PT. Novartis Indonesia
Dus, 10 vial @ 500mg
72. DKI Jakarta
Deksametason injeksi i.v./i.m. 5 mg/ml
n/a
PT. Indofarma
Dus, 100 ampul @ 1 ml 1,580.00
73. DKI Jakarta
Deksametason tablet 0,5 mg
n/a
Dus, 10 strip @ 10
tablet
74. DKI Jakarta
Desoksimetason krim 0,25%
n/a
PT. Dexa Medica
Kotak, tube @ 15 gram 9,983.00
75. DKI Jakarta
Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl)
n/a
PT. Lucas Djaja
ampul @ 1 ml
1,054.00
76. DKI Jakarta
Digoksin tablet 0,25 mg
n/a
PT. Yarindo Farmatama
97.00
77. DKI Jakarta
Diltiazem HCl tablet 30 mg
n/a
PT. Indofarma
Box 10 X 10 Tab
Dus, 10 strip @ 10
tablet
78. DKI Jakarta
Diltiazem infus injeksi 50 mg
Herbesser
Powder
PT. Tanabe Indonesia
Injection 50mg
10 vial @ 50mg
127,667.00
79. DKI Jakarta
Diltiazem injeksi 25 mg/5 mL
PT. Pratapa Nirmala
Vial 5 mL
46,667.00
80. DKI Jakarta
Diltiazem Kapsul SR 100 mg
3 blister @ 10 kapsul
3,667.00
81. DKI Jakarta
Diltiazem Kapsul SR 200 mg
3 blister @ 10 kapsul
4,015.00
82. DKI Jakarta

83. DKI Jakarta
Dimenhidrinat tablet 50 mg
Dinatrium edetat tetes mata 0,35%
Farmabes
Injeksi 25 mg
Herbesser CD
100
Herbesser CD
200
n/a
E.D.T.A
PT. Kimia Farma

104.00
37,500.00
84. DKI Jakarta
Doksazosin mesilat tablet 1 mg
Cardura 1mg
PT. Pfizer Indonesia
85. DKI Jakarta
Doksazosin mesilat tablet 2 mg
Cardura 2mg
Btl 100 tablet

botol 15 ml
Dus, 5 blister @10's
tab
Dus, 5 blister @10's
tab
Page 5 of 31
Dus, 4 blister @ 7
tablet
Dus, 4 blister @ 7
tablet
69. DKI Jakarta
76,000.00
150,000.00
112,000.00
68.00
134.00
3,480.00
5,480.00
86. DKI Jakarta
Doksorubisin serbuk injeksi i.v. 10 mg/vial
87.
88.
89.
90.
Doksorubisin serbuk injeksi i.v. 50 mg/vial

Domperidon suspensi/sirup 5 mg/5 ml
Domperidon tablet 10 mg
Domperidon tetes 5 mg/mL
Doxorubicin HCl
2 mg/ml
Doxorubin
n/a
n/a
n/a
91. DKI Jakarta
Dosetaksel injeksi 20 mg/0,5 ml
92. DKI Jakarta
PT. Sanbe Farma
vial @ 5 ml
60,000.00
PT. Combiphar
PT. Novapharin
PT. Novapharin
PT. Bernofarm
Vial 50mg/25ml
btl @ 60 ml
strip
Dus, botol @ 10 ml
279,000.00
3,333.00
167.00
15,600.00
n/a
PT. Sanbe Farma
Dus, 1 vial @0,5 ml+ 1

970,200.00
vial pelarut @1,5 ml
Dutasterid kaps lunak 0,5 mg
Avodart

Phamaceuticals
93. DKI Jakarta
Eksemestan tablet 25 mg
Aromasin
94. DKI Jakarta
Enoksaparin sodium inj 20 mg/0,2 mL
95. DKI Jakarta
96. DKI Jakarta
97. DKI Jakarta
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml
n/a
98. DKI Jakarta
Epirubisin serb injeksi 50 mg/25ml
99. DKI Jakarta
DKI Jakarta
DKI Jakarta
DKI Jakarta
DKI Jakarta
Lovenox 2000
ANTI-XA
Lovenox 4000
ANTI-XA
Lovenox 6000
ANTI-XA
PT. Aventis Pharma

PT. Aventis Pharma
PT. Aventis Pharma
7,100.00
42,600.00
40,740.00
71,875.00
100,000.00
Dus @ 30 Ampul
8,100.00
Epirubisin Kalbe PT Kalbe Farma
Vial @ 25 ml
500,000.00
Epirubisin serb injeksi 10 mg/5 ml
n/a
PT. Sanbe Farma
100. DKI Jakarta
Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI
D-Vit FT
PT. Gracia Pharmindo
101. DKI Jakarta
Ergokalsiferol (vitamin D3/D2) suspensi 10.000

UI/ml
D-Vit Syrup
Dus, 1 vial @5 ml
128,000.00
Dus 3 strip @ 10 Flash
650.00
tablet
Dus, Botol Plastik @
8,000.00
100 mL
102. DKI Jakarta
Eritromisin kapsul/kaplet 250 mg
n/a
PT. Kimia Farma
ktk 10 x 10 kapsul
497.00
103. DKI Jakarta
Eritromisin kapsul/kaplet 500 mg
n/a
PT. Indofarma
kss
930.00
Page 6 of 31
PT. Phapros, Tbk
Dus, Botol Plastik @ 30

Tablet
Dus, 2 blister @ 15
tablet
dus, 2 prefilled syringe
@ 0,2 ml
@ 0,4 ml
@ 0,6 ml
104. DKI Jakarta
Eritromisin sirup kering 200 mg/ 5 ml
n/a
PT. Phyto Kemo Agung Farma Botol @60 ml
7,700.00
105. DKI Jakarta
Eritropoetin-beta inj 2000 UI/0,3 mL
Recormon
Boks, 6 ampul
139,500.00
106. DKI Jakarta
Etambutol tablet 250 mg (HCl)
n/a
PT. Kimia Farma
ktk 20 x 10 tablet
314.00
107. DKI Jakarta
Etambutol tablet salut 500 mg (HCl)
n/a
PT. Indofarma
Dus, 10 strip @ 10 tss
451.00
108. DKI Jakarta
Etanol 70% cairan
n/a
PT. Novapharin
btl @ 100 ml
2,500.00
109. DKI Jakarta
Etonogestrel implan 68 mcg
Implanon
PT. Merck Sharp Dohme

Pharma Tbk
Dus, 1 blister @ 1
subdermal implant
128,779.00
110. DKI Jakarta
Etoposid injeksi 20 mg/ml
Posyd
PT. Combiphar
Vial 100mg/5ml
100,000.00
111. DKI Jakarta
Eugenol cairan
n/a
PT. Kimia Farma
Botol 10 ml
16,667.00
112. DKI Jakarta
Everolimus tab 0,25 mg
113. DKI Jakarta
Everolimus tab 0,5 mg
114. DKI Jakarta
Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut

Novoseven
untuk injeksi
PT. Ferron Par

Pharmaceuticals
115. DKI Jakarta
Fenitoin injeksi 50 mg/ml
n/a

Mercusana
KOTAK @ 10 ampul
20,250.00
116. DKI Jakarta
Fenitoin kapsul/kaplet 100 mg
n/a
PT. Ikapharmindo
Botol @ 100
133.00
117. DKI Jakarta
Fenobarbital injeksi i.m./i.v. 50 mg/ml
n/a
PT. Phapros, Tbk
Dus @ 30 Ampul
1,800.00
118. DKI Jakarta
Fenofibrat kaps 100 mg
n/a
119. DKI Jakarta
Fenofibrat kaps 300 mg
n/a
PT. Hexpharm Jaya

Laboratories
PT. Hexpharm Jaya
Laboratories
Dus, 3 strip @ 10
kapsul
Dus, 3 strip @ 10
kapsul
Certican 0,25
mg Tab
Certican 0,5 mg
Tab
Page 7 of 31
Dus, 6 blister @ 10
tablet
Dus, 6 blister @ 10
tablet
KOTAK @ 1 VIAL
SERBUK OBAT &
INFUSION KIT
11,813.00
23,250.00
9,200,000.00
1,075.00
1,375.00
120. DKI Jakarta
Fenoksimetil penisilin (penisilin V) tablet 250 mg
n/a
PT. Phapros, Tbk
Dus @ 10 X 10 's
290.00
121. DKI Jakarta
Fenoksimetil penisilin (penisilin V) tab 125 mg
Fenocin
PT. Actavis Indonesia
Dus 45 x 12 tab
235.00
122. DKI Jakarta
Fenoksimetil penisilin (penisilin V)tablet 500 mg
n/a
PT. Phapros, Tbk
Dus @ 10 X 10 's
510.00
123. DKI Jakarta
Fenoterol HBr inh solution 0,1%
Berotec
Solution
Dus, Canister 200 dosis 117,500.00
124. DKI Jakarta
Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10 ml
n/a
PT. Kimia Farma
Dus 5 ampul@ 10ml
128,000.00
125. DKI Jakarta
Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 2 ml
n/a
PT. Kimia Farma
Dus 5 ampul@ 2ml
33,914.00
126. DKI Jakarta
Fentanil patch 12,5 mcg/jam
Durogesic 12,5
PT. Kimia Farma
MU Matrix
Dus @ 5 patch
80,000.00
127. DKI Jakarta
Fentanil patch 25 mcg/jam
PT. Kimia Farma
Dus@ 5 patch
153,000.00
128. DKI Jakarta
Fentanil patch 50 mcg/jam
PT. Kimia Farma
Dus@ 5 patch
285,000.00
129. DKI Jakarta
Filgrastim inj 300 mcg/mL
Leucogen
PT Kalbe Farma
pfs @ 0,5 ml
375,000.00
130. DKI Jakarta
Fitomenadion (Vit.K1) tablet salut gula 10 mg
n/a
Botol @ 100 tablet

salut gula
634.00
131. DKI Jakarta
Fludarabin inj 50 mg
Fludara IV LYO
PT. Aventis Pharma
Dus, 5 vial @ 50 mg
1,248,319.00
132. DKI Jakarta
Fludarabin tab 10 mg
Fludara Oral
PT. Aventis Pharma
Dus, 4 blister @ 5
tablet salut selaput
275,000.00
133. DKI Jakarta
Flufenazin injeksi i.m. 25 mg/ml
Sikzonoate
Injeksi

Mercusana
Dus, 5 ampul @ 1ml
55,000.00
134. DKI Jakarta
Flukonazol injeksi 2 mg/ml
n/a
PT. Natura Laboratoria Prima
Dus, 1 Botol @ 100 mL 47,100.00
135. DKI Jakarta
Flukonazol tablet/kapsul 150 mg
n/a
PT. Kimia Farma
ktk 1 x 10 kapsul
Durogesic 25
MU Matrix
Durogesic 50
MU Matrix
Page 8 of 31
22,000.00
136. DKI Jakarta
Fluoksetin tablet 10 mg
Foransi 10
strip
419.00
137. DKI Jakarta
Fluoksetin tablet 20 mg
NOPRES
PT. Dexa Medica
DUS, 30 TABLET
421.00
138. DKI Jakarta
Fluorourasil inj 250 mg/mL
Curacil
PT Kalbe Farma
vial @ 1 ml
24,500.00
139. DKI Jakarta
Fluorourasil inj 500 mg/ 5 mL
Curacil
PT Kalbe Farma
vial @ 10 ml
33,000.00
140. DKI Jakarta
Flusinolon asetonid krim 0,025%
SYNARCUS
PT. Ifars Pharmaceutical

Laboratories
Dus, Tube 5 g
2,400.00
141. DKI Jakarta
Flutikason furoat intranasal spray
Avamys
142. DKI Jakarta
Flutikason propionat nebules 0,5 mg
143. DKI Jakarta
Fondaparinuks inj 2,5 mg/0,5 mL
Arixtra
PT. Glaxo Wellcome Indonesia Dus, 2 pfs 0.5 ml
241,667.00
144. DKI Jakarta
Furosemid injeksi i.v./i.m. 10 mg/ml
n/a
PT. Indofarma
1,829.00
145. DKI Jakarta
Furosemid tablet 40 mg
n/a
PT. Indofarma
Dus, 10 strip @ 10
tablet
85.00
146. DKI Jakarta
Gansiklovir serb inj 500 mg (50 mg/mL)
Cymevene
Boks, 1 ampul
399,500.00
147. DKI Jakarta
Gefitinib tab 250 mg
Iressa 250 mg
148. DKI Jakarta
Gemfibrozil kapsul/kaplet 300 mg
n/a
PT. Indofarma
149. DKI Jakarta
Gemfibrozil tablet 600 mg
n/a
PT. Indofarma
150. DKI Jakarta
Gemsitabin inj 1000 mg/vial
Gemzar 1000
mg
PT. Bayer Indonesia
vial
1,098,900.00
151. DKI Jakarta
Gemsitabin inj 200 mg/vial
n/a
PT. Sanbe Farma
Dus, 1 vial @200 mg
330,000.00
Dus, Botol 120 Dosis

Spay
Dus, 2 flow wrap@ 5
Flixotide Nbules PT. Glaxo Wellcome Indonesia nebules @ 1 dosis
(2ml)
Page 9 of 31
PT. Glaxo Wellcome Indonesia
Dus, 1 blister @ 10
tablet
kapsul
kaptab
93,333.00
12,917.00
295,000.00
289.00
679.00
152. DKI Jakarta
Gentamisin injeksi 40 mg/ ml
n/a
PT. Indofarma
Dus, 5 ampul @ 2 ml
3,399.00
153. DKI Jakarta
Gentamisin salep mata 0,3%
Genoint Salep
Mata
PT. Erela
Tube @ 3,5 gr
2,600.00
154. DKI Jakarta
Gentamisin tetes mata 0,3%
n/a
PT. Indofarma
Dus, botol plastik 5 ml 3,194.00
155. DKI Jakarta
Glibenklamid tablet 5 mg
n/a
PT. Indofarma
kaptab
56.00
156. DKI Jakarta
Gliklazid tab 80 mg
Glicab
Strip
232.00
157. DKI Jakarta
Glikuidon tab 30 mg
n/a
PT. Dexa Medica
Dus, 10 Strip @ 10
tablet
950.00
158. DKI Jakarta
Glimepiride tablet 1 mg
n/a
PT. Kimia Farma
ktk 5x10 tablet
265.00
159. DKI Jakarta
n/a
PT. Kimia Farma
ktk 5x10 tablet
436.00
160. DKI Jakarta
n/a
PT. Kimia Farma
ktk 5x10 tablet
404.00
161. DKI Jakarta
n/a
PT. Kimia Farma
ktk 5x10 tablet
430.00
162. DKI Jakarta
Gliseril trinitrat kaps SR 2,5 mg
Nitrokaf Retard PT. Kimia Farma
Dus 10x10
1,493.00
163. DKI Jakarta
Gliseril trinitrat kaps SR 5 mg
Nitrokaf Forte
PT. Kimia Farma
Dus 10x10
2,171.00
164. DKI Jakarta
Gliseril trinitrat tab sublingual 0,5 mg
Nitral
PT. Actavis Indonesia
Btl @ 30 tablet
1,500.00
165. DKI Jakarta
Gliserin lar 50%
Gliserin lar 50% PT. Lucas Djaja
Glycerin 100 ml
5,333.00
166. DKI Jakarta
Glukosa larutan infus 10 % steril
n/a
PT. Widatra Bhakti
botol @ 500 ml
5,700.00
167. DKI Jakarta
Glukosa larutan infus 5 % steril
n/a
PT. Widatra Bhakti
botol @ 500 ml
5,200.00
Page 10 of 31
168. DKI Jakarta
Goserelin asetat inj 10,8 mg/vial
Zoladex 10,8
mg
169. DKI Jakarta
Goserelin asetat inj 3,6 mg
Zoladex 3,6 mg PT. AstraZeneca indonesia
170. DKI Jakarta
Griseofulvin tablet 125 mg
n/a
PT. Indofarma
171. DKI Jakarta
Haloperidol inj 50 mg/mL
Haldol
Decanoas
172. DKI Jakarta
Haloperidol tablet 0,5 mg
n/a
PT. Indofarma
173. DKI Jakarta
Haloperidol tablet 5 mg
n/a
PT. Indofarma
174. DKI Jakarta
Haloperidol tablet 1,5 mg
n/a
PT. Indofarma
175. DKI Jakarta
Haloperidol tablet 2 mg
Lodomer 2

Mercusana
KOTAK @ 10 x 10 TAB
126.00
176. DKI Jakarta
Hiosin butilbromid injeksi 20 mg/ml
n/a
PT. Otto Pharmaceuticals
box 5ampul @1 ml
4,500.00
177. DKI Jakarta
Ibuprofen sirup 100 mg/5 ml
n/a
PT. Indofarma
Dus, botol 60 ml
3,499.00
178. DKI Jakarta
Ibuprofen suspensi 200 mg/5 ml
n/a
PT. Indofarma
Dus, botol 60 ml
4,499.00
179. DKI Jakarta
Ibuprofen tablet 400 mg
n/a
PT. Novapharin
strip
150.00
180. DKI Jakarta
Imidapril tab 10 mg
Tanapress
10mg
3 blister @ 10 tablet
3,908.00
181. DKI Jakarta
Imidapril tab 5 mg
Tanapress 5mg PT. Tanabe Indonesia
3 blister @ 10 tablet
2,120.00
182. DKI Jakarta
Iopromide 300-370 mg Iodium/mL (300 mg / 100

ml)
PT. Bayer Indonesia
Botol
245,000.00
PT. Bayer Indonesia
Botol
123,200.00
183. DKI Jakarta
Ultravist
300/100 mg
Ultravist
Iopromide 300-370 mg Iodium/mL (300 mg / 50 ml)
300/50 mg
Page 11 of 31
Dus, 1 syringe @ 10.8

mg
Dus, 1 syringe @ 3.6
mg
tablet
Dus 5 Ampul@1mL
tablet
tablet
tablet
2,300,000.00
840,000.00
219.00
83,333.00
59.00
96.00
69.00
184. DKI Jakarta

185. DKI Jakarta
Iopromide 300-370 mg Iodium/mL (370 mg / 100

ml)
Ultravist
370/100 mg
Ultravist
Iopromide 300-370 mg Iodium/mL (370 mg / 50 ml)
370/50 mg
PT. Bayer Indonesia
Botol
299,000.00
PT. Bayer Indonesia
Botol
150,300.00
186. DKI Jakarta
Irbesartan tab 150 mg
n/a
PT. Indofarma
Dus, 5 blister @ 10 kss 1,425.00
187. DKI Jakarta
Irbesartan tab 300 mg
n/a
PT. Indofarma
Dus, 5 blister @ 10 kss 2,470.00
188. DKI Jakarta
Irinotekan inf 20 mg/ml
n/a
PT. Sanbe Farma
Dus, 1 vial @2 ml
510,000.00
189. DKI Jakarta
Isosorbid Dinitrat tablet sublingual 5 mg
n/a
PT. Indofarma
Dus, 10 strip @ 10
tablet
88.00
190. DKI Jakarta
Kalium aspartat tab 300 mg
Kalipar
Strip
691.00
191. DKI Jakarta
Kalium Klorida tablet 600 mg
KSR
PT. Merck Tbk
Dus, 10 strip @ 10
tablet
1,580.00
192. DKI Jakarta
Kalsium Glukonat injeksi i.v 10% (100 mg/ml)
Kalsium
glukonat
PT. Ethica Industri Farmasi
Ampul
7,800.00
193. DKI Jakarta
Kandesartan tab 16 mg
n/a
PT. Dexa Medica
194. DKI Jakarta
Kandesartan tab 8 mg
n/a
PT. Dexa Medica
195. DKI Jakarta
Kapesitabin tab 500 mg
Xeloda
196. DKI Jakarta
Kaptopril tablet 50 mg
n/a
PT. Indofarma
197. DKI Jakarta
Kaptopril tablet scored 25 mg
n/a
PT. Errita Pharma
198. DKI Jakarta
Kaptopril tablet scored12,5 mg
n/a
PT. Indofarma
Page 12 of 31
Dus, 3 Blister @ 10
tablet
Dus, 3 Blister @ 10
tablet
Boks, 120 tablet
Dus, 10 strip @ 10
tablet
Dus, 10 strip @10
tablet
Dus, 10 strip @ 10
tablet
4,900.00
3,100.00
27,500.00
140.00
84.00
62.00
199. DKI Jakarta
Karbamazepin sirup 100 mg/5 ml
Tegretol Syrup
100mg/5ml,
120ml
200. DKI Jakarta
Karbamazepin tablet 200 mg
n/a
PT. Indofarma
tablet
245.00
201. DKI Jakarta
Karbogliserin tetes telinga 10%
Karbogliserin
tetes telinga
10%
PT. Lucas Djaja
Fenol 100 mg / 1 ml
2,042.00
202. DKI Jakarta
Ketamin injeksi i.v. 100 mg/ml
KTM
PT. Guardian Pharmatama
Vial @ 10 ml
110,000.00
203. DKI Jakarta
Ketokonazol krim 2%
n/a
PT. Novell Pharmaeutical

Laboratories
Box isi 1 Tube @ 15 g
4,700.00
204. DKI Jakarta
Ketokonazol krim 2%
n/a
PT. Kimia Farma
tube 10 gr
2,569.00
205. DKI Jakarta
Ketokonazol tablet 200 mg
n/a
PT. Dexa Medica
Dus, 5 Strip @ 10
tablet
300.00
206. DKI Jakarta
Ketorolac injeksi 30 mg/ml
n/a
PT. Phapros, Tbk
Dus @ 12 Ampul
2,300.00
207. DKI Jakarta
Klaritromisin tab 500 mg
ORIXAL

Laboratories
208. DKI Jakarta
Klindamisin kapsul/kaplet 150 mg
n/a
PT. Indofarma
209. DKI Jakarta
Klindamisin kapsul/kaplet 300 mg
n/a
PT. Indofarma
210. DKI Jakarta
Klobazam tab 10 mg
n/a
PT. Dexa Medica
Dus, 3 Strip @ 10
Kaplet salut selaput
Dus, 5 blister @ 10
kapsul
Dus, 5 blister @ 10
kapsul
Dus, 10 Strip @ 10
tablet
211. DKI Jakarta
Klonidin tablet 0,15 mg
n/a
PT. Kimia Farma
Ktk 10X10 TAB
184.00
212. DKI Jakarta
Klopidogrel tab 75 mg
n/a
PT. Hexpharm Jaya

Laboratories
Dus, 3 strip @ 10 tab
3,400.00
213. DKI Jakarta
Klorpromazin tablet salut 100 mg (HCl)
n/a
PT. Phapros, Tbk
Dus @ 10 X 10 's
150.00
Page 13 of 31
Dus, botol @ 120 ml
44,770.00
3,200.00
361.00
553.00
900.00
214. DKI Jakarta
Klorpromazin injeksi i.m. 25 mg/ml (HCl)
n/a
PT. Phapros, Tbk
Dus @ 30 Ampul
1,100.00
215. DKI Jakarta
Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl)
n/a
PT. Phapros, Tbk
Dus @ 30 Ampul
1,050.00
216. DKI Jakarta
Klozapin 100 mg
n/a
KOTAK @ 5 x 10 TAB
5,000.00
217. DKI Jakarta
Klozapin 25 mg
n/a
KOTAK @ 5 x 10 TAB
1,550.00
218. DKI Jakarta
Kodein tablet 10 mg
n/a
PT. Kimia Farma
ktk 10x10 tablet
500.00
219. DKI Jakarta
Kodein tablet 15 mg
n/a
PT. Kimia Farma
ktk 10x10 tablet
850.00
220. DKI Jakarta
Kodein tablet 20 mg
n/a
PT. Kimia Farma
ktk 10x10 tablet
1,100.00
221. DKI Jakarta
Kombinasi suspensi : Parafin + gliserin + fenolftalein
Laxadine Emulsi PT. Galenium Pharmasia

60 ml
Laboratories
Botol @ 60 ml
12,450.00
PT. Erela
Dus, 100 Sachet @ 30

Tablet
42.00
botol 15 ml
15,750.00
3,220.00
222. DKI Jakarta

223. DKI Jakarta
Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg

n/a
Asam folat 0,25 mg
Kombinasi tetes mata 2,5 mg/mL: Natrium klorida
Cendo Lyteers
8,664 mg; Kalium klorida 1,32 mg

Mercusana
Mercusana
224. DKI Jakarta
Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem
Dus, 4 blister @ 6
tablet
225. DKI Jakarta
Kombinasi: Levodopa 100 mg; Karbidopa 25 mg;

Entekapon 200 mg
Dus, botol plastik @ 30

8,900.00
226. DKI Jakarta
Kombinasi: Salmeterol 25 mcg; Flutikason propionat Seretide Inhaler

PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis
50 mcg
50 mcg
90,667.00
227. DKI Jakarta
Kombinasi: Salmeterol 50 mcg; Flutikason propionat Seretide Diskus

Dus, foil strip @ 60
100 mcg
100 mcg
dosis
100,833.00
Stalevo
Page 14 of 31
228. DKI Jakarta
Kombinasi: Salmeterol 50 mcg; Flutikason propionat Seretide Diskus

Dus, foil strip @ 60
250 mcg
250 mcg
dosis
113,333.00
229. DKI Jakarta
Kotrimoksazol DOEN I (dewasa) kombinasi :

Sulfametoksazol 400 mg Trimetoprim 80 mg
230. DKI Jakarta
PT. Promedrahardjo Farmasi

Industri
STRIP
138.00
Kotrimoksazol Suspensi komb: Sulfametoksazol 200

n/a
mg + Trimetoprim 40 mg / 5 ml
PT. Sampharindo Perdana
Botol, 60 ml
2,167.00
231. DKI Jakarta
Kuinin (Kina) tablet 200 mg
n/a
PT. Kimia Farma
ktk 60 tablet
670.00
232. DKI Jakarta
Kuinin injeksi i.v. 25% (sebagai 2 HCl)
n/a
PT. Kimia Farma
ktk 100 amp @ 2 ml
6,200.00
233. DKI Jakarta
Kuinin tablet 222 mg (H2SO4.7H2O)
n/a
PT. Kimia Farma
ktk 10 x 10 tablet
540.00
234. DKI Jakarta
Lamivudine tablet 150 mg
n/a
PT. Kimia Farma
Botol 60 tablet
1,400.00
235. DKI Jakarta
Lansoprazol inj 30 mg/ml
Prosogan Inj.
PT. Takeda Indonesia
Serbuk vial
82,042.00
236. DKI Jakarta
Lanzoprazol kapsul/kaplet 30 mg
n/a
PT. Indofarma
237. DKI Jakarta
Lapatinib tab 250 mg
Tykerb
238. DKI Jakarta
Larutan mengandung Asam Amino (Asam Amino

10%)
Kalbamin
239. DKI Jakarta

100 g, Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq)
Amiparen
240. DKI Jakarta

241. DKI Jakarta
n/a
Larutan mengandung Asam Amino (Asam Amino 27

Pan-amin G
g, Sorbitol 50 g, Cl- 52 mEq)
Larutan mengandung Asam Amino (Asam Amino 30
Aminofluid
g, Glukosa 7,3 % dan elektrolit)
Page 15 of 31

Phamaceuticals
PT. Finusolprima Farma
Internasional
Dus, 2 strip @ 10
kapsul
Dus, 7 Blister @ 10
tablet
473.00
67,200.00
botol 500 ml
56,300.00
PT Otsuka Indonesia
Softbag 500 ML
67,400.00
PT Otsuka Indonesia
Softbag 500 ML
37,500.00
PT Otsuka Indonesia
Double Chamber
Softbag 500 ML
61,600.00
242. DKI Jakarta
243. DKI Jakarta

244. DKI Jakarta
245. DKI Jakarta
Larutan mengandung Asam Amino (Asam Amino 5%

Aminofusin
dengan BCAA 45%, L-Ornithine L Aspartate 8.03
Hepar
gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)
6%, mengandung Taurine 0,24 gr/l)
7%, Komposisi: Asam Amino esensial: Asam Amino
non esensial = 60 : 40)
72.05 g, Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2
mEq, Asetat 46 mEq)
PT Kalbe Farma
botol 500 mL
75,350.00
Aminosteril
Infant 6%
PT. Fresenius Kabi Combiphar Botol Gelas 100 ml
36,667.00
Nephrosteril
50,820.00
Kidmin
PT Otsuka Indonesia
Softbag 200 ML
46,000.00
Softbag 500 ML
65,000.00
246. DKI Jakarta

79.9 g, Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq)
Aminoleban
PT Otsuka Indonesia
247. DKI Jakarta
Larutan mengandung Asam Amino (Asam amino 8%)
Aminosteril NHepa
78,720.00

Internasional
botol 250 ml
51,260.00

Internasional
botol 500 ml
64,900.00
250. DKI Jakarta
Larutan mengandung Asam Amino (Kombinasi Asam

aminno 50 g/L, Sorbitol 50 g/L, Xylitol 50 g/L, Asam
Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L,
Aminofusin
Nikotinamida (Niasinamida) 0.06 g/L, Piridoksin HCl L600
(Vit B6) 0.04 g/L, Riboflavin Natrium Fosfat 2.5
mg/L, elektrolit)
PT Kalbe Farma
botol 500 mL
42,000.00
251. DKI Jakarta
Larutan mengandung Asam Amino (Kombinasi Asam Aminofusin

amino 50 g/L, vitamin dan elektrolit)
Paed
PT Kalbe Farma
botol 250 mL
46,000.00
248. DKI Jakarta

249. DKI Jakarta

Eas Pfrimer
esensial 7%+Xylitol 10 g/L)
Larutan mengandung Asam Amino (BCAA 25 gr/L, LComafusin
Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic
Hepar
Acid 7 gr/L, Piridoxin 0.12 gr/L)
Page 16 of 31
252. DKI Jakarta

Kabiven 1440
Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan
ml
Elektrolit (Kalori = 1000 kkal, Akses peripheral))
PT. Fresenius Kabi Combiphar
Bag (3 Chamber) 1440

295,240.00
ml
253. DKI Jakarta

Kabiven 1920
Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan
ml
Elektrolit (Kalori = 1400 kkal, Akses peripheral))
PT. Fresenius Kabi Combiphar
Bag (3 Chamber) 1920

343,842.00
ml
254. DKI Jakarta
Larutan mengandung Asam Amino (Kombinasi

Glukosa dan elektrolit 150 gr + Asam Amino 48 gr
dgn akses sentral)
Combiflex Plus
PT. Phapros, Tbk
(790 kcal)
Bag Double chamber

(Dua compartement),
1000 mL
322,000.00
255. DKI Jakarta
Larutan mengandung Asam Amino (Kombinasi

Glukosa dan elektrolit 80 gr + Asam Amino 40 gr )
Combiflex peri
(480 kcal)
PT. Phapros, Tbk
Bag Double chamber

(Dua compartement),
1000 mL
218,700.00
256. DKI Jakarta
Larutan mengandung Elektrolit (Kalium Klorida)
Otsu - KCl
7,46%
PT Otsuka Indonesia
Ampoel 25 ML
2,050.00
PT. Widatra Bhakti
Botol 1000 ml
8,000.00
PT Otsuka Indonesia
Plastic Bottle 500 ML
9,000.00
PT Otsuka Indonesia
9,000.00
260. DKI Jakarta
Larutan mengandung Elektrolit (Sodium Lactate sol

(50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Totilac
Chloride 0.2 gr/L, elektrolit)
PT Kalbe Farma
flexybag 250 mL
87,000.00
261. DKI Jakarta
Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l,
Potassium 4.0 mmol/l, Calcium 2.5 mmol/l,
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)
PT. Phapros, Tbk
LDPE (Low Density Poly

12,650.00
Ethilene), botol plastik
257. DKI Jakarta

258. DKI Jakarta
259. DKI Jakarta
Larutan mengandung Elektrolit (Larutan Ringer

Wida RL
Laktat)
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109
Asering
mEq, Ca 3 mEq, Asetat 28 mEq)
Larutan mengandung Elektrolit (NaCl 1.125 gr,
KA EN 1B
Dekstrosa 18.75 gr)
Ringerfundin
500 mL
Page 17 of 31
262. DKI Jakarta

263. DKI Jakarta
264. DKI Jakarta
265. DKI Jakarta
266. DKI Jakarta

267. DKI Jakarta
268. DKI Jakarta
269. DKI Jakarta
270. DKI Jakarta

271. DKI Jakarta
272. DKI Jakarta
273. DKI Jakarta
274. DKI Jakarta
Larutan mengandung Karbohidrat (Fructose 120 g,

glucose 66 g, Xylitol 60 g/ L + elektrolit)
Larutan mengandung Karbohidrat (Fructose 60 g,
glucose 33 g, Xylitol 30 g/ L)
Larutan mengandung Karbohidrat (Maltose 100 gr)
Larutan mengandung Karbohidrat + Elektrolit
(25.00g maltose, 3.00 g sodium chloride, 0.15 g
potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)
(Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)
Triofusin 1000
PT Kalbe Farma
botol 500 mL
50,500.00
Triofusin 500
PT Kalbe Farma
Flexy bag 500 mL
42,350.00
Martos
PT Otsuka Indonesia
29,167.00
Potacol inj
PT Otsuka Indonesia
55,500.00
Tutofusin OPS
PT Kalbe Farma
botol 500 mL
37,500.00
PT Kalbe Farma
Botol Plastik 1000 mL
199,000.00
Triofusin E1000 PT Kalbe Farma
botol 500 mL
56,000.00
Wida HSD
PT. Widatra Bhakti
Botol 500 ml
9,500.00
Wida D5-NS
PT. Widatra Bhakti
Botol 500 ml
6,800.00
WIDA 2A
PT. Widatra Bhakti
Botol 500 ml
6,917.00
WIDA D5-1/4NS PT. Widatra Bhakti
Botol 500 ml
7,700.00
WIDA D5-1/2NS PT. Widatra Bhakti
Botol 500 ml
7,700.00
Futrolit
softbag 500ml
35,750.00
Larutan mengandung Karbohidrat + Elektrolit (Asam Clinimix

amino 28 gr/L, Glukosa 75 gr/L, elektrolit)
N9G15E
(Fructose 60 g, glucose 33 g, Xylitol 30 g/ L)
(Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat
3,1 g, air untuk injeksi ad 1000 ml)
(Glukosa 55 g ; Natrium Chloride 9 g, air untuk
injeksi ad 1000 ml)
(Glukosa: 25,0 g; NaCl: 4,5 g)
(Glukosa: 55.0 g; NaCl: 2.25 g)
(Glukosa: 55.0 g; NaCl: 4.5 g)
(Larutan nutrisi kombinasi infus per L: Na. 100mEQ,
K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat
38mEQ, Sorbitol 50g)
Page 18 of 31
PT. Sanbe Farma
275. DKI Jakarta

276. DKI Jakarta
277. DKI Jakarta
278. DKI Jakarta

(Larutan Ringer & Glukosa 5%)
Larutan mengandung Karbohidrat + Elektrolit (NaCl
1.75 g, KCL 1.5g, Glukosa 100 gr)
Larutan mengandung Karbohidrat + Elektrolit (Nacl
1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27
gr)
Larutan mengandung Karbohidrat + Elektrolit (Nacl
2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27
gr)
Wida RD
PT. Widatra Bhakti
Botol 500 ml
6,930.00
KA ENMG 3
PT Otsuka Indonesia
9,167.00
KA EN 3B
PT Otsuka Indonesia
10,000.00
KA EN 3A
PT Otsuka Indonesia
10,000.00
20%, Botol Kaca @100

105,500.00
ml, single bottle
279. DKI Jakarta
Larutan mengandung Lipid ( Infus Lipid Emulsi

MCT/LCT 20% 100 ml)
Lipofundin
MCT/LCT 1%
100
PT. Phapros, Tbk
280. DKI Jakarta
Larutan mengandung Lipid (Emulsi lemak 20%)
Intralipid
281. DKI Jakarta
Larutan mengandung Lipid (Infus Lipid Emulsi

MCT/LCT 20% 250 ml)
Lipofundin
MCT/LCT 1%
250
PT. Phapros, Tbk
Nutriflex Lipid
Special 1250
PT. Phapros, Tbk
Nutriflex Lipid
Peri 1250
PT. Phapros, Tbk
Nutriflex Lipid
Special 625
PT. Phapros, Tbk
Bag, 3 chamber ( 3
358,000.00
kompartemen), 625 ml
Ivelip
PT Kalbe Farma
Flexy bag 100 mL
89,800.00
strip 5 x 0.6 ml
72,000.00
282. DKI Jakarta
283. DKI Jakarta
284. DKI Jakarta
285. DKI Jakarta

286. DKI Jakarta
Larutan mengandung Lipid (Kombinasi Glukosa dan

elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr
dgn akses sentral)
elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT
50 gr)
elektrolit 90 gr + Asam Amino 35.9 gr + Lipid 25 gr
dgn akses sentral)
Larutan mengandung Lipid (Soybean Oil 200 g/L, Egg
Lecithins 12 gr/L, Glycerol Ph 25 gr/L, Sodium Oleate
0.3 gr/L)
Latanoprost tetes mata 0,01%
Cendo Glaopen PT. Cendo Industri Farmasi
Page 19 of 31
60,500.00
20%, Botol Kaca @250

210,000.00
ml, single bottle
Bag, 3 chamber ( 3
kompartemen), 1250
ml
Bag, 3 chamber ( 3
kompartemen), 1250
ml
591,000.00
511,000.00
287. DKI Jakarta
Leuprorelin asetat inj depot 1,88 mg
Tapros 1.88mg PT. Takeda Indonesia
Vial
700,000.00
288. DKI Jakarta
Leuprorelin asetat inj depot 11,25 mg
Tapros 3M
PT. Takeda Indonesia
Vial
2,700,000.00
289. DKI Jakarta
Levofloksasin inf 5 mg/mL
n/a
PT. Infion Pharmaceutical
Box, 1 Botol @ 100 ml 40,000.00
290. DKI Jakarta
Levofloksasin tablet 500 mg
n/a

Industri
STRIP
291. DKI Jakarta
Lidokain injeksi 2% (HCL)
n/a
PT. Bernofarm
Dus, 100 ampul @ 2 ml 839.00
292. DKI Jakarta
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a
PT. Indofarma
293. DKI Jakarta
Lidokain jeli 2%
Xylocaine Jelly
2%
Dus, 10 syringe @ 10 g 40,000.00
294. DKI Jakarta
Lisinopril tablet 10 mg
n/a
295. DKI Jakarta
Lisinopril tablet 5 mg
n/a
296. DKI Jakarta
Litium karbonat tablet 200 mg
Frimania 200
297. DKI Jakarta
Litium karbonat tablet 400 mg
Frimania 400
298. DKI Jakarta
Loperamid tablet 2 mg
n/a
299. DKI Jakarta
Loratadin tablet 10 mg
n/a
300. DKI Jakarta
Lorazepam tablet 2 mg
Merlopam 2
301. DKI Jakarta
Maprotilin HCl tab 25 mg
Ludios
302. DKI Jakarta
Maprotilin HCl tab 50 mg
Sandepril 50
Page 20 of 31

Laboratories
Laboratories
Mercusana
Mercusana
Laboratories
Industri
Mercusana
528.00
1,363.00
Box ,3 Strip @ 10 tablet 600.00

KOTAK @ 10 x 10 TAB
1,050.00
KOTAK @ 10 x 10 TAB
1,850.00
Dus, 10 Strip @ 10
Tablet
89.00
STRIP
154.00
KOTAK @ 10 x 10 TAB
1,341.00
Strip
1,200.00

Mercusana
KOTAK @ 5 x 10 TAB
3,276.00
303. DKI Jakarta
Melfalan tablet 2 mg
Alkeran
PT. Glaxo Wellcome Indonesia Box, Tablet 2 mg/25's
12,210.00
304. DKI Jakarta
Meropenem inj 1 g
n/a
PT. Bernofarm
Dus, 1 vial @ 1 g
54,000.00
305. DKI Jakarta
Metadon sir 50mg/5ml
n/a
PT. Kimia Farma
Botol 1000 ml
254,100.00
306. DKI Jakarta
Metilergometrin Maleat (Metilergometrin) tablet

salut 0,125 mg
n/a
PT. Kimia Farma
ktk 10 x 10 tablet salut 154.00
307. DKI Jakarta
Metilfenidat kapsul LA 20 mg
Ritalin LA
Dus, botol plastik @ 30

kapsul pelepasan
6,537.00
lambat
308. DKI Jakarta
Metilprednisolon tablet 16 mg
n/a
PT. Mahakam Beta Farma
Strip
309. DKI Jakarta
n/a
310. DKI Jakarta
n/a
PT. Dexa Medica
311. DKI Jakarta
Metoklopramide tablet 5 mg
n/a
PT. Kimia Farma
ktk 10 x 10 tablet
312. DKI Jakarta
Metronidazol infus 500 mg/100 ml
n/a
Dus, 1 Botol @ 100 ml 9,950.00
313. DKI Jakarta
Metronidazol supositoria 500 mg
Flagyl
PT. Aventis Pharma
Dus, 2 blister @ 5
suppositoria
314. DKI Jakarta
Metronidazol tablet 250 mg
n/a
PT. Phyto Kemo Agung Farma 10 strip @ 10 tab
110.00
315. DKI Jakarta
Metronidazol tablet 500 mg
n/a
PT. Phyto Kemo Agung Farma 10 strip @ 10 tab
160.00
316. DKI Jakarta
Midazolam injeksi i.v. 1 mg/ml
Fortanest
PT Kalbe Farma
Box isi 5 ampul
5,300.00
317. DKI Jakarta
Midazolam injeksi i.v. 5 mg/ml
Fortanest
PT Kalbe Farma
Box isi 5 ampul
12,000.00
318. DKI Jakarta
Mikafungin Na serb inj 50 mg
Mycamine
PT. Combiphar
Dus,1 vial@50mg
260,000.00
Page 21 of 31
Dus, 10 Blister @ 10
Tablet
tablet
635.00
205.00
300.00
108.00
3,220.00
319. DKI Jakarta
Mikonazol krim/salep 2 % (Nitrat)
n/a
PT. Kimia Farma
Tube 10 gram
3,000.00
320. DKI Jakarta
Mitomisin C (crystallin) serbuk inj 10 mg/vial
Mitomycin C
PT. Widatra Bhakti
10 mg /Vial
697,000.00
321. DKI Jakarta
Moksifloksasin tetes mata 0,5%
Vigamox
botol, tetes mata 3 ml 77,000.00
322. DKI Jakarta
Mometason furoat krim 0,1%
n/a
PT. Guardian Pharmatama
tube 10 gram
17,820.00
323. DKI Jakarta
Morfin HCL inj 10 mg/ml
n/a
PT. Kimia Farma
Dus 10 amp @ 1 ml
8,400.00
324. DKI Jakarta
Morfin HCL tablet SR 10 mg
325. DKI Jakarta
Morfin HCL tablet SR 15 mg
326. DKI Jakarta
Morfin injeksi i.m./s.k./i.v. 10 mg/ml
n/a
PT. Kimia Farma
Ktk 10 ampul @ 1ML
10,499.00
327. DKI Jakarta
Morfin tablet 10 mg
n/a
PT. Kimia Farma
Botol 30 tablet
1,300.00
328. DKI Jakarta
Nacl 0,9%
n/a
PT. Widatra Bhakti
Botol 500 ml
4,700.00
329. DKI Jakarta
Nadroparin inj 9500 Axa/mL syringe 0,3 mL
330. DKI Jakarta
Nadroparin inj 9500 Axa/mL, syringe 0,4 mL
331. DKI Jakarta
Nadroparin inj 9500 Axa/mL, syringe 0,6 mL
332. DKI Jakarta
MST Continus
10 mg
MST Continus
15 mg
Fraxiparine 0.3
ml
Fraxiparine 0.4
ml
Fraxiparine 0.6
ml
Dus, 5 blister @ 2 pfs

0.3 ml
0.4 ml
0.6 ml
Nalokson injeksi 0,4 mg/ml
Nokoba
PT. Pratapa Nirmala
Dus, 5 Ampul @ 2ml
61,600.00
333. DKI Jakarta
Natrium Bikarbonat injeksi i.v 8,4%
Meylon
PT Otsuka Indonesia
Ampoel 25 ML
6,200.00
334. DKI Jakarta
Natrium Diklofenak tablet 50 mg
n/a
PT. Phapros, Tbk
Dus @ 5 X 10 's
176.00
Page 22 of 31
54,144.00
66,640.00
94,962.00
335. DKI Jakarta
Natrium fusidat salep 20 mg/g
Fucilex
Ointment
PT. Molex Ayus
Tube 5 gr
6,490.00
336. DKI Jakarta
Nevirapin tablet 200 mg
n/a
PT. Kimia Farma
btl 60 tablet
2,800.00
337. DKI Jakarta
Nifedipin tab 20 mg, slow release; oros
blister
2,999.00
338. DKI Jakarta
Nifedipin tab 30 mg, oros
blister
3,500.00
339. DKI Jakarta
Nifedipin tablet/kapsul 10 mg
n/a
PT. Dexa Medica
Dus, 10 Strip @ 10
95.00
340. DKI Jakarta
Nistatin tablet salut 500.000 IU/ g
n/a
PT. Phapros, Tbk
Dus @ 10 X 10 's
640.00
341. DKI Jakarta
Noretisteron tablet 5 mg
Primolut N
PT. Bayer Indonesia
blister
2,618.00
342. DKI Jakarta
Obat Antituberkulosis FDC Kategori 1
n/a
PT. Kimia Farma
Paket
359,990.00
343. DKI Jakarta
Obat Antituberkulosis FDC Kategori 2
n/a
PT. Phapros, Tbk
Paket
1,199,900.00
344. DKI Jakarta
Obat Antituberkulosis FDC Kategori Anak
n/a
PT. Indofarma
Paket
214,990.00
345. DKI Jakarta
Obat Antituberkulosis FDC Sisipan
n/a
PT. Indofarma
Dus, 3 blister @ 28 kss 159,990.00
346. DKI Jakarta
Ofloxacin tablet 200 mg
n/a
347. DKI Jakarta
Ofloxacin tablet 400 mg
n/a
348. DKI Jakarta
Oksimetazolin tetes hidung 0,025%
Ilaidin Drops
349. DKI Jakarta
Oktreotid 10 mg
Adalat Oros 20
PT. Bayer Indonesia
mg
Adalat Oros 30
PT. Bayer Indonesia
mg

Laboratories
Laboratories
PT. Merck Tbk
Sandostatin LAR PT. Novartis Indonesia
Page 23 of 31

botol @ 10 ml
27,550.00
Dus, vial @ 355m + 1

prefilled syringe
pelarut @ 2,5 ml + 2
jarum suntik
2,950,000.00
350. DKI Jakarta
Olanzapin kapl salut 5 mg
Olandoz 5
PT. Sandoz Indonesia
3 X 10 fcc
6,450.00
351. DKI Jakarta
Olanzapin tab 10 mg
Olandoz 10
3 X 10 fcc
11,200.00
352. DKI Jakarta
Omeprazol injeksi 40 mg/ 10 ml
n/a
Dus, 1 Vial @ 40 mg
36,000.00
353. DKI Jakarta
Omeprazol kapsul/kaplet 20 mg
n/a
PT. Novapharin
strip
211.00
354. DKI Jakarta
ondansetron inj 4 mg/ 2 mL
n/a
PT. Indofarma
Dus, 5 Ampul @ 2ml
2,400.00
355. DKI Jakarta
Ondansetron tab 4 mg
n/a
Box 3 X 10 Tab
716.00
356. DKI Jakarta
Ondansetron tablet 8 mg
n/a
Box 3 X 10 Tab
1,189.00
1,902,240.00
219,540.00
357. DKI Jakarta
Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2

unit Ultaclam, 1 unit Tenckoff Catheter, Titanium
Adaptor)
n/a
PT Kalbe Farma
Transfer Set: Set;

Ultaclam: Kantong
Plastik; Tenckoff
Catheter: Box;
Titanium Adaptor:
Kantong Plastik
358. DKI Jakarta
Paket CAPD Pergantian Transfer Set per 6 bulan
n/a
PT Kalbe Farma
Set
Page 24 of 31
359. DKI Jakarta
Paket CAPD Rutin 120 ( 4x ganti cairan perhari

dengan komposisi Larutan Dialisa 1.5 %, Larutan
Dialisa 2.5 %, Larutan Dialisa 4.25 %, Minicap)
Larutan Dialisa
1.5%: Dianeal
Low Calcium
with 1,5%
Dextrose;
Larutan Dialisa
2.5%: Dianeal
Low Calcium
PT Kalbe Farma
with 2,5%
Dextrose;
Larutan Dialisa
4.25%: Dianeal
Low Calcium
with 4.25%
Dextrose
360. DKI Jakarta
Parasetamol sirup 120 mg / 5 ml
n/a
PT. Afifarma
botol 60 ml
1,438.00
361. DKI Jakarta
Parasetamol tablet 500 mg
n/a
PT. Afifarma
Dus, 10 strip
@10tablet
87.00
362. DKI Jakarta
Pegylated interferon alfa-2a inj 135 mcg/0,5 ml
Pegasys
Boks, 1 pfs
1,077,815.00
363. DKI Jakarta
Pegylated interferon alfa-2a inj 180 mcg/0,5 ml
Pegasys
Boks, 1 pfs
1,248,220.00
364. DKI Jakarta
Permetrin krim 5%
Scabimite
Cream 10
PT. Galenium Pharmasia

Laboratories
Tube @ 10 g
11,475.00
365. DKI Jakarta
Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl)
n/a
PT. Kimia Farma
Ktk 10 ampx2ml
14,500.00
366. DKI Jakarta
Pioglitazon tab 15 mg
DECULIN 15 MG PT. Dexa Medica
30 TAB/BOX
3,120.00
Page 25 of 31
Larutan Dialisa 1.5 %:

2.000 ml; Larutan
Dialisa 2.5 %: 2.000 ml;
5,522,580.00
Larutan Dialisa 4.25 %:
2.000 ml; Minicap:
Kantong Plastik
367. DKI Jakarta
Pioglitazon tab 30 mg
DECULIN 30 MG PT. Dexa Medica
30 TAB/BOX
4,525.00
368. DKI Jakarta
Pirantel suspensi 125 mg/5 ml
n/a
PT. Holi Pharma
Botol 60 ml
8,360.00
369. DKI Jakarta
Pirantel tablet score (base) 125 mg
n/a
PT. Holi Pharma
370. DKI Jakarta
Pirazinamid tablet 500 mg
n/a
PT. Holi Pharma
371. DKI Jakarta
Polikresulen cairan
Aptil
PT. Pratapa Nirmala
Dus, Botol @ 10ml
17,393.00
372. DKI Jakarta
Povidon Iodida larutan 10% 1000 ml
n/a
PT. Afifarma
botol @ 1000 ml
37,109.00
373. DKI Jakarta
n/a
PT. Afifarma
botol @ 30 ml
2,163.00
374. DKI Jakarta
n/a
PT. Afifarma
botol @ 300 ml
14,203.00
375. DKI Jakarta
Pramipeksol tab ER 0,375 mg
376. DKI Jakarta
Pramipeksol tab ER 0,750 mg
377. DKI Jakarta
Pravastatin tablet 20 mg
n/a

Laboratories
378. DKI Jakarta
Propanolol tablet 10 mg ( HCl )
n/a
PT. Dexa Medica
379. DKI Jakarta
Propranolol tablet 40 mg (HCl)
n/a
PT. Holi Pharma
380. DKI Jakarta
Quetiapin tab 200 mg
381. DKI Jakarta
382. DKI Jakarta
Sifrol ER
0,375mg
Sifrol ER
0,750mg
Seroquel XR
200 mg
Seroquel XR
300 mg
Seroquel XR
400 mg
Page 26 of 31


Dus, 25 Blister @ 4
tablet
Dus 10 strip @ 10
tablet
298.00
208.00
Dus, 3 alu blister @ 10

7,200.00
tablet
Dus, 3 alu blister @ 10
11,268.00
tablet
Box ,5 Strip @ 10 tablet 2,300.00
Dus, 10 Strip @ 10
tablet
Dus, 10 strip @ 10
tablet
Dus, 1 blister @ 10
tablet
Dus, 1 blister @ 10
tablet
Dus, 1 blister @ 10
tablet
65.00
107.00
17,391.00
19,500.00
23,185.00
383. DKI Jakarta
Ramipril tablet 5 mg
n/a
PT. Dexa Medica
Dus, 10 Strip @ 10
kaptab
384. DKI Jakarta
Ranitidin injeksi 25 mg/2 ml
n/a
Dus, 10 Ampul @ 2 ml 1,140.00
385. DKI Jakarta
Ranitidin tablet 150 mg
n/a
PT. Dexa Medica
Dus, 10 Strip @ 10
120.00
386. DKI Jakarta
Retinol (Vitamin A) 100.000 IU
n/a
PT. Kimia Farma
Botol 50 kapsul lunak
260.00
387. DKI Jakarta
Ringer Laktat larutan infus
n/a
PT. Widatra Bhakti
botol 500 ml
5,200.00
388. DKI Jakarta
Risperidon tablet 1 mg
n/a
PT. Dexa Medica
Dus, 5 Blister @ 10
tablet
1,000.00
389. DKI Jakarta
n/a

Mercusana
KOTAK @ 5 x 10 TAB
1,008.00
390. DKI Jakarta
n/a
PT. Dexa Medica
391. DKI Jakarta
Ropinirol Tablet Salut 2 mg
392. DKI Jakarta
393. DKI Jakarta
394. DKI Jakarta
Salbutamol inhalasi/aerosol 100 mcg/dosis
395. DKI Jakarta
Salbutamol serb inh 200 mcg/kaps
396. DKI Jakarta
Salbutamol serb inh 200 mcg/kaps + rotahaler
397. DKI Jakarta
Salbutamol tablet 4 mg (sebagai Sulfat)
398. DKI Jakarta
Sefadroksil sirup kering 125 mg/5ml
Requip PD 24
Hour 2 mg
Requip PD 24
Hour 4 mg
Requip PD 24
Hour 8 mg
Dus, 5 Blister @ 10
tablet
Dus, 7 blister @ 4
Tablet lepas Lambat
Dus, 7 blister @ 4
Tablet lepas Lambat
Dus, 7 blister @ 4
Tablet lepas Lambat
Ventolin Inhaler PT. Glaxo Wellcome Indonesia Dus, botol 200 dosis
Ventolin
Rotacaps
Ventolin
Rotahaler
Kapsul
580.00
2,000.00
5,248.00
6,275.00
7,383.00
63,750.00
431.00
PT. Glaxo Wellcome Indonesia Dus, 1 Rotahaler
5,867.00
n/a
PT. Kimia Farma
ktk 10 x 10 tablet
89.00
n/a
PT. Holi Pharma
Dus, Botol 60 ml
4,896.00
Page 27 of 31
399. DKI Jakarta
Sefadroksil kapsul/kaplet 250 mg
n/a
PT. Hexpharm Jaya

Laboratories
400. DKI Jakarta
Sefadroksil kapsul/kaplet 500 mg
n/a
PT. Bernofarm
401. DKI Jakarta
Sefadroksil sir kering 250 mg/5 mL
n/a
PT. Holi Pharma
Dus, Botol 60 ml
5,940.00
402. DKI Jakarta
Sefaleksin kapsul/kaplet 500 mg
n/a

Laboratories
Dus, 5 Strip @ 10
Kapsul
1,000.00
403. DKI Jakarta
Sefepim inj 1 g
n/a
Box 2 Vial @ 1000mg
48,060.00
404. DKI Jakarta
Sefiksim kapsul/kaplet 100 mg
n/a
PT. Dexa Medica
Dus, 5 Strip @ 10
kapsul
850.00
405. DKI Jakarta
Sefiksim sirup kering 100 mg/ 5 ml
n/a
Dus, Botol 30 ml
8,800.00
406. DKI Jakarta
Sefotaksim injeksi 0,5 g
n/a
Dus, 2 vial @ 500 mg
4,997.00
407. DKI Jakarta
Sefotaksim injeksi 1 g
n/a
Dus, 10 Vial @ 1 g
2,950.00
408. DKI Jakarta
Sefpodoksim proksetil tab 100 mg
Banadoz 100
Dus, 3 blister @ 10
tablet
3,700.00
409. DKI Jakarta
Seftazidim injeksi 1 g
n/a
PT. Hexpharm Jaya

Laboratories
Dus, 2 vial @ 1 g
17,060.00
410. DKI Jakarta
Seftriakson serbuk injeksi 1 g/vial
n/a
Dus, 10 Vial @ 1 g
3,300.00
411. DKI Jakarta
Sefuroksim tab 500 mg
Zinnat 500
412. DKI Jakarta
Setirizin tablet 10 mg
n/a
PT. Pertiwi Agung
413. DKI Jakarta
Sianokobalamin (vitamin B12) injeksi 500 mcg
n/a
PT. Lucas Djaja
100 ampul @ 1 ml
1,077.00
414. DKI Jakarta
Siklosporin kaps 100 mg
Sandimmun
Neoral 100mg
Kap
Dus, 10 blister @ 5
kapsul lunak
43,000.00
Page 28 of 31

Laboratories
PT. Hexpharm Jaya
Laboratories
Dus, 5 strip @ 10
kapsul
Dus, 10 strip @ 10
kapsul
Dus, 1 Blister @ 10
Tablet salut selaput
Box, 10 strips @ 10
capsules
513.00
509.00
7,200.00
181.00
415. DKI Jakarta
Siklosporin kapsul lunak 25 mg
Sandimmun
Neoral 25mg
Kap
416. DKI Jakarta
Simvastatin scored tablet 10 mg
n/a
417. DKI Jakarta
Simvastatin tablet 20 mg
n/a
PT. Bernofarm
418. DKI Jakarta
Siprofloksasin infus 2%
n/a
PT. Dexa Medica
Vial 200 ml
15,000.00
419. DKI Jakarta
Siprofloksasin tablet 500 mg (sebagai HCl)
n/a
PT. Bernofarm
tab ss
255.00
420. DKI Jakarta
Spiramisin tablet 500 mg
n/a
PT. Indofarma
421. DKI Jakarta
Spironolakton tablet 100 mg
n/a
PT. Dexa Medica
422. DKI Jakarta
Spironolakton tablet 25 mg
n/a
PT. Dexa Medica
423. DKI Jakarta
Sufentanil injeksi iv, epidural 5 mcg/ml
Sufentanyl
Injeksi
iv.Epidural 5
mcg / ml
PT. Kimia Farma
424. DKI Jakarta
Takrolimus kaps 0.5 mg
Prograf
PT. Combiphar
425. DKI Jakarta
Takrolimus kaps 1 mg
Prograf
PT. Combiphar
426. DKI Jakarta
Tamsulosin tab 0,2 mg
Harnal D
PT. Combiphar
427. DKI Jakarta
Tamsulosin tab 0,2 mg
Harnal D 0.2
PT. Combiphar
mg Disp. Tablet
Box/ 2 blister @ 14
tablet
5,800.00
428. DKI Jakarta
Tamsulosin tab SR 0,4 mg
Harnal OCAS
0.4 mg Tablet
Box/ 3 blister @ 10
Tablet
6,800.00
Page 29 of 31
PT. Combiphar
Dus, 10 blister @ 5
kapsul lunak
Dus, 3 Strip @ 10
Kaplet salut selaput
Dus, 3 strip @ 10
kaptab ss
Dus, 10 Strip @ 10
tablet
Dus, 10 Strip @ 10
tablet
dus 5 amp @ dus 10
Pounch @ 5 blister @
10 capsule
Dus, 1 pouch @5
blister@10 kaps
Box @ 2 blister @ 14
tablet
12,000.00
169.00
485.00
900.00
315.00
127,000.00
11,167.00
21,500.00
5,800.00
Sebivo 600 mg
Tab
Bricasma
Respules
Dus, 2 blister @ 14
tablet
Dus, 2 pak @ 5
respules
Terbutalin tablet 2,5 mg
Molasma Tablet PT. Molex Ayus
Box 50's
99.00
432. DKI Jakarta
Terbutalin turbu (serbuk ih) 0,50 mg
Bricasma
Turbuhaler 0,5 PT. AstraZeneca indonesia
mg
Dus, 1 Turbuhaler @
200 dosis
71,100.00
433. DKI Jakarta
Tetrakain HCl tetes mata 0,5%
Pantocain 0.5% PT. Cendo Industri Farmasi
botol 5 ml
11,500.00
434. DKI Jakarta
Tetrasiklin kapsul/kaplet 250 mg
n/a
PT. Holi Pharma
435. DKI Jakarta
Tiamazol tab 10 mg
Thyrozol 10
PT. Merck Tbk
436. DKI Jakarta
Tiamazol tab 5 mg
Thyrozol 5
PT. Merck Tbk
437. DKI Jakarta
Timolol tetes mata 0,25%
438. DKI Jakarta
Timolol tetes mata 0,5%
439. DKI Jakarta
Tiotropium kaps 18 mcg + handihaller
440. DKI Jakarta
Tramadol injeksi 50 mg/ml
n/a
441. DKI Jakarta
Travoprost tetes mata 0,004%
Travatan
442. DKI Jakarta
Triamsinolon asetonid nasal spray 55 mcg/puff
Nasacort AQ
PT. Aventis Pharma
443. DKI Jakarta
Trifluoperazin tablet 5 mg
n/a
PT. Darya Varia
strip
405.00
444. DKI Jakarta
Urea krim 10%
Soft U Derm
PT. Galenium Pharmasia

Laboratories
tube
6,400.00
429. DKI Jakarta
Telbivudin tab 600 mg
430. DKI Jakarta
Terbutalin cairan ih 2,5 mg/mL
431. DKI Jakarta
Isotic Adretor
0,25%
Isotic Adretor
0,5%
Spiriva 10s +
Handihaler
Page 30 of 31
PT. Pratapa Nirmala

PT. Pratapa Nirmala
Dus, 10 strip @ 10
kapsul
tablet
tablet
5ml
5ml
Dus, 1 blister @10
kapsul + handihaler
28,500.00
6,250.00
149.00
1,135.00
563.00
9,128.00
9,722.00
152,543.00
Dus, 10 Ampul @ 2 ml 2,395.00

botol, tetes mata 2,5
ml
Dus, botol plastik 120
dosis
115,000.00
90,000.00
445. DKI Jakarta
Vaksin polio inj (Vaksin Poliomyelitis yang

diinaktifkan)
446. DKI Jakarta
Valproat tab SR 250 mg
447. DKI Jakarta
Valproat tab SR 500 mg
448. DKI Jakarta
Valsartan tab 80 mg
449. DKI Jakarta
Valsartan tab 160 mg
450. DKI Jakarta
Verapamil tab 240 mg
Isoptin 240 mg PT. Abbott Indonesia
Tablet
6,200.00
451. DKI Jakarta
Verapamil tablet 80 mg (HCl)
n/a
PT. Kimia Farma
Ktk 10X10 TAB
234.00
452. DKI Jakarta
Vinblastin serbuk injeksi 10 mg
Vinblastine
PT. Combiphar
Vial 10mg/10ml
210,000.00
453. DKI Jakarta
Vitamin B Kompleks tablet
n/a
PT. Kimia Farma
Dus 10 strip x 10 tab
107.00
454. DKI Jakarta
Zidovudin 300 mg + Lamivudine 150 mg
n/a
PT. Kimia Farma
Botol 60 tablet
3,429.00
455. DKI Jakarta
Zinc drop 10 mg/mL
Zincpro Drops
PT. Combiphar
Drops 10 mg/ml, Botol

12,840.00
@15 ml
456. DKI Jakarta
Zinc sir 20 mg/5 Ml
Zircum Kid
Sirup
PT. Meprofarm
Dus, botol 60 ml
7,400.00
457. DKI Jakarta
Zinc tablet dispersible20 mg
n/a
PT. Indofarma
Dus, 10 strip @ 10
tablet dispersible
474.00
Imovax Polio
Depakote ER
250 mg
Depakote ER
500 mg
Diovan 80mg
Tab
DIOVAN 160
MG
Page 31 of 31
PT. Aventis Pharma
1 vial of 10ml (10 d's)
285,000.00
Tablet
2,793.00
Tablet
5,450.00

Dus, 2 blister @ 14
tablet
Dus, 2 blister @ 14
tablet
3,900.00
6,500.00

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DAFTAR OBAT E-KATALOG

PT. Kimia Farma

Adefovir Dipivoksil tablet/kaplet 10 mg

PT. SmithKline Beecham

Albendazol suspensi 200 mg/5 ml

Albendazol tablet/kapsul/kaplet 400 mg

PT. Holi Pharma

Alopurinol tablet/kapsul/kaplet 100 mg

PT. Pertiwi Agung

Alprazolam tablet/kapsul/kaplet 0,25 mg

PT. Dexa Medica

Alprazolam tablet/kapsul/kaplet 0,5 mg

PT. Otto Pharmaceuticals

PT. Sanbe Farma

PT. Phapros, Tbk

PT. Darya Varia

Dus, 10 strip @ 10 tss

10. DKI Jakarta

Amikasin injeksi 250 mg/ml

11. DKI Jakarta

Aminofilin injeksi 24 mg/ml

14. DKI Jakarta

Amiodaron tablet/kaplet 200 mg

15. DKI Jakarta

Amitriptilin tablet salut 25 mg (HCl)

16. DKI Jakarta

PT. Pertiwi Agung

17. DKI Jakarta

PT. Pertiwi Agung

18. DKI Jakarta

Amoksisilin kapsul/kaplet 250 mg

Dus, 5 strip @ 6 tablet 344.00

19. DKI Jakarta

Amoksisilin kapsul/kaplet/tablet scored 500 mg

20. DKI Jakarta

Amoksisilin sirup kering forte 250 mg/5 ml

22. DKI Jakarta

Analog insulin long acting inj 100 UI/ml,

PT. Mersifarma Tirmaku

dus, 5 solostar pen @

PT. Ferron Par

Injeksi 100 IU/ml,

PT. Tempo Scan Pacific

25. DKI Jakarta

Analog insulin rapid acting inj 100 UI/ml,

PT. Ferron Par

Injeksi 100 IU/ml,

26. DKI Jakarta

Analog insulin rapid acting inj 100 UI/ml,

PT. Ferron Par

27. DKI Jakarta

Analog insulin rapid actinginj 100 UI/ml,

dus, 5 solostar pen @

28. DKI Jakarta

Analog insulin rapid actinginj 100 UI/ml,

PT. Tempo Scan Pacific

29. DKI Jakarta

PT. AstraZeneca indonesia

23. DKI Jakarta

24. DKI Jakarta

Analog insulin mix acting inj 100 UI/ml, Analog

30. DKI Jakarta

31. DKI Jakarta