Berdasarkan Berita Acara Hasil Pelelangan Nomor : BN.01.04/7367/2015 tanggal 27 Maret 2015, dengan ini
dengan diumumkan bahwa sebagai pemenang lelang untuk pengadaan obat reguler tahun 2015 ( kebutuhan 5 bulan ) (tahap3)
adalah sebagai berikut:
PT. AAM
Harga Satuan Jml Harga
No. Uraian Vol Satuan Merk/ Type (Rp) (Rp)
1 Dumin RT tube rectal 125 mg/2,5 ml 20 Tube Actavis 11.077,00 221.540,00
2 Avelox inf 400mg/250ml 6 Btl Bayer Schering
Pharma 427.432,50 2.564.595,00
3 Nimotop tab 30 mg 1.100 Tablet Bayer Schering
Pharma 5.650,20 6.215.220,00
4 Disolf tab 490 mg 120 Tablet Dexa Medica 6.792,50 815.100,00
5 Flamicort inj 40 mg/ml, 1 ml 50 Vial Dexa Medica 74.800,00 3.740.000,00
6 Sistenol capl 6.840 Tablet Dexa Medica 1.309,00 8.953.560,00
7 SNMC inj, 20 ml 1.520 Amp Dexa Medica 81.241,94 123.487.748,80
8 Vectrine tab 300 mg 100 Tablet Dexa Medica 3.599,75 359.975,00
9 Vometa drops 5 mg/ml, 10 ml 6 Btl Dexa Medica 35.062,50 210.375,00
10 Acanthe SPF 30+ 46 Tube Ferron 52.937,50 2.435.125,00
11 Biobran tab 1.620 Tablet Ferron 9.350,00 15.147.000,00
12 Cinogenta cr, 10 g 11 Tube Ferron 37.056,25 407.618,75
13 Crome inj 50 mg/10 ml 140 Amp Ferron 16.280,00 2.279.200,00
14 Dermovel cr 0,1%, 10 g 55 Tube Ferron 54.862,50 3.017.437,50
15 Dermovel cr 0,1%, 5 g 75 Tube Ferron 33.687,50 2.526.562,50
16 Evalen gel 0,1%, 10 g 210 Tube Ferron 35.200,00 7.392.000,00
17 Frazon inj 2 mg/ml, 2 ml 56 Amp Ferron 11.440,00 640.640,00
18 Ketesse inj 50 mg/2 ml 695 Amp Ferron 36.581,16 25.423.906,20
19 Seloxy AA capl 180 Tablet Ferron 5.646,67 1.016.400,60
20 Seloxy cap 300 Tablet Ferron 4.331,25 1.299.375,00
21 Termisil cr 1%, 10 g 7 Tube Ferron 44.275,00 309.925,00
22 Dynastat inj 40 mg/2 ml 24 Vial Pfizer 102.687,75 2.464.506,00
23 Lipitor tab 10 mg 120 Tablet Pfizer 15.463,80 1.855.656,00
24 Lipitor tab 20 mg 1.260 Tablet Pfizer 15.463,80 19.484.388,00
25 Lipitor tab 40 mg 5.910 Tablet Pfizer 15.463,80 91.391.058,00
26 Lyrica cap 50 mg 588 Cap Pfizer 7.834,08 4.606.439,04
27 Lyrica cap 75 mg 1.554 Cap Pfizer 11.313,15 17.580.635,10
28 Viagra tab 100 mg 4.500 Tablet Pfizer 120.059,53 540.267.885,00
29 Viagra tab 50 mg 260 Tablet Pfizer 91.635,64 23.825.266,40
30 Adona (AC-17) inj 25 mg/5 ml 80 Amp Tanabe Indonesia 14.414,40 1.153.152,00
31 Adona (AC-17) inj 50 mg/10 ml 470 Amp Tanabe Indonesia 20.592,00 9.678.240,00
32 Adona (AC-17) tab 10 mg 200 Tablet Tanabe Indonesia 1.995,84 399.168,00
921.169.697,89
PT. AMS
Harga Satuan Jml Harga
No. Uraian Vol Satuan Merk/ Type (Rp) (Rp)
1 Gamunex inj 10%, 10 ml 50 Vial Dipa Pharmalab
Intersains 1.718.000,00 85.900.000,00
2 Gamunex inj 10%, 50 ml 20 Vial Dipa Pharmalab
Intersains 7.392.000,00 147.840.000,00
3 Acne Feldin lot 6,6%, 110 ml 100 Btl Galenium Pharmasia 33.000,00
Lab 3.300.000,00
4 Ressal acne lotion, 100 ml 40 Btl Galenium Pharmasia
Lab 29.568,00 1.182.720,00
5 Topsy cr 5%, 5 g 5 Tube Galenium Pharmasia
Lab 42.240,00 211.200,00
6 Prorenal tab 200 Tablet Novell Pharma 5.940,00 1.188.000,00
7 Q ten cap 30 mg 90 Cap Novell Pharma 5.198,00 467.820,00
8 Zamel syr, 60 ml 10 Btl Novell Pharma 32.340,00 323.400,00
9 Microlax enema, 5 ml 160 Tube Pharos Indonesia 15.950,00 2.552.000,00
10 Narfoz inj 4 mg/2 ml 195 Amp Pharos Indonesia 23.656,00 4.612.920,00
11 Ozen drops 10 mg/ml, 12 ml 10 Btl Pharos Indonesia 56.100,00 561.000,00
12 Praxion drops 100 mg/ml, 10 ml 2 Btl Pharos Indonesia 16.830,00 33.660,00
13 Praxion forte syr 250 mg/ml, 60 ml 10 Btl Pharos Indonesia 22.440,00 224.400,00
14 Proris syr 100 mg/5 ml, 60 ml 10 Btl Pharos Indonesia 16.500,00 165.000,00
15 Salbuven Expectorant syr,100 ml 15 Btl Pharos Indonesia 37.400,00 561.000,00
16 Salbuven syr, 100 ml 35 Btl Pharos Indonesia 14.633,00 512.155,00
17 Ecron inj 10 mg/vial 5 Vial Pharos/Korea United
Pharm 133.650,00 668.250,00
18 Pantozol inj 40 mg 210 Vial Pharos/Nycomed 142.962,00 30.022.020,00
19 Pantozol tab 40 mg 105 Tablet Pharos/Nycomed 16.594,00 1.742.370,00
20 Benzolac CL gel 10 g 50 Tube SDM Lab 25.080,00 1.254.000,00
21 Benzolac gel 5 %, 5 gr 14 Tube SDM Lab 15.205,00 212.870,00
22 Carmed cr 20%, 40 g 20 Tube SDM Lab 32.134,00 642.680,00
23 Carmed lot, 120 ml 16 Btl SDM Lab 27.693,00 443.088,00
24 Desolex cr 0.05%, 10 g 25 Tube SDM Lab 19.599,00 489.975,00
25 Desolex lot 0.05%, 10 ml 19 Btl SDM Lab 22.128,00 420.432,00
26 Erymed cr 2%, 20 g 20 Tube SDM Lab 24.714,00 494.280,00
27 Erymed Plus sol, 30 ml 10 Btl SDM Lab 36.784,00 367.840,00
28 Erymed sol 2%, 30 ml 34 Btl SDM Lab 24.714,00 840.276,00
29 Ketomed cr 2%, 15 g 15 Tube SDM Lab 21.632,00 324.480,00
30 Kloderma cr 0.05%, 5 g 15 Tube SDM Lab 17.556,00 263.340,00
31 Kloderma oint 0.05%, 10 g 70 Tube SDM Lab 26.125,00 1.828.750,00
32 Medi-Klin gel, 15 g 90 Tube SDM Lab 19.751,00 1.777.590,00
33 Mediklin sol 1.2%, 30 ml 45 Btl SDM Lab 36.575,00 1.645.875,00
34 Medi-Klin TR gel, 15 g 15 Tube SDM Lab 34.772,00 521.580,00
35 Melanox ES cr, 15 g 75 Tube SDM Lab 51.728,00 3.879.600,00
36 Mofacort cr 1%, 10 g 85 Tube SDM Lab 57.475,00 4.885.375,00
37 Mofacort cr 1%, 5 g 25 Tube SDM Lab 30.044,00 751.100,00
38 Niacef gel 4%, 15 g 680 Tube SDM Lab 24.714,00 16.805.520,00
39 Parasol lot SPF 30, 120 ml 137 Btl SDM Lab 75.352,00 10.323.224,00
40 Refaquin cr, 15 g 40 Tube SDM Lab 54.027,00 2.161.080,00
41 Regrou sol 2%, 30ml 15 Btl SDM Lab 47.548,00 713.220,00
42 Reviderm cr 0,01 %, 15 g 85 Tube SDM Lab 22.760,00 1.934.600,00
43 Reviderm cr 0.02 %, 15 g 69 Tube SDM Lab 24.140,00 1.665.660,00
44 Tekasol oint 1%, 10 g 15 Tube SDM Lab 32.918,00 493.770,00
45 Vitacid cr 0.025%, 15 g 37 Tube SDM Lab 19.829,00 733.673,00
46 Vitacid cr 0.05%, 20 g 50 Tube SDM Lab 29.103,00 1.455.150,00
47 Vitacid sol 0.05%, 50 ml 5 Btl SDM Lab 38.500,00 192.500,00
339.589.443,00
PT. APL
Harga Satuan Jml Harga
No. Uraian Vol Satuan Merk/ Type (Rp) (Rp)
1 Locoid cr 1%, 10 g 80 Tube Astelas 62.194,00 4.975.520,00
2 Locoid Scalp lot 0.1%, 20 g 4 Btl Astelas 107.932,00 431.728,00
3 Brilinta tab 90 mg 56 Tablet Astra Zeneca 13.667,00 765.352,00
4 Crestor tab 10 mg 140 Tablet Astra Zeneca 16.033,00 2.244.620,00
5 Nexium IV inj 40 mg 40 Vial Astra Zeneca 171.589,00 6.863.560,00
6 Nexium tab 20 mg 28 Tablet Astra Zeneca 14.510,00 406.280,00
7 Gammaraas inj 2.5 g/50 ml 90 Vial COMBIPHAR 2.859.813,00 257.383.170,00
8 Hepa-Merz Granul sach, 3 g 40 Sache COMBIPHAR 39.930,00 1.597.200,00
9 Hepa-Merz inj 5 g/10 ml 500 Amp COMBIPHAR 114.950,00 57.475.000,00
10 Levopront syr 60 mg/5 ml, 120 ml 5 Btl COMBIPHAR 58.078,00 290.390,00
11 Maltofer Chewable tab 300 Tablet COMBIPHAR 2.823,00 846.900,00
12 Maltofer Fol Chewable tab 90 Tablet COMBIPHAR 3.025,00 272.250,00
13 Mederma gel, 20 g 5 Tube COMBIPHAR 166.375,00 831.875,00
14 Pantogar cap 270 Cap COMBIPHAR 5.647,00 1.524.690,00
15 Phental inj 100 mg/1 ml 215 Amp COMBIPHAR 9.075,00 1.951.125,00
16 Sibro oint, 20 g 240 Tube COMBIPHAR 84.700,00 20.328.000,00
17 Daryant-Tulle 10 cm X 10 cm 5.820 Lbr Darya-Varia 14.025,00 81.625.500,00
18 Moloco + B12 tab 100 Tablet Darya-Varia 2.743,00 274.300,00
19 Salofalk tab 500 mg 300 Cap Darya-Varia 10.128,00 3.038.400,00
20 Somatostatin-Lyomark inj 3 mg/vial 312 Vial Lyomark 774.400,00 241.612.800,00
21 Ferlin drops, 15 ml 20 Btl Medifarma 25.740,00 514.800,00
22 Sumagesic tab 600 mg 1.000 Tablet Medifarma/UAP 379,00 379.000,00
23 Elocon cr 0,1% 5 g 45 Tube Merck Sharp &
Dohme 51.966,00 2.338.470,00
24 Elocon cr 0,1%, 10 g 30 Tube Merck Sharp &
Dohme 87.252,00 2.617.560,00
25 Elocon lot 0,1%, 10 ml 25 Btl Merck Sharp &
Dohme 90.016,00 2.250.400,00
26 Elocon oint 0.1%, 10 g 15 Tube Merck Sharp &
Dohme 87.252,00 1.308.780,00
27 Neostrata AHA 15 lot plus, 200 ml 3 Btl Neostrata 264.137,00 792.411,00
28 Neostrata AHA Ultra Smoothing cr, 40 g 6 Btl Neostrata 276.715,00 1.660.290,00
29 Neostrata AHA Ultra Smoothing lot,200 ml 3 Btl Neostrata 276.715,00 830.145,00
30 Neostrata Bionic Face cr, 40 g 10 Tube Neostrata 276.715,00 2.767.150,00
31 Neostrata Bionic lot, 100 ml 15 Btl Neostrata 264.137,00 3.962.055,00
32 Neostrata Daytime Protection cr, 40 g 55 Tube Neostrata 319.839,00 17.591.145,00
33 Neostrata PHA Eye cr, 15 g 10 Tube Neostrata 270.126,00 2.701.260,00
34 Neostrata Prosystem 20% Rejuv Peel, 30 ml 1 Btl Neostrata 486.351,00 486.351,00
35 Neostrata Prosystem 35% Rejuv Peel, 30 ml 1 Btl Neostrata 502.297,00 502.297,00
36 Neostrata Prosystem 50% Rejuv Peel, 30 ml 1 Btl Neostrata 556.652,00 556.652,00
37 Neostrata Ultra Daytime Smothing cr, 40 6 Tube Neostrata 303.069,00 1.818.414,00
38 Acuatim cr, 10 g 40 Tube Otsuka Indonesia 94.740,00 3.789.600,00
39 Meptin syr 5 mcg/ml, 60 ml 10 Btl Otsuka Indonesia 44.220,00 442.200,00
40 Tygacil inj 50 mg/5 ml 240 Vial Pfizer 603.487,00 144.836.880,00
41 Zithromax inj 500 mg 10 Vial Pfizer 182.607,00 1.826.070,00
42 Zyvox inf 2 mg/ml, 300 ml 20 Btl Pfizer 580.774,00 11.615.480,00
43 Lasix inj 20 mg/2 ml 20 Amp Sanofi Aventis 6.492,00 129.840,00
44 Novalgin inj 500 mg/ml, 2 ml 1.515 Amp Sanofi Aventis 9.387,00 14.221.305,00
45 Trental tab 400 mg 200 Tablet Sanofi Aventis 9.696,00 1.939.200,00
46 Atopiclair cr 100 ml 2 Tube Transfarma Medica
Indah 197.100,00 394.200,00
47 Atopiclair lot 120 ml 2 Btl Transfarma Medica
Indah 207.000,00 414.000,00
48 Elidel cr 1%, 10 g 5 Tube Transfarma Medica
Indah 161.388,00 806.940,00
49 Papulex hydrating cr 50 ml 6 Btl Transfarma Medica
Indah 156.800,00 940.800,00
50 Papulex moussant clns gel 150 ml 10 Tube Transfarma Medica
Indah 160.200,00 1.602.000,00
51 Papulex oil free cr 40 ml 10 Btl Transfarma Medica
Indah 128.200,00 1.282.000,00
52 Precedex inj 100mcg/ml, 2ml 55 Amp Transfarma Medica
Indah 509.157,00 28.003.635,00
940.059.990,00
PT. Enseval
Harga Satuan Jml Harga
No. Uraian Vol Satuan Merk/ Type (Rp) (Rp)
1 Theracim inj 50 mg/10 ml 20 Vial Innogene 3.252.562,00 65.051.240,00
2 Interdoxin cap 100 mg 700 Cap INTERBAT 5.104,00 3.572.800,00
3 Interhistin tab 50 mg 100 Tablet INTERBAT 506,00 50.600,00
4 Intersun SPF 30 lot, 100 ml 150 Btl INTERBAT 41.606,40 6.240.960,00
5 Intersun SPF 35 cr, 20 g 36 Tube INTERBAT 28.661,60 1.031.817,60
6 ATP Kalbe inj 20 mg/2 ml 100 Amp Kalbe Farma 38.500,00 3.850.000,00
7 Bactesyn tab 375 mg 750 Tablet Kalbe Farma 16.500,00 12.375.000,00
8 Brainact inj 500 mg/4 ml 2.340 Amp Kalbe Farma 69.740,00 163.191.600,00
9 Brainact tab 500 mg 810 Tablet Kalbe Farma 12.246,67 9.919.802,70
10 Ceremax inf 10 mg/50 ml 80 Btl Kalbe Farma 291.500,00 23.320.000,00
11 Ferofort capl 400 Tablet Kalbe Farma 1.705,00 682.000,00
12 Fordesia tab 5 mg 660 Tablet Kalbe Farma 24.128,50 15.924.810,00
13 Forres tab 50 mg 50 Tablet Kalbe Farma 4.070,00 203.500,00
14 Frego tab 5 mg 650 Tablet Kalbe Farma 5.434,00 3.532.100,00
15 Kalmeco cap 500 mcg 11.100 Cap Kalbe Farma 2.046,00 22.710.600,00
16 Kalmeco inj 500 mcg/ml 2.115 Vial Kalbe Farma 19.360,00 40.946.400,00
17 Neurotam inf 12 g/60 ml 20 Btl Kalbe Farma 225.500,00 4.510.000,00
18 Neurotam inj 3 g/15 ml 140 Amp Kalbe Farma 57.200,00 8.008.000,00
19 Neurotam syr 10%, 100 ml 16 Btl Kalbe Farma 63.800,00 1.020.800,00
20 Premaston tab 5 mg 120 Tablet Kalbe Farma 4.033,33 483.999,60
21 Profertil tab 50 mg 30 Tablet Kalbe Farma 14.410,00 432.300,00
22 Suprane sol, 240 ml 4.560 ml Kalbe Farma 10.000,00 45.600.000,00
23 Tamoliv inf 10 mg/ml, 100 ml 376 Btl Kalbe Farma 55.000,00 20.680.000,00
453.338.329,90
PT. Indofarma
Harga Satuan Jml Harga
No. Uraian Vol Satuan Merk/ Type (Rp) (Rp)
1 Lactulax syr, 120 ml 95 Btl Fresenius 61.380,00 5.831.100,00
2 Bactoderm cr 2%, 5 g 110 Tube Ikapharmindo 41.221,40 4.534.354,00
3 Bactoderm oint 2%, 10 g 35 Tube Ikapharmindo 59.400,00 2.079.000,00
4 Bioacne cr, 10 g 110 Tube Ikapharmindo 17.765,00 1.954.150,00
5 Biolastin cr, 10 g 15 Tube Ikapharmindo 30.492,00 457.380,00
6 Biolite Whitening cr, 10 g 134 Tube Ikapharmindo 37.383,50 5.009.389,00
7 Clinika gel 1%, 10 g 65 Tube Ikapharmindo 18.601,00 1.209.065,00
8 Clinika soln 1%, 30 ml 90 Btl Ikapharmindo 38.491,20 3.464.208,00
9 Gentasolon cr, 10 g 10 Tube Ikapharmindo 24.186,80 241.868,00
10 Gentasolon cr, 5 g 15 Tube Ikapharmindo 16.526,40 247.896,00
11 Ikaderm cr 0,05%, 10 g 45 Tube Ikapharmindo 33.000,00 1.485.000,00
12 Ikaderm oint 0,05%, 10 g 40 Tube Ikapharmindo 33.000,00 1.320.000,00
13 Ikagen cr 0,1%, 10 g 100 Tube Ikapharmindo 15.015,00 1.501.500,00
14 Ikagen oint 0,1%, 10 g 90 Tube Ikapharmindo 16.491,20 1.484.208,00
15 Ikaphen inj 50 mg/ml, 2 ml 250 Amp Ikapharmindo 83.077,50 20.769.375,00
16 Nomika tab 100 mg 400 Tablet Ikapharmindo 8.791,20 3.516.480,00
17 Probio-C sol, 10 ml 280 Btl Ikapharmindo 46.183,50 12.931.380,00
18 Zoloral tab 200 mg 100 Tablet Ikapharmindo 4.158,00 415.800,00
19 Zinkid syr 10 mg/5 ml, 100 ml 215 Btl Promedic 23.925,00 5.143.875,00
73.596.028,00
PT. RNI
Harga Jml Harga
No. Uraian Vol Satuan Merk/ Type Satuan(Rp) (Rp)
1 Vaksin Hepatitis B inj 20 mcg/ml 800 Amp Biofarma 51.000,00 40.800.000,00
2 Bio ATP tab 200 Tablet Phapros 2.238,00 447.600,00
3 Cardismo tab 20 mg 500 Tablet Phapros 2.578,00 1.289.000,00
4 Hypobhac inj 100 mg/ml, 1.5 ml 380 Amp Phapros 136.997,00 52.058.860,00
5 Mictonorm tab 15 mg 28 Tablet Phapros 10.116,00 283.248,00
6 Pehacain inj 1.480 Amp Phapros 2.957,00 4.376.360,00
7 Proinfark inj 20 mg/ml, 10 ml 140 Amp Phapros 12.540,00 1.755.600,00
101.010.668,00
PT. MUP
Harga Jml Harga
No. Uraian Vol Satuan Merk/ Type Satuan(Rp) (Rp)
1 Chirocaine inj 5 mg/ml 760 Amp Abbott Indonesia 96.050,00 72.998.000,00
2 Fosmicin inj 1 g 540 Vial Meiji 70.488,00 38.063.520,00
3 Fosmicin inj 2 g 140 Vial Meiji 125.125,00 17.517.500,00
4 Meixam inj 1 g 5 Vial Meiji 26.136,00 130.680,00
5 Sibital inj 200 mg/2 ml 160 Amp Mersifarma 9.653,00 1.544.480,00
6 Otsutran - 40 inf, 500 ml 20 plabbot Otsuka Indonesia 93.005,00 1.860.100,00
132.114.280,00
PT. Tempo
Harga Jml Harga
No. Uraian Vol Satuan Merk/ Type Satuan(Rp) (Rp)
1 Cardioplegia inj, 20 ml 20 Amp Tempo Scan
Pacific/Hospira 166.500 3.330.000,00
3.330.000,00
PT. MPI
Harga Jml Harga
No. Uraian Vol Satuan Merk/ Type Satuan(Rp) (Rp)
1 HTK Perfusion Sol, 1000 ml 30 plabbot Dipa Pharmalab
Intersains 1.980.000,00 59.400.000,00
2 Thecort cr, 5 g 25 Tube Guardian
Pharmatama 49.925,00 1.248.125,00
3 Bestalin tab 25 mg 100 Tablet LAPI 3.239,00 323.900,00
4 Clast tab 0.5 mg 100 Tablet Meiji 1.871,00 187.100,00
61.159.125,00