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KATALOG HARGA OBAT

RSIA SAYANG IBU - BATUSANGKAR


RUMAH SAKIT IBU DAN ANAK
JALAN HAMKA NO 73, BATUSANGKAR
TANAH DATAR,SUMATRA BARAT
HUBUNGI KAMI UNTUK INFO LANJUT:
0752-7372 | 0853-6429-3187
Layanan :
Klinik dokter umum,Layanan Spesialis Kandungan,
Spesialis Anak, USG 4, Operasi Sesar,,
Pijat Bayi, Rawat Inap, Persalinan Bidan/Dokter,Imunisasi,
PAPS SMEAR,General Checku Up
NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
ACTAPIN 10 MG TAB 259 MBS OBAT - BEBAS Rp4.333 Rp6.000 TABLET 01/02/2017

ACTAPIN 10 MG TAB 259 MBS OBAT - KARYAWAN Rp4.333 Rp5.500 TABLET 01/02/2017

ACTAPIN 10 MG TAB 259 MBS OBAT - OWNER Rp4.333 Rp5.000 TABLET 01/02/2017

ACTAPIN 10 MG TAB 259 MBS OBAT - STANDAR Rp4.333 Rp6.500 TABLET 01/02/2017

ACYCLOVIR TAB 284 AMS OBAT - BEBAS Rp485 Rp700 TABLET 01/03/2019

ACYCLOVIR TAB 284 AMS OBAT - KARYAWAN Rp485 Rp600 TABLET 01/03/2019

ACYCLOVIR TAB 284 AMS OBAT - OWNER Rp485 Rp600 TABLET 01/03/2019

ACYCLOVIR TAB 284 AMS OBAT - STANDAR Rp485 Rp700 TABLET 01/03/2019

ADALAT OROS 508 APOTIK RAIHAN OBAT - BEBAS Rp8.000 Rp10.000 TABLET 01/05/2017

ADALAT OROS 508 APOTIK RAIHAN OBAT - KARYAWAN Rp8.000 Rp9.000 TABLET 01/05/2017

ADALAT OROS 508 APOTIK RAIHAN OBAT - OWNER Rp8.000 Rp8.000 TABLET 01/05/2017

ADALAT OROS 508 APOTIK RAIHAN OBAT - STANDAR Rp8.000 Rp10.500 TABLET 01/05/2017

ALBOTYL COSENTRAT 5 ML 146 AMS OBAT - BEBAS Rp21.000 Rp29.000 CAIRAN 01/05/2020

ALBOTYL COSENTRAT 5 ML 146 AMS OBAT - KARYAWAN Rp21.000 Rp25.500 CAIRAN 01/05/2020

ALBOTYL COSENTRAT 5 ML 146 AMS OBAT - OWNER Rp21.000 Rp23.500 CAIRAN 01/05/2020

ALBOTYL COSENTRAT 5 ML 146 AMS OBAT - STANDAR Rp21.000 Rp30.500 CAIRAN 01/05/2020

ALBOTYL OVULA 288 AMS OBAT - BEBAS Rp18.333 Rp25.500 SUPPOS 01/09/2017

ALBOTYL OVULA 288 AMS OBAT - KARYAWAN Rp18.333 Rp22.500 SUPPOS 01/09/2017

ALBOTYL OVULA 288 AMS OBAT - OWNER Rp18.333 Rp20.500 SUPPOS 01/09/2017

ALBOTYL OVULA 288 AMS OBAT - STANDAR Rp18.333 Rp26.500 SUPPOS 01/09/2017

ALCO DROP 461 MBS OBAT - BEBAS Rp55.000 Rp76.000 DROP 01/09/2017

ALCO DROP 461 MBS OBAT - KARYAWAN Rp55.000 Rp66.500 DROP 01/09/2017

ALCO DROP 461 MBS OBAT - OWNER Rp55.000 Rp60.500 DROP 01/09/2017

ALCO DROP 461 MBS OBAT - STANDAR Rp55.000 Rp79.000 DROP 01/09/2017

ALCO PLUS 300 MBS OBAT - BEBAS Rp26.000 Rp36.000 SIRUP 01/12/2016

ALCO PLUS 300 MBS OBAT - KARYAWAN Rp26.000 Rp31.500 SIRUP 01/12/2016

ALCO PLUS 300 MBS OBAT - OWNER Rp26.000 Rp29.000 SIRUP 01/12/2016

ALCO PLUS 300 MBS OBAT - STANDAR Rp26.000 Rp37.500 SIRUP 01/12/2016

ALINAMIN INJ 1 UDC OBAT - BEBAS Rp13.611 Rp19.000 INJEKSI 01/01/2017

ALINAMIN INJ 1 UDC OBAT - KARYAWAN Rp13.611 Rp18.000 INJEKSI 01/01/2017

ALINAMIN INJ 1 UDC OBAT - OWNER Rp13.611 Rp15.000 INJEKSI 01/01/2017

23 September 2016 Page 1 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
ALINAMIN INJ 1 UDC OBAT - STANDAR Rp13.611 Rp20.000 INJEKSI 01/01/2017

ALKOHOL 70 % 379 CITRA MEDICA ALKES 1 Rp24.823 Rp35.500 ALKES 01/11/2018

ALKOHOL 70 % 379 CITRA MEDICA ALKES KARYAWAN2 Rp24.823 Rp30.500 ALKES 01/11/2018

ALKOHOL 70 % 379 CITRA MEDICA ALKES OWNER Rp24.823 Rp27.500 ALKES 01/11/2018

ALKOHOL 70 % 379 CITRA MEDICA ALKES STANDAR ALKES

ALPRAZOLAM 1 MG 537 MBS OBAT - BEBAS Rp883 Rp1.300 TABLET 01/01/2018

ALPRAZOLAM 1 MG 537 MBS OBAT - KARYAWAN Rp883 Rp1.100 TABLET 01/01/2018

ALPRAZOLAM 1 MG 537 MBS OBAT - OWNER Rp883 Rp1.000 TABLET 01/01/2018

ALPRAZOLAM 1 MG 537 MBS OBAT - STANDAR Rp883 Rp1.300 TABLET 01/01/2018

ALPRAZOLAM TAB 220 MBS OBAT - BEBAS Rp575 Rp800 TABLET 01/03/2017

ALPRAZOLAM TAB 220 MBS OBAT - KARYAWAN Rp575 Rp700 TABLET 01/03/2017

ALPRAZOLAM TAB 220 MBS OBAT - OWNER Rp575 Rp700 TABLET 01/03/2017

ALPRAZOLAM TAB 220 MBS OBAT - STANDAR Rp575 Rp900 TABLET 01/03/2017

AMBROXOL SYR 158 BSP OBAT - BEBAS Rp3.240 Rp4.500 SIRUP 01/07/2018

AMBROXOL SYR 158 BSP OBAT - KARYAWAN Rp3.240 Rp4.000 SIRUP 01/07/2018

AMBROXOL SYR 158 BSP OBAT - OWNER Rp3.240 Rp3.600 SIRUP 01/07/2018

AMBROXOL SYR 158 BSP OBAT - STANDAR Rp3.240 Rp5.000 SIRUP 01/07/2018

AMBROXOL TAB 178 AMS OBAT - BEBAS Rp160 Rp500 TABLET 01/09/2017

AMBROXOL TAB 178 AMS OBAT - KARYAWAN Rp160 Rp200 TABLET 01/09/2017

AMBROXOL TAB 178 AMS OBAT - OWNER Rp160 Rp200 TABLET 01/09/2017

AMBROXOL TAB 178 AMS OBAT - STANDAR Rp160 Rp500 TABLET 01/09/2017

AMINOFLUID 370 MERAPI OBAT - BEBAS Rp104.500 Rp144.000 INFUS 17/06/2016

AMINOFLUID 370 MERAPI OBAT - KARYAWAN Rp104.500 Rp126.500 INFUS 17/06/2016

AMINOFLUID 370 MERAPI OBAT - OWNER Rp104.500 Rp115.000 INFUS 17/06/2016

AMINOFLUID 370 MERAPI OBAT - STANDAR Rp104.500 Rp149.500 INFUS 17/06/2016

AMINOPHYLIN INJ 326 PARIT OBAT - BEBAS Rp5.625 Rp8.000 AMPUL 01/04/2018

AMINOPHYLIN INJ 326 PARIT OBAT - KARYAWAN Rp5.625 Rp7.000 AMPUL 01/04/2018

AMINOPHYLIN INJ 326 PARIT OBAT - OWNER Rp5.625 Rp6.500 AMPUL 01/04/2018

AMINOPHYLIN INJ 326 PARIT OBAT - STANDAR Rp5.625 Rp8.500 AMPUL 01/04/2018

AMLODIPIN 10 MG 47 AAM OBAT - BEBAS Rp1.615 Rp2.300 TABLET 01/07/2017

AMLODIPIN 10 MG 47 AAM OBAT - KARYAWAN Rp1.615 Rp2.000 TABLET 01/07/2017

AMLODIPIN 10 MG 47 AAM OBAT - OWNER Rp1.615 Rp1.800 TABLET 01/07/2017

AMLODIPIN 10 MG 47 AAM OBAT - STANDAR Rp1.615 Rp2.400 TABLET 01/07/2017

AMLODIPIN 5 MG 48 AAM OBAT - BEBAS Rp917 Rp1.300 TABLET 01/08/2018

AMLODIPIN 5 MG 48 AAM OBAT - KARYAWAN Rp917 Rp1.200 TABLET 01/08/2018

AMLODIPIN 5 MG 48 AAM OBAT - OWNER Rp917 Rp1.000 TABLET 01/08/2018

AMLODIPIN 5 MG 48 AAM OBAT - STANDAR Rp917 Rp1.400 TABLET 01/08/2018

AMOXAN 500 MG CAP 12 BSP OBAT - BEBAS Rp3.020 Rp4.200 KAPSUL 01/09/2018

AMOXAN 500 MG CAP 12 BSP OBAT - KARYAWAN Rp3.020 Rp3.700 KAPSUL 01/09/2018

AMOXAN 500 MG CAP 12 BSP OBAT - OWNER Rp3.020 Rp3.400 KAPSUL 01/09/2018

AMOXAN 500 MG CAP 12 BSP OBAT - STANDAR Rp3.020 Rp4.500 KAPSUL 01/09/2018

AMOXAN DROP 181 BSP OBAT - BEBAS Rp20.710 Rp28.500 SIRUP 01/06/2018

23 September 2016 Page 2 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
AMOXAN DROP 181 BSP OBAT - KARYAWAN Rp20.710 Rp25.000 SIRUP 01/06/2018

AMOXAN DROP 181 BSP OBAT - OWNER Rp20.710 Rp23.000 SIRUP 01/06/2018

AMOXAN DROP 181 BSP OBAT - STANDAR Rp20.710 Rp30.000 SIRUP 01/06/2018

AMOXAN INJ 175 BSP OBAT - BEBAS Rp20.710 Rp28.500 VIAL 01/07/2017

AMOXAN INJ 175 BSP OBAT - KARYAWAN Rp20.710 Rp25.500 VIAL 01/07/2017

AMOXAN INJ 175 BSP OBAT - OWNER Rp20.710 Rp23.000 VIAL 01/07/2017

AMOXAN INJ 175 BSP OBAT - STANDAR Rp20.710 Rp30.000 VIAL 01/07/2017

AMOXAN SYR 141 BSP OBAT - BEBAS Rp20.710 Rp28.500 SIRUP 01/09/2018

AMOXAN SYR 141 BSP OBAT - KARYAWAN Rp20.710 Rp25.000 SIRUP 01/09/2018

AMOXAN SYR 141 BSP OBAT - OWNER Rp20.710 Rp23.000 SIRUP 01/09/2018

AMOXAN SYR 141 BSP OBAT - STANDAR Rp20.710 Rp30.000 SIRUP 01/09/2018

AMOXAN SYR FORTE 176 BSP OBAT - BEBAS Rp29.535 Rp41.000 SIRUP 26/06/2018

AMOXAN SYR FORTE 176 BSP OBAT - KARYAWAN Rp29.535 Rp36.000 SIRUP 26/06/2018

AMOXAN SYR FORTE 176 BSP OBAT - OWNER Rp29.535 Rp32.500 SIRUP 26/06/2018

AMOXAN SYR FORTE 176 BSP OBAT - STANDAR Rp29.535 Rp42.500 SIRUP 26/06/2018

AMOXICILLIN CAP 333 BSP OBAT - BEBAS Rp364 Rp600 KAPSUL 01/01/2017

AMOXICILLIN CAP 333 BSP OBAT - KARYAWAN Rp364 Rp500 KAPSUL 01/01/2017

AMOXICILLIN CAP 333 BSP OBAT - OWNER Rp364 Rp400 KAPSUL 01/01/2017

AMOXICILLIN CAP 333 BSP OBAT - STANDAR Rp364 Rp600 KAPSUL 01/01/2017

AMOXICILLIN SYR 337 APOTIK BUNDO OBAT - BEBAS Rp4.000 Rp5.000 SIRUP 01/01/2018

AMOXICILLIN SYR 337 APOTIK BUNDO OBAT - KARYAWAN Rp4.000 Rp4.500 SIRUP 01/01/2018

AMOXICILLIN SYR 337 APOTIK BUNDO OBAT - OWNER Rp4.000 Rp4.000 SIRUP 01/01/2018

AMOXICILLIN SYR 337 APOTIK BUNDO OBAT - STANDAR Rp4.000 Rp5.500 SIRUP 01/01/2018

ANALSIK 223 BSP OBAT - BEBAS Rp1.100 Rp1.600 TABLET 22/05/2018

ANALSIK 223 BSP OBAT - KARYAWAN Rp1.100 Rp1.400 TABLET 22/05/2018

ANALSIK 223 BSP OBAT - OWNER Rp1.100 Rp1.300 TABLET 22/05/2018

ANALSIK 223 BSP OBAT - STANDAR Rp1.100 Rp1.600 TABLET 22/05/2018

ANTANGIN FIT SASET 215 BSP OBAT - BEBAS Rp1.591 Rp2.500 SACHET 01/06/2017

ANTANGIN FIT SASET 215 BSP OBAT - KARYAWAN Rp1.591 Rp2.000 SACHET 01/06/2017

ANTANGIN FIT SASET 215 BSP OBAT - OWNER Rp1.591 Rp1.800 SACHET 01/06/2017

ANTANGIN FIT SASET 215 BSP OBAT - STANDAR Rp1.591 Rp2.300 SACHET 01/06/2017

ANTANGIN SYR 73 BSP OBAT - BEBAS Rp1.591 Rp2.200 SACHET 01/10/2017

ANTANGIN SYR 73 BSP OBAT - KARYAWAN Rp1.591 Rp2.000 SACHET 01/10/2017

ANTANGIN SYR 73 BSP OBAT - OWNER Rp1.591 Rp1.800 SACHET 01/10/2017

ANTANGIN SYR 73 BSP OBAT - STANDAR Rp1.591 Rp2.300 SACHET 01/10/2017

ANTIMO ANAK 278 TSJ OBAT - BEBAS Rp800 Rp1.500 CAIRAN 01/05/2018

ANTIMO ANAK 278 TSJ OBAT - KARYAWAN Rp800 Rp1.000 CAIRAN 01/05/2018

ANTIMO ANAK 278 TSJ OBAT - OWNER Rp800 Rp1.000 CAIRAN 01/05/2018

ANTIMO ANAK 278 TSJ OBAT - STANDAR Rp800 Rp1.500 CAIRAN 01/05/2018

ANTIMO DEWASA 279 TSJ OBAT - BEBAS Rp360 Rp500 TABLET 01/01/2017

ANTIMO DEWASA 279 TSJ OBAT - KARYAWAN Rp360 Rp400 TABLET 01/01/2017

ANTIMO DEWASA 279 TSJ OBAT - OWNER Rp360 Rp400 TABLET 01/01/2017

23 September 2016 Page 3 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
ANTIMO DEWASA 279 TSJ OBAT - STANDAR Rp360 Rp500 TABLET 01/01/2017

APOLAR SALAP 336 APL OBAT - BEBAS Rp35.000 Rp48.500 SALEP 01/05/2016

APOLAR SALAP 336 APL OBAT - KARYAWAN Rp35.000 Rp42.500 SALEP 01/05/2016

APOLAR SALAP 336 APL OBAT - OWNER Rp35.000 Rp38.500 SALEP 01/05/2016

APOLAR SALAP 336 APL OBAT - STANDAR Rp35.000 Rp50.000 SALEP 01/05/2016

AQUA INJ 145 MERAPI OBAT - BEBAS Rp4.600 Rp6.500 CAIRAN 29/09/2018

AQUA INJ 145 MERAPI OBAT - KARYAWAN Rp4.600 Rp5.600 CAIRAN 29/09/2018

AQUA INJ 145 MERAPI OBAT - OWNER Rp4.600 Rp5.100 CAIRAN 29/09/2018

AQUA INJ 145 MERAPI OBAT - STANDAR Rp4.600 Rp7.000 CAIRAN 29/09/2018

ARDIUM TAB 335 APL OBAT - BEBAS Rp7.738 Rp10.700 TABLET 01/09/2019

ARDIUM TAB 335 APL OBAT - KARYAWAN Rp7.738 Rp9.400 TABLET 01/09/2019

ARDIUM TAB 335 APL OBAT - OWNER Rp7.738 Rp8.600 TABLET 01/09/2019

ARDIUM TAB 335 APL OBAT - STANDAR Rp7.738 Rp11.500 TABLET 01/09/2019

ARKAFIT TAB 510 APOTIK RAIHAN OBAT - BEBAS Rp400 Rp500 TABLET 01/04/2017

ARKAFIT TAB 510 APOTIK RAIHAN OBAT - KARYAWAN Rp400 Rp500 TABLET 01/04/2017

ARKAFIT TAB 510 APOTIK RAIHAN OBAT - OWNER Rp400 Rp400 TABLET 01/04/2017

ARKAFIT TAB 510 APOTIK RAIHAN OBAT - STANDAR Rp400 Rp600 TABLET 01/04/2017

ASAM MEFENAMAT TAB 323 APOTIK METRO OBAT - BEBAS Rp220 Rp500 TABLET 01/04/2020

ASAM MEFENAMAT TAB 323 APOTIK METRO OBAT - KARYAWAN Rp220 Rp300 TABLET 01/04/2020

ASAM MEFENAMAT TAB 323 APOTIK METRO OBAT - OWNER Rp220 Rp300 TABLET 01/04/2020

ASAM MEFENAMAT TAB 323 APOTIK METRO OBAT - STANDAR Rp220 Rp500 TABLET 01/04/2020

BAY BAY FEVER ANK 263 MERAPI ALKES 1 Rp7.980 Rp11.500 ALKES 01/04/2018

BAY BAY FEVER ANK 263 MERAPI ALKES KARYAWAN2 Rp7.980 Rp10.000 ALKES 01/04/2018

BAY BAY FEVER ANK 263 MERAPI ALKES OWNER Rp7.980 Rp9.000 ALKES 01/04/2018

BAY BAY FEVER ANK 263 MERAPI ALKES STANDAR ALKES

BAY-BAY FEVER BAYI 312 MERAPI ALKES 1 Rp5.605 Rp8.000 SACHET 01/04/2018

BAY-BAY FEVER BAYI 312 MERAPI ALKES KARYAWAN2 Rp5.605 Rp7.000 SACHET 01/04/2018

BAY-BAY FEVER BAYI 312 MERAPI ALKES OWNER Rp5.605 Rp6.500 SACHET 01/04/2018

BAY-BAY FEVER BAYI 312 MERAPI ALKES STANDAR SACHET

BECOM C TAB 68 BSP OBAT - BEBAS Rp1.200 Rp1.700 TABLET 01/10/2018

BECOM C TAB 68 BSP OBAT - KARYAWAN Rp1.200 Rp1.500 TABLET 01/10/2018

BECOM C TAB 68 BSP OBAT - OWNER Rp1.200 Rp1.400 TABLET 01/10/2018

BECOM C TAB 68 BSP OBAT - STANDAR Rp1.200 Rp1.800 TABLET 01/10/2018

BEISI DELIVERY SISTIM 536 INVOICE ALKES 1 Rp1.600.000 Rp2.288.000 ALKES

BEISI DELIVERY SISTIM 536 INVOICE ALKES KARYAWAN2 Rp1.600.000 Rp1.936.000 ALKES

BEISI DELIVERY SISTIM 536 INVOICE ALKES OWNER Rp1.600.000 Rp1.760.000 ALKES

BEISI DELIVERY SISTIM 536 INVOICE ALKES STANDAR ALKES

BENOVIT C TAB 2 UDC OBAT - BEBAS Rp1.500 Rp2.100 TABLET 01/01/2018

BENOVIT C TAB 2 UDC OBAT - KARYAWAN Rp1.500 Rp2.000 TABLET 01/01/2018

BENOVIT C TAB 2 UDC OBAT - OWNER Rp1.500 Rp1.650 TABLET 01/01/2018

BENOVIT C TAB 2 UDC OBAT - STANDAR Rp1.500 Rp2.200 TABLET 01/07/2018

BENOZYM 311 UDC OBAT - BEBAS Rp2.000 Rp3.000 TABLET 01/03/2017

23 September 2016 Page 4 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
BENOZYM 311 UDC OBAT - KARYAWAN Rp2.000 Rp2.500 TABLET 01/03/2017

BENOZYM 311 UDC OBAT - OWNER Rp2.000 Rp2.200 TABLET 01/03/2017

BENOZYM 311 UDC OBAT - STANDAR Rp2.000 Rp3.000 TABLET 01/03/2017

BEPANTHEN 307 DOSNI OBAT - BEBAS Rp40.960 Rp56.500 SALEP 01/06/2016

BEPANTHEN 307 DOSNI OBAT - KARYAWAN Rp40.960 Rp49.500 SALEP 01/06/2016

BEPANTHEN 307 DOSNI OBAT - OWNER Rp40.960 Rp45.000 SALEP 01/06/2016

BEPANTHEN 307 DOSNI OBAT - STANDAR Rp40.960 Rp59.000 SALEP 01/06/2016

BERZIMPLEX 310 UDC OBAT - BEBAS Rp1.500 Rp2.100 TABLET 01/11/2016

BERZIMPLEX 310 UDC OBAT - KARYAWAN Rp1.500 Rp1.900 TABLET 01/11/2016

BERZIMPLEX 310 UDC OBAT - OWNER Rp1.500 Rp1.700 TABLET 01/11/2016

BERZIMPLEX 310 UDC OBAT - STANDAR Rp1.500 Rp2.200 TABLET 01/11/2016

BESTALIN TAB 260 PENTA VALEN OBAT - BEBAS Rp3.325 Rp5.000 TABLET 01/09/2018

BESTALIN TAB 260 PENTA VALEN OBAT - KARYAWAN Rp3.325 Rp4.000 TABLET 01/09/2018

BESTALIN TAB 260 PENTA VALEN OBAT - OWNER Rp3.325 Rp3.700 TABLET 01/09/2018

BESTALIN TAB 260 PENTA VALEN OBAT - STANDAR Rp3.325 Rp4.800 TABLET 01/09/2018

BETADIN KUMUR 100 ML 399 TSJ OBAT - BEBAS Rp9.500 Rp13.500 CAIRAN 01/10/2018

BETADIN KUMUR 100 ML 399 TSJ OBAT - KARYAWAN Rp9.500 Rp11.500 CAIRAN 01/10/2018

BETADIN KUMUR 100 ML 399 TSJ OBAT - OWNER Rp9.500 Rp10.500 CAIRAN 01/10/2018

BETADIN KUMUR 100 ML 399 TSJ OBAT - STANDAR Rp9.500 Rp14.000 CAIRAN 01/10/2018

BINUTRION VE INF 96 BSP OBAT - BEBAS Rp98.200 Rp135.000 CAIRAN 01/06/2017

BINUTRION VE INF 96 BSP OBAT - KARYAWAN Rp98.200 Rp119.000 CAIRAN 01/06/2017

BINUTRION VE INF 96 BSP OBAT - OWNER Rp98.200 Rp108.000 CAIRAN 01/06/2017

BINUTRION VE INF 96 BSP OBAT - STANDAR Rp98.200 Rp140.500 CAIRAN 01/06/2017

BIOCEF 21 MBS OBAT - BEBAS Rp130.000 Rp179.000 VIAL 01/01/2018

BIOCEF 21 MBS OBAT - KARYAWAN Rp130.000 Rp157.500 VIAL 01/01/2018

BIOCEF 21 MBS OBAT - OWNER Rp130.000 Rp143.000 VIAL 01/01/2018

BIOCEF 21 MBS OBAT - STANDAR Rp130.000 Rp186.000 VIAL 01/01/2018

BIOPLASENTON 65 ENSEVAL OBAT - BEBAS Rp13.500 Rp19.000 SALEP 01/11/2019

BIOPLASENTON 65 ENSEVAL OBAT - KARYAWAN Rp13.500 Rp16.500 SALEP 01/11/2019

BIOPLASENTON 65 ENSEVAL OBAT - OWNER Rp13.500 Rp15.000 SALEP 01/11/2019

BIOPLASENTON 65 ENSEVAL OBAT - STANDAR Rp13.500 Rp19.500 SALEP 01/11/2019

BIOSANBE TAB 82 BSP OBAT - BEBAS Rp900 Rp1.300 TABLET 19/08/2018

BIOSANBE TAB 82 BSP OBAT - KARYAWAN Rp900 Rp1.100 TABLET 19/08/2018

BIOSANBE TAB 82 BSP OBAT - OWNER Rp900 Rp1.000 TABLET 19/08/2018

BIOSANBE TAB 82 BSP OBAT - STANDAR Rp900 Rp1.300 TABLET 19/08/2018

BISOLVON BATUK&FLU SYR 134 TSJ OBAT - BEBAS Rp27.200 Rp37.500 SIRUP 01/07/2016

BISOLVON BATUK&FLU SYR 134 TSJ OBAT - KARYAWAN Rp27.200 Rp33.000 SIRUP 01/07/2016

BISOLVON BATUK&FLU SYR 134 TSJ OBAT - OWNER Rp27.200 Rp30.000 SIRUP 01/07/2016

BISOLVON BATUK&FLU SYR 134 TSJ OBAT - STANDAR Rp27.200 Rp39.000 SIRUP 01/07/2016

BISOLVON INJ 31 TEMPO OBAT - BEBAS Rp52.932 Rp73.000 AMPUL 01/10/2019

BISOLVON INJ 31 TEMPO OBAT - KARYAWAN Rp52.932 Rp64.500 AMPUL 01/10/2019

BISOLVON INJ 31 TEMPO OBAT - OWNER Rp52.932 Rp58.500 AMPUL 01/10/2019

23 September 2016 Page 5 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
BISOLVON INJ 31 TEMPO OBAT - STANDAR Rp52.932 Rp76.000 AMPUL 01/10/2019

BISOLVON SYR 120 TSJ OBAT - BEBAS Rp28.050 Rp39.000 SIRUP 01/10/2019

BISOLVON SYR 120 TSJ OBAT - KARYAWAN Rp28.050 Rp34.000 SIRUP 01/10/2019

BISOLVON SYR 120 TSJ OBAT - OWNER Rp28.050 Rp31.000 SIRUP 01/10/2019

BISOLVON SYR 120 TSJ OBAT - STANDAR Rp28.050 Rp40.500 SIRUP 01/10/2016

BLEDSTOP INJ 89 BSP OBAT - BEBAS Rp6.650 Rp9.500 AMPUL 01/07/2017

BLEDSTOP INJ 89 BSP OBAT - KARYAWAN Rp6.650 Rp8.500 AMPUL 01/07/2017

BLEDSTOP INJ 89 BSP OBAT - OWNER Rp6.650 Rp7.500 AMPUL 01/07/2017

BLEDSTOP INJ 89 BSP OBAT - STANDAR Rp6.650 Rp10.000 AMPUL 01/07/2017

BLEDSTOP TAB 131 BSP OBAT - BEBAS Rp450 Rp700 TABLET 01/07/2017

BLEDSTOP TAB 131 BSP OBAT - KARYAWAN Rp450 Rp600 TABLET 01/07/2017

BLEDSTOP TAB 131 BSP OBAT - OWNER Rp450 Rp500 TABLET 01/07/2017

BLEDSTOP TAB 131 BSP OBAT - STANDAR Rp450 Rp700 TABLET 01/07/2017

BLESIFEM TAB 142 BSP OBAT - BEBAS Rp11.400 Rp16.000 TABLET 01/04/2018

BLESIFEM TAB 142 BSP OBAT - KARYAWAN Rp11.400 Rp14.000 TABLET 01/04/2018

BLESIFEM TAB 142 BSP OBAT - OWNER Rp11.400 Rp12.600 TABLET 01/04/2018

BLESIFEM TAB 142 BSP OBAT - STANDAR Rp11.400 Rp16.500 TABLET 01/04/2018

BLOOD LANCET GC 380 CITRA MEDICA ALKES 3 Rp180 Rp300 ALKES

BLOOD LANCET GC 380 CITRA MEDICA ALKES KARYAWAN2 Rp180 Rp200 ALKES

BLOOD LANCET GC 380 CITRA MEDICA ALKES OWNER Rp180 Rp200 ALKES

BLOOD LANCET GC 380 CITRA MEDICA ALKES STANDAR ALKES

BORAGINOL N 58 UDC OBAT - BEBAS Rp7.682 Rp10.500 SUPPOS 07/10/2018

BORAGINOL N 58 UDC OBAT - KARYAWAN Rp7.682 Rp9.500 SUPPOS 07/10/2018

BORAGINOL N 58 UDC OBAT - OWNER Rp7.682 Rp8.500 SUPPOS 07/10/2018

BORAGINOL N 58 UDC OBAT - STANDAR Rp7.682 Rp11.000 SUPPOS 07/10/2018

BORAGINOL S 189 UDC OBAT - BEBAS Rp9.683 Rp13.500 SUPPOS 01/07/2018

BORAGINOL S 189 UDC OBAT - KARYAWAN Rp9.683 Rp12.000 SUPPOS 01/07/2018

BORAGINOL S 189 UDC OBAT - OWNER Rp9.683 Rp11.000 SUPPOS 01/07/2018

BORAGINOL S 189 UDC OBAT - STANDAR Rp9.683 Rp14.000 SUPPOS 01/07/2018

BREATY TETES HIDUNG 521 AMS OBAT - BEBAS Rp15.000 Rp21.000 CAIRAN 01/04/2021

BREATY TETES HIDUNG 521 AMS OBAT - KARYAWAN Rp15.000 Rp18.500 CAIRAN 01/04/2021

BREATY TETES HIDUNG 521 AMS OBAT - OWNER Rp15.000 Rp16.500 CAIRAN 01/04/2021

BREATY TETES HIDUNG 521 AMS OBAT - STANDAR Rp15.000 Rp21.500 CAIRAN 01/04/2021

BUCAIN SPINAL 243 UDC OBAT - BEBAS Rp55.000 Rp76.000 VIAL 01/10/2019

BUCAIN SPINAL 243 UDC OBAT - KARYAWAN Rp55.000 Rp66.500 VIAL 01/10/2019

BUCAIN SPINAL 243 UDC OBAT - OWNER Rp55.000 Rp60.500 VIAL 01/10/2019

BUCAIN SPINAL 243 UDC OBAT - STANDAR Rp55.000 Rp79.000 VIAL 01/10/2019

BUCAINSPINAL INJ 165 UDC OBAT - BEBAS Rp55.000 Rp76.000 AMPUL 01/10/2019

BUCAINSPINAL INJ 165 UDC OBAT - KARYAWAN Rp55.000 Rp67.000 AMPUL 01/10/2019

BUCAINSPINAL INJ 165 UDC OBAT - OWNER Rp55.000 Rp60.500 AMPUL 01/10/2019

BUCAINSPINAL INJ 165 UDC OBAT - STANDAR Rp55.000 Rp79.000 AMPUL 01/10/2019

BUFECT SRY 186 BSP OBAT - BEBAS Rp13.100 Rp18.000 SIRUP 15/06/2018

23 September 2016 Page 6 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
BUFECT SRY 186 BSP OBAT - KARYAWAN Rp13.100 Rp16.000 SIRUP 15/06/2018

BUFECT SRY 186 BSP OBAT - OWNER Rp13.100 Rp14.500 SIRUP 15/06/2018

BUFECT SRY 186 BSP OBAT - STANDAR Rp13.100 Rp19.000 SIRUP 15/06/2018

BUFECT SYR FORTE 185 BSP OBAT - BEBAS Rp18.500 Rp25.500 SIRUP 29/06/2018

BUFECT SYR FORTE 185 BSP OBAT - KARYAWAN Rp18.500 Rp22.500 SIRUP 29/06/2018

BUFECT SYR FORTE 185 BSP OBAT - OWNER Rp18.500 Rp20.500 SIRUP 29/06/2018

BUFECT SYR FORTE 185 BSP OBAT - STANDAR Rp18.500 Rp20.700 SIRUP 29/06/2018

BUNASCANSPINAL INJ 169 PARIT OBAT - BEBAS Rp58.000 Rp80.000 AMPUL 01/06/2017

BUNASCANSPINAL INJ 169 PARIT OBAT - KARYAWAN Rp58.000 Rp70.500 AMPUL 01/06/2017

BUNASCANSPINAL INJ 169 PARIT OBAT - OWNER Rp58.000 Rp64.000 AMPUL 01/06/2017

BUNASCANSPINAL INJ 169 PARIT OBAT - STANDAR Rp58.000 Rp83.000 AMPUL 01/06/2017

CA GLUCONAS INJ 262 PARIT OBAT - BEBAS Rp13.636 Rp19.000 AMPUL 01/03/2019

CA GLUCONAS INJ 262 PARIT OBAT - KARYAWAN Rp13.636 Rp16.500 AMPUL 01/03/2019

CA GLUCONAS INJ 262 PARIT OBAT - OWNER Rp13.636 Rp15.000 AMPUL 01/03/2019

CA GLUCONAS INJ 262 PARIT OBAT - STANDAR Rp13.636 Rp19.500 AMPUL 01/03/2019

CAL 95 59 PENTA VALEN OBAT - BEBAS Rp4.400 Rp6.000 TABLET 01/12/2018

CAL 95 59 PENTA VALEN OBAT - KARYAWAN Rp4.400 Rp5.400 TABLET 01/12/2018

CAL 95 59 PENTA VALEN OBAT - OWNER Rp4.400 Rp5.000 TABLET 01/12/2018

CAL 95 59 PENTA VALEN OBAT - STANDAR Rp4.400 Rp6.300 TABLET 01/12/2018

CAL 95 TAB 479 TSJ OBAT - BEBAS Rp4.000 Rp5.500 TABLET 01/01/2020

CAL 95 TAB 479 TSJ OBAT - KARYAWAN Rp4.000 Rp5.000 TABLET 01/01/2020

CAL 95 TAB 479 TSJ OBAT - OWNER Rp4.000 Rp4.500 TABLET 01/01/2020

CAL 95 TAB 479 TSJ OBAT - STANDAR Rp4.000 Rp6.000 TABLET 01/01/2020

CALADIN CAIR 60 ML 225 AMS OBAT - BEBAS Rp10.300 Rp14.500 CAIRAN 01/06/2018

CALADIN CAIR 60 ML 225 AMS OBAT - KARYAWAN Rp10.300 Rp12.500 CAIRAN 01/06/2018

CALADIN CAIR 60 ML 225 AMS OBAT - OWNER Rp10.300 Rp11.500 CAIRAN 01/06/2018

CALADIN CAIR 60 ML 225 AMS OBAT - STANDAR Rp10.300 Rp15.000 CAIRAN 01/06/2018

CALADIN CAIR 95 ML 226 AMS OBAT - BEBAS Rp10.400 Rp14.500 CAIRAN 01/05/2018

CALADIN CAIR 95 ML 226 AMS OBAT - KARYAWAN Rp10.400 Rp12.500 CAIRAN 01/05/2018

CALADIN CAIR 95 ML 226 AMS OBAT - OWNER Rp10.400 Rp11.500 CAIRAN 01/05/2018

CALADIN CAIR 95 ML 226 AMS OBAT - STANDAR Rp10.400 Rp15.000 CAIRAN 01/05/2018

CALADIN CEAM 277 AMS OBAT - BEBAS Rp4.950 Rp7.000 SALEP 01/04/2018

CALADIN CEAM 277 AMS OBAT - KARYAWAN Rp4.950 Rp6.000 SALEP 01/04/2018

CALADIN CEAM 277 AMS OBAT - OWNER Rp4.950 Rp5.500 SALEP 01/04/2018

CALADIN CEAM 277 AMS OBAT - STANDAR Rp4.950 Rp7.000 SALEP 01/04/2018

CALADIN PAWDER 43 AMS OBAT - BEBAS Rp7.300 Rp10.500 BEDAK 01/08/2020

CALADIN PAWDER 43 AMS OBAT - KARYAWAN Rp7.300 Rp9.000 BEDAK 01/08/2020

CALADIN PAWDER 43 AMS OBAT - OWNER Rp7.300 Rp8.000 BEDAK 01/08/2020

CALADIN PAWDER 43 AMS OBAT - STANDAR Rp7.300 Rp11.000 BEDAK 01/08/2020

CALADIN SABUN CAIR 153 AMS OBAT - BEBAS Rp11.650 Rp16.000 CAIRAN 01/04/2017

CALADIN SABUN CAIR 153 AMS OBAT - KARYAWAN Rp11.650 Rp14.500 CAIRAN 01/04/2017

CALADIN SABUN CAIR 153 AMS OBAT - OWNER Rp11.650 Rp13.000 CAIRAN 01/04/2017

23 September 2016 Page 7 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
CALADIN SABUN CAIR 153 AMS OBAT - STANDAR Rp11.650 Rp17.000 CAIRAN 01/04/2027

CALPRO TAB 218 PARIT OBAT - BEBAS Rp1.667 Rp2.300 TABLET 01/01/2017

CALPRO TAB 218 PARIT OBAT - KARYAWAN Rp1.667 Rp2.100 TABLET 01/01/2017

CALPRO TAB 218 PARIT OBAT - OWNER Rp1.667 Rp1.900 TABLET 01/01/2017

CALPRO TAB 218 PARIT OBAT - STANDAR Rp1.667 Rp2.500 TABLET 01/01/2017

CANESTEN SD 282 DOSNI OBAT - BEBAS Rp94.365 Rp130.000 SUPPOS 01/08/2017

CANESTEN SD 282 DOSNI OBAT - KARYAWAN Rp94.365 Rp114.500 SUPPOS 01/08/2017

CANESTEN SD 282 DOSNI OBAT - OWNER Rp94.365 Rp104.000 SUPPOS 01/08/2017

CANESTEN SD 282 DOSNI OBAT - STANDAR Rp94.365 Rp135.000 SUPPOS 01/08/2017

CARNEVIT INJ 251 ENSEVAL OBAT - BEBAS Rp144.000 Rp198.000 AMPUL 01/04/2017

CARNEVIT INJ 251 ENSEVAL OBAT - KARYAWAN Rp144.000 Rp174.500 AMPUL 01/04/2017

CARNEVIT INJ 251 ENSEVAL OBAT - OWNER Rp144.000 Rp158.500 AMPUL 01/04/2017

CARNEVIT INJ 251 ENSEVAL OBAT - STANDAR Rp144.000 Rp206.000 AMPUL 01/04/2017

CDR FORTOS TAB 322 DOSNI OBAT - BEBAS Rp28.620 Rp39.500 TABLET 01/04/2017

CDR FORTOS TAB 322 DOSNI OBAT - KARYAWAN Rp28.620 Rp35.000 TABLET 01/04/2017

CDR FORTOS TAB 322 DOSNI OBAT - OWNER Rp28.620 Rp31.500 TABLET 01/04/2017

CDR FORTOS TAB 322 DOSNI OBAT - STANDAR Rp28.620 Rp41.000 TABLET 01/04/2017

CEFADROXIL CAP 105 AAM OBAT - BEBAS Rp802 Rp1.200 KAPSUL 01/10/2019

CEFADROXIL CAP 105 AAM OBAT - KARYAWAN Rp802 Rp1.000 KAPSUL 01/10/2019

CEFADROXIL CAP 105 AAM OBAT - OWNER Rp802 Rp900 KAPSUL 01/10/2019

CEFADROXIL CAP 105 AAM OBAT - STANDAR Rp802 Rp1.200 KAPSUL 01/10/2019

CEFADROXIL SYR 7 DOSNI OBAT - BEBAS Rp8.945 Rp12.500 SIRUP 01/10/2020

CEFADROXIL SYR 469 TSJ OBAT - BEBAS Rp8.945 Rp12.500 SIRUP 01/06/2019

CEFADROXIL SYR 469 TSJ OBAT - KARYAWAN Rp8.945 Rp11.000 SIRUP 01/06/2019

CEFADROXIL SYR 7 DOSNI OBAT - KARYAWAN Rp8.945 Rp11.000 SIRUP 01/10/2020

CEFADROXIL SYR 7 DOSNI OBAT - OWNER Rp8.945 Rp10.000 SIRUP 01/10/2020

CEFADROXIL SYR 469 TSJ OBAT - OWNER Rp8.945 Rp10.000 SIRUP 01/06/2019

CEFADROXIL SYR 7 DOSNI OBAT - STANDAR Rp8.945 Rp13.000 SIRUP 01/10/2020

CEFADROXIL SYR 469 TSJ OBAT - STANDAR Rp8.945 Rp13.000 SIRUP 01/06/2019

CEFIXIM 100 MG CAP 6 DOSNI OBAT - BEBAS Rp2.090 Rp2.900 KAPSUL 01/06/2018

CEFIXIM 100 MG CAP 456 ENSEVAL OBAT - BEBAS Rp1.300 Rp1.800 KAPSUL 01/12/2017

CEFIXIM 100 MG CAP 6 DOSNI OBAT - KARYAWAN Rp2.090 Rp2.500 KAPSUL 01/06/2018

CEFIXIM 100 MG CAP 456 ENSEVAL OBAT - KARYAWAN Rp1.300 Rp1.600 KAPSUL 01/12/2017

CEFIXIM 100 MG CAP 6 DOSNI OBAT - OWNER Rp2.090 Rp2.300 KAPSUL 01/06/2018

CEFIXIM 100 MG CAP 456 ENSEVAL OBAT - OWNER Rp1.300 Rp1.500 KAPSUL 01/12/2017

CEFIXIM 100 MG CAP 456 ENSEVAL OBAT - STANDAR Rp1.300 Rp2.000 KAPSUL 01/12/2017

CEFIXIM 100 MG CAP 6 DOSNI OBAT - STANDAR Rp2.090 Rp3.000 KAPSUL 01/06/2018

CEFIXIM SYR 339 DOSNI OBAT - BEBAS Rp33.000 Rp45.500 SIRUP 01/05/2018

CEFIXIM SYR 490 ENSEVAL OBAT - BEBAS Rp18.000 Rp25.000 SIRUP 01/01/2018

CEFIXIM SYR 339 DOSNI OBAT - KARYAWAN Rp33.000 Rp40.000 SIRUP 01/05/2018

CEFIXIM SYR 490 ENSEVAL OBAT - KARYAWAN Rp18.000 Rp22.000 SIRUP 01/01/2018

CEFIXIM SYR 490 ENSEVAL OBAT - OWNER Rp18.000 Rp20.000 SIRUP 01/01/2018

23 September 2016 Page 8 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
CEFIXIM SYR 339 DOSNI OBAT - OWNER Rp33.000 Rp36.500 SIRUP 01/05/2018

CEFIXIM SYR 490 ENSEVAL OBAT - STANDAR Rp18.000 Rp26.000 SIRUP 01/01/2018

CEFIXIM SYR 339 DOSNI OBAT - STANDAR Rp33.000 Rp47.500 SIRUP 01/05/2018

CEFOTAXIM INJ 361 MDI OBAT - BEBAS Rp15.500 Rp21.500 VIAL 01/11/2019

CEFOTAXIM INJ 361 MDI OBAT - KARYAWAN Rp15.500 Rp19.000 VIAL 01/11/2019

CEFOTAXIM INJ 361 MDI OBAT - OWNER Rp15.500 Rp17.500 VIAL 01/11/2019

CEFOTAXIM INJ 361 MDI OBAT - STANDAR Rp15.500 Rp22.500 VIAL 01/11/2019

CEFSPAN CAP 190 ENSEVAL OBAT - BEBAS Rp19.600 Rp27.000 KAPSUL 01/07/2017

CEFSPAN CAP 190 ENSEVAL OBAT - KARYAWAN Rp19.600 Rp24.000 KAPSUL 01/07/2017

CEFSPAN CAP 190 ENSEVAL OBAT - OWNER Rp19.600 Rp22.000 KAPSUL 01/07/2017

CEFSPAN CAP 190 ENSEVAL OBAT - STANDAR Rp19.600 Rp28.000 KAPSUL 01/07/2017

CEFSPAN SYR 95 ENSEVAL OBAT - BEBAS Rp92.000 Rp126.500 SIRUP 01/09/2017

CEFSPAN SYR 95 ENSEVAL OBAT - KARYAWAN Rp92.000 Rp111.500 SIRUP 01/09/2017

CEFSPAN SYR 95 ENSEVAL OBAT - OWNER Rp92.000 Rp101.500 SIRUP 01/09/2017

CEFSPAN SYR 95 ENSEVAL OBAT - STANDAR Rp92.000 Rp132.000 SIRUP 01/09/2017

CEFTRIAXON INJ 403 MDI OBAT - BEBAS Rp17.500 Rp24.500 VIAL 01/12/2018

CEFTRIAXON INJ 403 MDI OBAT - KARYAWAN Rp17.500 Rp21.500 VIAL 01/12/2018

CEFTRIAXON INJ 403 MDI OBAT - OWNER Rp17.500 Rp19.500 VIAL 01/12/2018

CEFTRIAXON INJ 403 MDI OBAT - STANDAR Rp17.500 Rp25.000 VIAL 01/12/2018

CENDO MYCETIN SALAP MATA 280 PENTA VALEN OBAT - BEBAS Rp14.025 Rp19.500 SALEP 01/01/2017

CENDO MYCETIN SALAP MATA 280 PENTA VALEN OBAT - KARYAWAN Rp14.025 Rp17.000 SALEP 01/01/2017

CENDO MYCETIN SALAP MATA 280 PENTA VALEN OBAT - OWNER Rp14.025 Rp15.500 SALEP 01/01/2017

CENDO MYCETIN SALAP MATA 280 PENTA VALEN OBAT - STANDAR Rp14.025 Rp20.500 SALEP 01/01/2017

CENDOFENICOL TETES MATA 344 PENTA VALEN OBAT - BEBAS Rp24.062 Rp33.500 CAIRAN 31/05/2016

CENDOFENICOL TETES MATA 344 PENTA VALEN OBAT - KARYAWAN Rp24.062 Rp29.500 CAIRAN 31/05/2016

CENDOFENICOL TETES MATA 344 PENTA VALEN OBAT - OWNER Rp24.062 Rp26.500 CAIRAN 31/05/2016

CENDOFENICOL TETES MATA 344 PENTA VALEN OBAT - STANDAR Rp24.062 Rp34.500 CAIRAN 31/05/2016

CENTABIO GEL 342 BSP OBAT - BEBAS Rp13.350 Rp18.500 SALEP 01/10/2016

CENTABIO GEL 342 BSP OBAT - KARYAWAN Rp13.350 Rp16.500 SALEP 01/10/2016

CENTABIO GEL 342 BSP OBAT - OWNER Rp13.350 Rp15.000 SALEP 01/10/2016

CENTABIO GEL 342 BSP OBAT - STANDAR Rp13.350 Rp19.000 SALEP 01/10/2016

CETIRIZIN DROP 517 APOTIK METRO OBAT - BEBAS Rp29.000 Rp36.500 DROP 01/01/2018

CETIRIZIN DROP 517 APOTIK METRO OBAT - KARYAWAN Rp29.000 Rp32.000 DROP 01/01/2018

CETIRIZIN DROP 517 APOTIK METRO OBAT - OWNER Rp29.000 Rp29.000 DROP 01/01/2018

CETIRIZIN DROP 517 APOTIK METRO OBAT - STANDAR Rp29.000 Rp38.000 DROP 01/01/2018

CETIRIZIN SYR 516 APOTIK METRO OBAT - BEBAS Rp14.000 Rp17.500 SIRUP 01/01/2017

CETIRIZIN SYR 516 APOTIK METRO OBAT - KARYAWAN Rp14.000 Rp15.500 SIRUP 01/01/2017

CETIRIZIN SYR 516 APOTIK METRO OBAT - OWNER Rp14.000 Rp14.000 SIRUP 01/01/2017

CETIRIZIN SYR 516 APOTIK METRO OBAT - STANDAR Rp14.000 Rp18.500 SIRUP 01/01/2017

CETIRIZIN TAB 257 AAM OBAT - BEBAS Rp289 Rp500 TABLET 01/03/2017

CETIRIZIN TAB 257 AAM OBAT - KARYAWAN Rp289 Rp400 TABLET 01/03/2017

CETIRIZIN TAB 257 AAM OBAT - OWNER Rp289 Rp400 TABLET 01/03/2017

23 September 2016 Page 9 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
CETIRIZIN TAB 257 AAM OBAT - STANDAR Rp289 Rp500 TABLET 01/03/2017

CHROME 2/0 ROLL 447 PT SI ALKES JAKARTA PASIEN Rp1.966.200 Rp2.163.000 ALKES

CHROME 2/0 ROLL 447 PT SI ALKES KARYAWAN1 Rp1.966.200 Rp2.065.000 ALKES

CHROME 2/0 ROLL 447 PT SI ALKES OWNER Rp1.966.200 Rp1.966.500 ALKES

CHROME 2/0 ROLL 447 PT SI ALKES STANDAR ALKES

CHROMIC 1 ROLL 448 PT SI ALKES JAKARTA PASIEN Rp1.966.200 Rp2.165.000 ALKES

CHROMIC 1 ROLL 448 PT SI ALKES KARYAWAN1 Rp1.966.200 Rp2.065.000 ALKES

CHROMIC 1 ROLL 448 PT SI ALKES OWNER Rp1.966.200 Rp1.966.500 ALKES

CHROMIC 1 ROLL 448 PT SI ALKES STANDAR ALKES

CHROMIC 1 SASET 442 PT SI ALKES JAKARTA PASIEN Rp111.139 Rp122.500 ALKES

CHROMIC 1 SASET 442 PT SI ALKES KARYAWAN1 Rp111.139 Rp117.000 ALKES

CHROMIC 1 SASET 442 PT SI ALKES OWNER Rp111.139 Rp111.500 ALKES

CHROMIC 1 SASET 442 PT SI ALKES STANDAR ALKES

CHROMIC 2/0 SASET 443 PT SI ALKES JAKARTA PASIEN Rp98.514 Rp108.500 ALKES

CHROMIC 2/0 SASET 443 PT SI ALKES KARYAWAN1 Rp98.514 Rp103.500 ALKES

CHROMIC 2/0 SASET 443 PT SI ALKES OWNER Rp98.514 Rp99.000 ALKES

CHROMIC 2/0 SASET 443 PT SI ALKES STANDAR ALKES

CHROMIC 3/0 SASET 445 PT SI ALKES JAKARTA PASIEN Rp98.514 Rp108.500 ALKES

CHROMIC 3/0 SASET 445 PT SI ALKES KARYAWAN1 Rp98.514 Rp103.500 ALKES

CHROMIC 3/0 SASET 445 PT SI ALKES OWNER Rp98.514 Rp98.000 ALKES

CHROMIC 3/0 SASET 445 PT SI ALKES STANDAR ALKES

CHROMIC 4/0 SASET 446 PT SI ALKES JAKARTA PASIEN Rp102.195 Rp112.500 ALKES

CHROMIC 4/0 SASET 446 PT SI ALKES KARYAWAN1 Rp102.195 Rp107.500 ALKES

CHROMIC 4/0 SASET 446 PT SI ALKES OWNER Rp102.195 Rp102.500 ALKES

CHROMIC 4/0 SASET 446 PT SI ALKES STANDAR ALKES

CIPROFLOXACIN 500 MG TAB 124 DOSNI OBAT - BEBAS Rp700 Rp1.000 TABLET 01/05/2019

CIPROFLOXACIN 500 MG TAB 124 DOSNI OBAT - KARYAWAN Rp700 Rp900 TABLET 01/05/2019

CIPROFLOXACIN 500 MG TAB 124 DOSNI OBAT - OWNER Rp700 Rp800 TABLET 01/05/2019

CIPROFLOXACIN 500 MG TAB 124 DOSNI OBAT - STANDAR Rp700 Rp1.000 TABLET 01/05/2019

CIPROFLOXACIN TAB 489 TSJ OBAT - BEBAS Rp430 Rp600 TABLET 01/02/2020

CIPROFLOXACIN TAB 489 TSJ OBAT - KARYAWAN Rp430 Rp600 TABLET 01/02/2020

CIPROFLOXACIN TAB 489 TSJ OBAT - OWNER Rp430 Rp500 TABLET 01/02/2020

CIPROFLOXACIN TAB 489 TSJ OBAT - STANDAR Rp430 Rp700 TABLET 01/02/2020

CLINDAMYCIN 300 37 AMS OBAT - BEBAS Rp1.050 Rp1.500 KAPSUL 01/11/2019

CLINDAMYCIN 300 37 AMS OBAT - KARYAWAN Rp1.050 Rp1.300 KAPSUL 01/11/2019

CLINDAMYCIN 300 37 AMS OBAT - OWNER Rp1.050 Rp1.200 KAPSUL 01/11/2019

CLINDAMYCIN 300 37 AMS OBAT - STANDAR Rp1.050 Rp1.600 KAPSUL 01/11/2019

CODEIN 10 MG TAB 340 APOTIK F TOMENDRA OBAT - BEBAS Rp1.500 Rp2.000 TABLET 01/03/2019

CODEIN 10 MG TAB 340 APOTIK F TOMENDRA OBAT - KARYAWAN Rp1.500 Rp1.700 TABLET 01/03/2019

CODEIN 10 MG TAB 340 APOTIK F TOMENDRA OBAT - OWNER Rp1.500 Rp1.500 TABLET 01/03/2019

CODEIN 10 MG TAB 340 APOTIK F TOMENDRA OBAT - STANDAR Rp1.500 Rp2.000 TABLET 01/03/2019

COHISTAN SYR 193 APL OBAT - BEBAS Rp12.650 Rp17.500 SIRUP 01/07/2017

23 September 2016 Page 10 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
COHISTAN SYR 193 APL OBAT - KARYAWAN Rp12.650 Rp15.500 SIRUP 01/07/2017

COHISTAN SYR 193 APL OBAT - OWNER Rp12.650 Rp14.000 SIRUP 01/07/2017

COHISTAN SYR 193 APL OBAT - STANDAR Rp12.650 Rp18.000 SIRUP 01/07/2017

COLSANCETINE INJ 365 BSP OBAT - BEBAS Rp9.416 Rp13.000 VIAL 05/09/2017

COLSANCETINE INJ 365 BSP OBAT - KARYAWAN Rp9.416 Rp11.500 VIAL 05/09/2017

COLSANCETINE INJ 365 BSP OBAT - OWNER Rp9.416 Rp10.500 VIAL 05/09/2017

COLSANCETINE INJ 365 BSP OBAT - STANDAR Rp9.416 Rp13.500 VIAL 05/09/2017

COMBANTRIN SYR ANK 216 TSJ OBAT - BEBAS Rp12.460 Rp17.500 SIRUP 01/12/2016

COMBANTRIN SYR ANK 216 TSJ OBAT - KARYAWAN Rp12.460 Rp15.000 SIRUP 01/12/2016

COMBANTRIN SYR ANK 216 TSJ OBAT - OWNER Rp12.460 Rp14.000 SIRUP 01/12/2016

COMBANTRIN SYR ANK 216 TSJ OBAT - STANDAR Rp12.460 Rp18.000 SIRUP 01/12/2016

COMBIVEN NEBU 94 TEMPO OBAT - BEBAS Rp13.607 Rp19.000 CAIRAN 01/05/2017

COMBIVEN NEBU 94 TEMPO OBAT - KARYAWAN Rp13.607 Rp16.500 CAIRAN 01/05/2017

COMBIVEN NEBU 94 TEMPO OBAT - OWNER Rp13.607 Rp15.000 CAIRAN 01/05/2017

COMBIVEN NEBU 94 TEMPO OBAT - STANDAR Rp13.607 Rp19.500 CAIRAN 01/05/2017

CONTERPAIN SALEP 217 TSJ OBAT - BEBAS Rp18.900 Rp26.000 SALEP 01/04/2018

CONTERPAIN SALEP 217 TSJ OBAT - KARYAWAN Rp18.900 Rp23.000 SALEP 01/04/2018

CONTERPAIN SALEP 217 TSJ OBAT - OWNER Rp18.900 Rp21.000 SALEP 01/04/2018

CONTERPAIN SALEP 217 TSJ OBAT - STANDAR Rp18.900 Rp27.000 SALEP 01/04/2018

CORTIDEK TAB 341 BSP OBAT - BEBAS Rp242 Rp400 TABLET 01/06/2017

CORTIDEK TAB 341 BSP OBAT - KARYAWAN Rp242 Rp300 TABLET 01/06/2017

CORTIDEK TAB 341 BSP OBAT - OWNER Rp242 Rp300 TABLET 01/06/2017

CORTIDEK TAB 341 BSP OBAT - STANDAR Rp242 Rp500 TABLET 01/06/2017

CORTIDEX INJ 87 BSP OBAT - BEBAS Rp5.650 Rp8.000 CAIRAN 01/06/2017

CORTIDEX INJ 87 BSP OBAT - KARYAWAN Rp5.650 Rp7.000 CAIRAN 01/06/2017

CORTIDEX INJ 87 BSP OBAT - OWNER Rp5.650 Rp6.500 CAIRAN 01/06/2017

CORTIDEX INJ 87 BSP OBAT - STANDAR Rp5.650 Rp8.000 CAIRAN 01/06/2017

COSTIL SYR 75 AMS OBAT - BEBAS Rp32.500 Rp45.000 SIRUP 01/06/2019

COSTIL SYR 75 AMS OBAT - KARYAWAN Rp32.500 Rp39.500 SIRUP 01/06/2019

COSTIL SYR 75 AMS OBAT - OWNER Rp32.500 Rp36.000 SIRUP 01/06/2019

COSTIL SYR 75 AMS OBAT - STANDAR Rp32.500 Rp46.500 SIRUP 01/06/2019

COTRIMOXAZOL TAB 224 BSP OBAT - BEBAS Rp162 Rp300 TABLET 19/05/2019

COTRIMOXAZOL TAB 224 BSP OBAT - KARYAWAN Rp162 Rp200 TABLET 19/05/2019

COTRIMOXAZOL TAB 224 BSP OBAT - OWNER Rp162 Rp200 TABLET 19/05/2019

COTRIMOXAZOL TAB 224 BSP OBAT - STANDAR Rp162 Rp300 TABLET 19/05/2019

CRYPTAL 200MG TAB 343 PARIT OBAT - BEBAS Rp57.500 Rp79.500 TABLET 01/09/2016

CRYPTAL 200MG TAB 343 PARIT OBAT - KARYAWAN Rp57.500 Rp70.000 TABLET 01/09/2016

CRYPTAL 200MG TAB 343 PARIT OBAT - OWNER Rp57.500 Rp63.500 TABLET 01/09/2016

CRYPTAL 200MG TAB 343 PARIT OBAT - STANDAR Rp57.500 Rp82.500 TABLET 01/09/2016

CTM 4 MG TAB 515 APOTIK METRO OBAT - BEBAS Rp200 Rp250 TABLET 01/03/2020

CTM 4 MG TAB 515 APOTIK METRO OBAT - KARYAWAN Rp200 Rp250 TABLET 01/03/2020

CTM 4 MG TAB 515 APOTIK METRO OBAT - OWNER Rp200 Rp200 TABLET 01/03/2020

23 September 2016 Page 11 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
CTM 4 MG TAB 515 APOTIK METRO OBAT - STANDAR Rp200 Rp300 TABLET 01/03/2020

CURCUMA TAB 203 PARIT OBAT - BEBAS Rp840 Rp1.200 TABLET 01/08/2017

CURCUMA TAB 203 PARIT OBAT - KARYAWAN Rp840 Rp1.100 TABLET 01/08/2017

CURCUMA TAB 203 PARIT OBAT - OWNER Rp840 Rp1.000 TABLET 01/08/2017

CURCUMA TAB 203 PARIT OBAT - STANDAR Rp840 Rp1.200 TABLET 01/08/2017

CURVIT SYR 540 PARIT OBAT - BEBAS Rp22.000 Rp30.500 SIRUP 01/06/2018

CURVIT SYR 540 PARIT OBAT - KARYAWAN Rp22.000 Rp27.000 SIRUP 01/06/2018

CURVIT SYR 540 PARIT OBAT - OWNER Rp22.000 Rp24.500 SIRUP 01/06/2018

CURVIT SYR 540 PARIT OBAT - STANDAR Rp22.000 Rp31.500 SIRUP 01/06/2018

CYGEST 200 MG 163 MBS OBAT - BEBAS Rp12.100 Rp17.000 SUPPOS 01/12/2017

CYGEST 200 MG 163 MBS OBAT - KARYAWAN Rp12.100 Rp15.000 SUPPOS 01/12/2017

CYGEST 200 MG 163 MBS OBAT - OWNER Rp12.100 Rp13.500 SUPPOS 01/12/2017

CYGEST 200 MG 163 MBS OBAT - STANDAR Rp12.100 Rp17.500 SUPPOS 01/12/2017

CYPTAL 200 TAB 276 PARIT OBAT - BEBAS Rp57.500 Rp79.000 TABLET 01/11/2016

CYPTAL 200 TAB 276 PARIT OBAT - KARYAWAN Rp57.500 Rp70.000 TABLET 01/11/2016

CYPTAL 200 TAB 276 PARIT OBAT - OWNER Rp57.500 Rp63.500 TABLET 01/11/2016

CYPTAL 200 TAB 276 PARIT OBAT - STANDAR Rp57.500 Rp82.500 TABLET 01/11/2016

D 10 % INF 97 MERAPI OBAT - BEBAS Rp14.000 Rp19.500 CAIIRAN 01/06/2018

D 10 % INF 97 MERAPI OBAT - KARYAWAN Rp14.000 Rp17.000 CAIIRAN 01/06/2018

D 10 % INF 97 MERAPI OBAT - OWNER Rp14.000 Rp15.500 CAIIRAN 01/06/2018

D 10 % INF 97 MERAPI OBAT - STANDAR Rp14.000 Rp20.000 CAIIRAN 01/06/2018

D 5% INFUS 92 MERAPI OBAT - BEBAS Rp12.000 Rp16.500 INFUS 01/10/2018

D 5% INFUS 92 MERAPI OBAT - KARYAWAN Rp12.000 Rp14.500 INFUS 01/10/2018

D 5% INFUS 92 MERAPI OBAT - OWNER Rp12.000 Rp13.500 INFUS 01/10/2018

D 5% INFUS 92 MERAPI OBAT - STANDAR Rp12.000 Rp17.500 INFUS 01/10/2018

D5 +1/2 NS OTSU 271 MERAPI OBAT - BEBAS Rp10.340 Rp14.500 INFUS 01/11/2016

D5 +1/2 NS OTSU 271 MERAPI OBAT - KARYAWAN Rp10.340 Rp12.500 INFUS 01/11/2016

D5 +1/2 NS OTSU 271 MERAPI OBAT - OWNER Rp10.340 Rp11.500 INFUS 01/11/2016

D5 +1/2 NS OTSU 271 MERAPI OBAT - STANDAR Rp10.340 Rp15.000 INFUS 01/11/2016

D5 1/4 NS SANBE 283 BSP OBAT - BEBAS Rp17.900 Rp25.000 INFUS 01/07/2018

D5 1/4 NS SANBE 283 BSP OBAT - KARYAWAN Rp17.900 Rp22.000 INFUS 01/07/2018

D5 1/4 NS SANBE 283 BSP OBAT - OWNER Rp17.900 Rp20.000 INFUS 01/07/2018

D5 1/4 NS SANBE 283 BSP OBAT - STANDAR Rp17.900 Rp26.000 INFUS 01/07/2018

D5 SANBE INF 369 BSP OBAT - BEBAS Rp17.490 Rp24.000 INFUS 25/11/2016

D5 SANBE INF 369 BSP OBAT - KARYAWAN Rp17.490 Rp21.500 INFUS 25/11/2016

D5 SANBE INF 369 BSP OBAT - OWNER Rp17.490 Rp20.000 INFUS 25/11/2016

D5 SANBE INF 369 BSP OBAT - STANDAR Rp17.490 Rp25.000 INFUS 25/11/2016

D5+1/2 NS SANBE INF 477 BSP OBAT - BEBAS Rp16.500 Rp23.000 CAIRAN 01/07/2018

D5+1/2 NS SANBE INF 477 BSP OBAT - KARYAWAN Rp16.500 Rp20.000 CAIRAN 01/07/2018

D5+1/2 NS SANBE INF 477 BSP OBAT - OWNER Rp16.500 Rp18.500 CAIRAN 01/07/2018

D5+1/2 NS SANBE INF 477 BSP OBAT - STANDAR Rp16.500 Rp24.000 CAIRAN 01/07/2018

DACTARIN CREAM 458 TSJ OBAT - BEBAS Rp18.000 Rp25.000 SALEP 01/06/2018

23 September 2016 Page 12 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
DACTARIN CREAM 458 TSJ OBAT - KARYAWAN Rp18.000 Rp22.000 SALEP 01/06/2018

DACTARIN CREAM 458 TSJ OBAT - OWNER Rp18.000 Rp20.000 SALEP 01/06/2018

DACTARIN CREAM 458 TSJ OBAT - STANDAR Rp18.000 Rp26.000 SALEP 01/06/2018

DACTARIN DIAPER 524 TSJ OBAT - BEBAS Rp46.818 Rp65.000 SALEP 01/04/2018

DACTARIN DIAPER 524 TSJ OBAT - KARYAWAN Rp46.818 Rp57.000 SALEP 01/04/2018

DACTARIN DIAPER 524 TSJ OBAT - OWNER Rp46.818 Rp51.500 SALEP 01/04/2018

DACTARIN DIAPER 524 TSJ OBAT - STANDAR Rp46.818 Rp70.000 SALEP 01/04/2018

DAKTARIN POWDER 320 PARIT OBAT - BEBAS Rp43.260 Rp59.500 ALKES 01/07/2017

DAKTARIN POWDER 320 PARIT OBAT - KARYAWAN Rp43.260 Rp52.500 ALKES 01/07/2017

DAKTARIN POWDER 320 PARIT OBAT - OWNER Rp43.260 Rp48.000 ALKES 01/07/2017

DAKTARIN POWDER 320 PARIT OBAT - STANDAR Rp43.260 Rp62.000 ALKES 01/07/2017

DALFAROL 200 CAP 67 APL OBAT - BEBAS Rp2.541 Rp3.500 KAPSUL 01/05/2019

DALFAROL 200 CAP 67 APL OBAT - KARYAWAN Rp2.541 Rp3.100 KAPSUL 01/05/2019

DALFAROL 200 CAP 67 APL OBAT - OWNER Rp2.541 Rp2.800 KAPSUL 01/05/2019

DALFAROL 200 CAP 67 APL OBAT - STANDAR Rp2.541 Rp3.700 KAPSUL 01/05/2019

DANSERA TAB 118 MBS OBAT - BEBAS Rp5.000 Rp7.000 TABLET 01/09/2018

DANSERA TAB 118 MBS OBAT - KARYAWAN Rp5.000 Rp6.100 TABLET 01/09/2018

DANSERA TAB 118 MBS OBAT - OWNER Rp5.000 Rp5.500 TABLET 01/09/2018

DANSERA TAB 118 MBS OBAT - STANDAR Rp5.000 Rp7.500 TABLET 01/09/2018

DECUBAL CREAM 463 MBS OBAT - BEBAS Rp19.800 Rp27.500 SALEP 01/11/2018

DECUBAL CREAM 463 MBS OBAT - KARYAWAN Rp19.800 Rp24.000 SALEP 01/11/2018

DECUBAL CREAM 463 MBS OBAT - OWNER Rp19.800 Rp22.000 SALEP 01/11/2018

DECUBAL CREAM 463 MBS OBAT - STANDAR Rp19.800 Rp28.500 SALEP 01/11/2018

DEHIDRALIT 41 AMS OBAT - BEBAS Rp14.000 Rp19.500 CAIRAN 01/07/2017

DEHIDRALIT 41 AMS OBAT - KARYAWAN Rp14.000 Rp17.000 CAIRAN 01/07/2017

DEHIDRALIT 41 AMS OBAT - OWNER Rp14.000 Rp15.500 CAIRAN 01/07/2017

DEHIDRALIT 41 AMS OBAT - STANDAR Rp14.000 Rp20.500 CAIRAN 01/07/2017

DEPAKEN SYR 334 UDC OBAT - BEBAS Rp135.000 Rp186.000 SIRUP 01/06/2017

DEPAKEN SYR 334 UDC OBAT - KARYAWAN Rp135.000 Rp163.500 SIRUP 01/06/2017

DEPAKEN SYR 334 UDC OBAT - OWNER Rp135.000 Rp148.500 SIRUP 01/06/2017

DEPAKEN SYR 334 UDC OBAT - STANDAR Rp135.000 Rp193.000 SIRUP 01/06/2017

DIANE 35 TAB 476 TSJ TABLET

DIANE 35 TAB 476 TSJ OBAT - BEBAS Rp88.800 Rp122.500 TABLET 01/01/2020

DIANE 35 TAB 345 DOSNI OBAT - BEBAS Rp93.270 Rp128.500 TABLET 01/05/2018

DIANE 35 TAB 476 TSJ OBAT - KARYAWAN Rp88.800 Rp107.500 TABLET 01/01/2020

DIANE 35 TAB 345 DOSNI OBAT - KARYAWAN Rp93.270 Rp113.000 TABLET 01/05/2018

DIANE 35 TAB 345 DOSNI OBAT - OWNER Rp93.270 Rp103.000 TABLET 01/05/2018

DIANE 35 TAB 476 TSJ OBAT - OWNER Rp88.800 Rp98.000 TABLET 01/01/2020

DIANE 35 TAB 476 TSJ OBAT - STANDAR Rp88.800 Rp127.000 TABLET 01/01/2020

DIANE 35 TAB 345 DOSNI OBAT - STANDAR Rp93.270 Rp133.500 TABLET 01/05/2018

DISFLATYL 299 AMS OBAT - BEBAS Rp505 Rp1.000 TABLET 01/09/2017

DISFLATYL 299 AMS OBAT - KARYAWAN Rp505 Rp600 TABLET 01/09/2017

23 September 2016 Page 13 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
DISFLATYL 299 AMS OBAT - OWNER Rp505 Rp600 TABLET 01/09/2017

DISFLATYL 299 AMS OBAT - STANDAR Rp505 Rp1.000 TABLET 01/09/2017

DOMPERIDON SYR 471 TSJ OBAT - BEBAS Rp11.500 Rp16.000 SIRUP 01/11/2018

DOMPERIDON SYR 471 TSJ OBAT - KARYAWAN Rp11.500 Rp14.000 SIRUP 01/11/2018

DOMPERIDON SYR 471 TSJ OBAT - OWNER Rp11.500 Rp13.000 SIRUP 01/11/2018

DOMPERIDON SYR 471 TSJ OBAT - STANDAR Rp11.500 Rp16.500 SIRUP 01/11/2018

DOPAMET 250 MG TAB 119 MBS OBAT - BEBAS Rp1.870 Rp2.600 TABLET 01/01/2018

DOPAMET 250 MG TAB 119 MBS OBAT - KARYAWAN Rp1.870 Rp2.300 TABLET 01/01/2018

DOPAMET 250 MG TAB 119 MBS OBAT - OWNER Rp1.870 Rp2.100 TABLET 01/01/2018

DOPAMET 250 MG TAB 119 MBS OBAT - STANDAR Rp1.870 Rp2.700 TABLET 01/01/2018

DULCOLAC SUPP 330 TEMPO OBAT - BEBAS Rp16.588 Rp23.000 SUPPOS 01/06/2017

DULCOLAC SUPP 330 TEMPO OBAT - KARYAWAN Rp16.588 Rp20.500 SUPPOS 01/06/2017

DULCOLAC SUPP 330 TEMPO OBAT - OWNER Rp16.588 Rp19.000 SUPPOS 01/06/2017

DULCOLAC SUPP 330 TEMPO OBAT - STANDAR Rp16.588 Rp24.000 SUPPOS 01/06/2017

DULCOLAX TAB 234 TSJ OBAT - BEBAS Rp1.074 Rp1.500 TABLET 01/01/2018

DULCOLAX TAB 234 TSJ OBAT - KARYAWAN Rp1.074 Rp1.300 TABLET 01/01/2018

DULCOLAX TAB 234 TSJ OBAT - OWNER Rp1.074 Rp1.200 TABLET 01/01/2018

DULCOLAX TAB 234 TSJ OBAT - STANDAR Rp1.074 Rp1.600 TABLET 01/01/2018

DUMIN RECTAL 125 5 MBS OBAT - BEBAS Rp11.660 Rp16.500 SUPPOS 31/10/2018

DUMIN RECTAL 125 5 MBS OBAT - KARYAWAN Rp11.660 Rp14.500 SUPPOS 31/10/2018

DUMIN RECTAL 125 5 MBS OBAT - OWNER Rp11.660 Rp13.000 SUPPOS 31/10/2018

DUMIN RECTAL 125 5 MBS OBAT - STANDAR Rp11.660 Rp17.000 SUPPOS 31/10/2018

DUMIN RECTAL 250 SUPP 245 MBS OBAT - BEBAS Rp16.280 Rp22.500 SUPPOS 01/03/2018

DUMIN RECTAL 250 SUPP 245 MBS OBAT - KARYAWAN Rp16.280 Rp20.000 SUPPOS 01/03/2018

DUMIN RECTAL 250 SUPP 245 MBS OBAT - OWNER Rp16.280 Rp18.000 SUPPOS 01/03/2018

DUMIN RECTAL 250 SUPP 245 MBS OBAT - STANDAR Rp16.280 Rp23.500 SUPPOS 01/03/2018

DUMIN TAB 270 MBS OBAT - BEBAS Rp335 Rp500 TABLET 01/08/2019

DUMIN TAB 270 MBS OBAT - KARYAWAN Rp335 Rp400 TABLET 01/08/2019

DUMIN TAB 270 MBS OBAT - OWNER Rp335 Rp400 TABLET 01/08/2019

DUMIN TAB 270 MBS OBAT - STANDAR Rp335 Rp500 TABLET 01/08/2019

EFEDRIN HCL TAB 493 APOTIK RSUD OBAT - BEBAS Rp300 Rp500 TABLET 01/07/2018

EFEDRIN HCL TAB 493 APOTIK RSUD OBAT - KARYAWAN Rp300 Rp400 TABLET 01/07/2018

EFEDRIN HCL TAB 493 APOTIK RSUD OBAT - OWNER Rp300 Rp300 TABLET 01/08/2018

EFEDRIN HCL TAB 493 APOTIK RSUD OBAT - STANDAR Rp300 Rp500 TABLET 01/08/2018

ELKANA CL SYR 160 BSP OBAT - BEBAS Rp43.000 Rp59.500 SIRUP 01/10/2017

ELKANA CL SYR 160 BSP OBAT - KARYAWAN Rp43.000 Rp52.000 SIRUP 01/10/2017

ELKANA CL SYR 160 BSP OBAT - OWNER Rp43.000 Rp47.500 SIRUP 01/10/2017

ELKANA CL SYR 160 BSP OBAT - STANDAR Rp43.000 Rp61.500 SIRUP 01/10/2017

ELKANA SYR 192 BSP OBAT - BEBAS Rp19.350 Rp27.000 SIRUP 01/12/2016

ELKANA SYR 192 BSP OBAT - KARYAWAN Rp19.350 Rp24.000 SIRUP 01/12/2016

ELKANA SYR 192 BSP OBAT - OWNER Rp19.350 Rp21.500 SIRUP 01/12/2016

ELKANA SYR 192 BSP OBAT - STANDAR Rp19.350 Rp28.000 SIRUP 01/12/2016

23 September 2016 Page 14 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
ELKANA TAB 83 BSP OBAT - BEBAS Rp700 Rp1.000 TABLET 02/09/2017

ELKANA TAB 83 BSP OBAT - KARYAWAN Rp700 Rp900 TABLET 02/09/2017

ELKANA TAB 83 BSP OBAT - OWNER Rp700 Rp800 TABLET 02/09/2017

ELKANA TAB 83 BSP OBAT - STANDAR Rp700 Rp1.000 TABLET 02/09/2017

ELSAZYM SASET 331 MBS OBAT - BEBAS Rp8.000 Rp11.000 SACHET 01/12/2016

ELSAZYM SASET 331 MBS OBAT - KARYAWAN Rp8.000 Rp10.000 SACHET 01/12/2016

ELSAZYM SASET 331 MBS OBAT - OWNER Rp8.000 Rp9.000 SACHET 01/12/2016

ELSAZYM SASET 331 MBS OBAT - STANDAR Rp8.000 Rp11.500 SACHET 01/12/2016

EMINETON TAB 88 ENSEVAL OBAT - BEBAS Rp1.400 Rp2.000 TABLET 31/10/2017

EMINETON TAB 88 ENSEVAL OBAT - KARYAWAN Rp1.400 Rp1.700 TABLET 31/10/2017

EMINETON TAB 88 ENSEVAL OBAT - OWNER Rp1.400 Rp1.600 TABLET 31/10/2017

EMINETON TAB 88 ENSEVAL OBAT - STANDAR Rp1.400 Rp2.000 TABLET 31/10/2017

ENERVONCE TAB 513 TSJ OBAT - BEBAS Rp663 Rp1.000 TABLET 01/10/2017

ENERVONCE TAB 513 TSJ OBAT - KARYAWAN Rp663 Rp900 TABLET 01/10/2017

ENERVONCE TAB 513 TSJ OBAT - OWNER Rp663 Rp800 TABLET 01/10/2007

ENERVONCE TAB 513 TSJ OBAT - STANDAR Rp663 Rp1.000 TABLET 01/10/2017

ENYSTIN DROP 15 ENSEVAL OBAT - BEBAS Rp31.000 Rp43.000 DROP 01/07/2017

ENYSTIN DROP 15 ENSEVAL OBAT - KARYAWAN Rp31.000 Rp38.000 DROP 01/07/2017

ENYSTIN DROP 15 ENSEVAL OBAT - OWNER Rp31.000 Rp34.500 DROP 01/07/2017

ENYSTIN DROP 15 ENSEVAL OBAT - STANDAR Rp31.000 Rp44.500 DROP 01/07/2017

EPEXOL DROP 136 BSP OBAT - BEBAS Rp34.000 Rp47.000 DROP 01/09/2017

EPEXOL DROP 136 BSP OBAT - KARYAWAN Rp34.000 Rp42.000 DROP 01/09/2017

EPEXOL DROP 136 BSP OBAT - OWNER Rp34.000 Rp37.500 DROP 01/09/2017

EPEXOL DROP 136 BSP OBAT - STANDAR Rp34.000 Rp49.000 DROP 01/09/2017

EPEXOL SYR 519 BSP OBAT - BEBAS Rp14.750 Rp20.500 SIRUP 01/11/2018

EPEXOL SYR 519 BSP OBAT - KARYAWAN Rp14.750 Rp18.000 SIRUP 01/11/2018

EPEXOL SYR 519 BSP OBAT - OWNER Rp14.750 Rp16.500 SIRUP 01/11/2018

EPEXOL SYR 519 BSP OBAT - STANDAR Rp14.750 Rp21.500 SIRUP 01/11/2018

EPINEFRIN INJ 366 APOTIK RSUD OBAT - BEBAS Rp4.000 Rp5.000 VIAL 01/04/2017

EPINEFRIN INJ 366 APOTIK RSUD OBAT - KARYAWAN Rp4.000 Rp4.500 VIAL 01/04/2017

EPINEFRIN INJ 366 APOTIK RSUD OBAT - OWNER Rp4.000 Rp4.000 VIAL 01/04/2017

EPINEFRIN INJ 366 APOTIK RSUD OBAT - STANDAR Rp4.000 Rp5.500 VIAL 01/04/2017

EPSONAL TAB 503 APOTIK F TOMENDRA OBAT - BEBAS Rp8.000 Rp10.000 TABLET 01/01/2017

EPSONAL TAB 503 APOTIK F TOMENDRA OBAT - KARYAWAN Rp8.000 Rp8.800 TABLET 01/01/2017

EPSONAL TAB 503 APOTIK F TOMENDRA OBAT - OWNER Rp8.000 Rp8.000 TABLET 01/01/2017

EPSONAL TAB 503 APOTIK F TOMENDRA OBAT - STANDAR Rp8.000 Rp10.500 TABLET 01/01/2017

ERYSANBE 500 MG TAB 372 BSP OBAT - BEBAS Rp2.400 Rp3.500 TABLET 01/11/2019

ERYSANBE 500 MG TAB 372 BSP OBAT - KARYAWAN Rp2.400 Rp3.000 TABLET 01/11/2019

ERYSANBE 500 MG TAB 372 BSP OBAT - OWNER Rp2.400 Rp2.700 TABLET 01/11/2019

ERYSANBE 500 MG TAB 372 BSP OBAT - STANDAR Rp2.400 Rp3.500 TABLET 01/11/2019

ERYSANBE SYR 179 BSP OBAT - BEBAS Rp19.900 Rp27.500 SIRUP 25/05/2019

ERYSANBE SYR 179 BSP OBAT - KARYAWAN Rp19.900 Rp24.000 SIRUP 25/05/2019

23 September 2016 Page 15 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
ERYSANBE SYR 179 BSP OBAT - OWNER Rp19.900 Rp22.000 SIRUP 25/05/2019

ERYSANBE SYR 179 BSP OBAT - STANDAR Rp19.900 Rp28.500 SIRUP 25/05/2019

ETT NO 3 & 3,5 453 CITRA MEDICA ALKES 1 Rp36.575 Rp48.000 ALKES

ETT NO 3 & 3,5 453 CITRA MEDICA ALKES KARYAWAN2 Rp36.575 Rp40.500 ALKES

ETT NO 3 & 3,5 453 CITRA MEDICA ALKES OWNER Rp36.575 Rp37.000 ALKES

ETT NO 3 & 3,5 453 CITRA MEDICA ALKES STANDAR ALKES

EXTENTION 150 CM 377 MBS ALKES 1 Rp37.300 Rp53.500 ALKES

EXTENTION 150 CM 377 MBS ALKES KARYAWAN2 Rp37.300 Rp45.500 ALKES

EXTENTION 150 CM 377 MBS ALKES OWNER Rp37.300 Rp41.500 ALKES

EXTENTION 150 CM 377 MBS ALKES STANDAR ALKES

FARMADOL INF 486 PARIT OBAT - BEBAS Rp57.000 Rp78.500 CAIRAN 01/05/2017

FARMADOL INF 486 PARIT OBAT - KARYAWAN Rp57.000 Rp69.000 CAIRAN 01/05/2017

FARMADOL INF 486 PARIT OBAT - OWNER Rp57.000 Rp63.000 CAIRAN 01/05/2017

FARMADOL INF 486 PARIT OBAT - STANDAR Rp57.000 Rp81.500 CAIRAN 01/05/2017

FARMADOL TAB 487 PARIT OBAT - BEBAS Rp280 Rp400 TABLET 01/05/2019

FARMADOL TAB 487 PARIT OBAT - KARYAWAN Rp280 Rp400 TABLET 01/05/2019

FARMADOL TAB 487 PARIT OBAT - OWNER Rp280 Rp400 TABLET 01/05/2019

FARMADOL TAB 487 PARIT OBAT - STANDAR Rp280 Rp500 TABLET 01/05/2019

FEROFORT 177 ENSEVAL OBAT - BEBAS Rp1.650 Rp2.500 TABLET 01/08/2017

FEROFORT 177 ENSEVAL OBAT - KARYAWAN Rp1.650 Rp2.000 TABLET 01/08/2017

FEROFORT 177 ENSEVAL OBAT - OWNER Rp1.650 Rp2.000 TABLET 01/08/2017

FEROFORT 177 ENSEVAL OBAT - STANDAR Rp1.650 Rp2.500 TABLET 01/08/2017

FG TROCHES TAB 346 MERAPI OBAT - BEBAS Rp900 Rp1.300 TABLET 01/08/2017

FG TROCHES TAB 346 MERAPI OBAT - KARYAWAN Rp900 Rp1.100 TABLET 01/08/2017

FG TROCHES TAB 346 MERAPI OBAT - OWNER Rp900 Rp1.000 TABLET 01/08/2017

FG TROCHES TAB 346 MERAPI OBAT - STANDAR Rp900 Rp1.300 TABLET 01/08/2017

FIESTA CONDOM 3S 122 AMS OBAT - BEBAS Rp6.764 Rp9.500 ALKES 01/09/2019

FIESTA CONDOM 3S 122 AMS OBAT - KARYAWAN Rp6.764 Rp8.500 ALKES 01/09/2019

FIESTA CONDOM 3S 122 AMS OBAT - OWNER Rp6.764 Rp7.500 ALKES 01/09/2019

FIESTA CONDOM 3S 122 AMS OBAT - STANDAR Rp6.764 Rp10.000 ALKES 01/09/2019

FIKOM ORANGE TAB BTL 511 PARIT OBAT - BEBAS Rp12.500 Rp17.500 TABLET 01/03/2018

FIKOM ORANGE TAB BTL 511 PARIT OBAT - KARYAWAN Rp12.500 Rp15.500 TABLET 01/03/2018

FIKOM ORANGE TAB BTL 511 PARIT OBAT - OWNER Rp12.500 Rp14.000 TABLET 01/03/2018

FIKOM ORANGE TAB BTL 511 PARIT OBAT - STANDAR Rp12.500 Rp18.000 TABLET 01/03/2018

FITKOM F&V BOTOL 484 PARIT OBAT - BEBAS Rp17.500 Rp24.500 TABLET 01/12/2016

FITKOM F&V BOTOL 484 PARIT OBAT - KARYAWAN Rp17.500 Rp21.500 TABLET 01/12/2016

FITKOM F&V BOTOL 484 PARIT OBAT - OWNER Rp17.500 Rp19.500 TABLET 01/12/2016

FITKOM F&V BOTOL 484 PARIT OBAT - STANDAR Rp17.500 Rp25.000 TABLET 01/12/2016

FITKOM GUMMY BOX 483 PARIT OBAT - BEBAS Rp2.728 Rp4.000 SACHET 01/06/2017

FITKOM GUMMY BOX 483 PARIT OBAT - KARYAWAN Rp2.728 Rp3.500 SACHET 01/06/2017

FITKOM GUMMY BOX 483 PARIT OBAT - OWNER Rp2.728 Rp3.000 SACHET 01/06/2017

FITKOM GUMMY BOX 483 PARIT OBAT - STANDAR Rp2.728 Rp4.000 SACHET 01/06/2017

23 September 2016 Page 16 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
FLEXIMUV CREM 250 ENSEVAL OBAT - BEBAS Rp73.000 Rp100.500 SALEP 01/01/2017

FLEXIMUV CREM 250 ENSEVAL OBAT - KARYAWAN Rp73.000 Rp88.500 SALEP 01/01/2017

FLEXIMUV CREM 250 ENSEVAL OBAT - OWNER Rp73.000 Rp80.500 SALEP 01/01/2017

FLEXIMUV CREM 250 ENSEVAL OBAT - STANDAR Rp73.000 Rp104.500 SALEP 01/01/2017

FOLAC TAB 117 MBS OBAT - BEBAS Rp700 Rp1.000 TABLET 01/11/2018

FOLAC TAB 117 MBS OBAT - KARYAWAN Rp700 Rp900 TABLET 01/11/2018

FOLAC TAB 117 MBS OBAT - OWNER Rp700 Rp800 TABLET 01/11/2018

FOLAC TAB 117 MBS OBAT - STANDAR Rp700 Rp1.000 TABLET 01/11/2018

FOLAFIT 400 MG 46 BSP OBAT - BEBAS Rp750 Rp1.100 TABLET 01/10/2018

FOLAFIT 400 MG 46 BSP OBAT - KARYAWAN Rp750 Rp1.000 TABLET 01/10/2018

FOLAFIT 400 MG 46 BSP OBAT - OWNER Rp750 Rp900 TABLET 01/10/2018

FOLAFIT 400 MG 46 BSP OBAT - STANDAR Rp750 Rp1.100 TABLET 01/10/2018

FOLLET CAT NO 18 387 CITRA MEDICA ALKES 1 Rp15.000 Rp21.500 ALKES

FOLLET CAT NO 18 387 CITRA MEDICA ALKES KARYAWAN2 Rp15.000 Rp18.500 ALKES

FOLLET CAT NO 18 387 CITRA MEDICA ALKES OWNER Rp15.000 Rp16.500 ALKES

FOLLET CAT NO 18 387 CITRA MEDICA ALKES STANDAR ALKES

FORMALIN TAB 275 ALAM JAYA ALKES 1 Rp1.500 Rp2.000 TABLET

FORMALIN TAB 275 ALAM JAYA ALKES KARYAWAN2 Rp1.500 Rp1.700 TABLET

FORMALIN TAB 275 ALAM JAYA ALKES OWNER Rp1.500 Rp1.500 TABLET

FORMALIN TAB 275 ALAM JAYA ALKES STANDAR Rp1.500 TABLET

FORTEN 25 MG 81 TSJ OBAT - BEBAS Rp300 Rp500 TABLET 30/11/2018

FORTEN 25 MG 81 TSJ OBAT - KARYAWAN Rp300 Rp400 TABLET 30/11/2018

FORTEN 25 MG 81 TSJ OBAT - OWNER Rp300 Rp400 TABLET 30/11/2018

FORTEN 25 MG 81 TSJ OBAT - STANDAR Rp300 Rp500 TABLET 30/11/2018

FRES CARE 252 MBS OBAT - BEBAS Rp10.500 Rp14.500 CAIRAN 01/12/2018

FRES CARE 252 MBS OBAT - KARYAWAN Rp10.500 Rp13.000 CAIRAN 01/12/2018

FRES CARE 252 MBS OBAT - OWNER Rp10.500 Rp12.000 CAIRAN 01/12/2018

FRES CARE 252 MBS OBAT - STANDAR Rp10.500 Rp15.000 CAIRAN 01/12/2018

FUROSEMIDE 367 APOTIK BUNDO OBAT - BEBAS Rp2.300 Rp3.000 VIAL 01/10/2017

FUROSEMIDE 367 APOTIK BUNDO OBAT - KARYAWAN Rp2.300 Rp2.500 VIAL 01/10/2017

FUROSEMIDE 367 APOTIK BUNDO OBAT - OWNER Rp2.300 Rp2.500 VIAL 01/10/2017

FUROSEMIDE 367 APOTIK BUNDO OBAT - STANDAR Rp2.300 Rp3.000 VIAL 01/10/2017

FUTROLIT INF 261 BSP OBAT - BEBAS Rp55.440 Rp76.500 INFUS 01/11/2017

FUTROLIT INF 261 BSP OBAT - KARYAWAN Rp55.440 Rp67.000 INFUS 01/11/2017

FUTROLIT INF 261 BSP OBAT - OWNER Rp55.440 Rp61.000 INFUS 01/01/2017

FUTROLIT INF 261 BSP OBAT - STANDAR Rp55.440 Rp79.500 INFUS 01/01/2017

FUZID SYR 244 MBS OBAT - BEBAS Rp34.000 Rp47.000 SIRUP 01/02/2017

FUZID SYR 244 MBS OBAT - KARYAWAN Rp34.000 Rp41.500 SIRUP 01/02/2017

FUZID SYR 244 MBS OBAT - OWNER Rp34.000 Rp37.500 SIRUP 01/02/2017

FUZID SYR 244 MBS OBAT - STANDAR Rp34.000 Rp49.000 SIRUP 01/07/2017

GASTRUL TAB 274 PARIT OBAT - BEBAS Rp9.500 Rp13.500 TABLET 01/10/2016

GASTRUL TAB 274 PARIT OBAT - KARYAWAN Rp9.500 Rp11.500 TABLET 01/10/2016

23 September 2016 Page 17 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
GASTRUL TAB 274 PARIT OBAT - OWNER Rp9.500 Rp10.500 TABLET 01/10/2016

GASTRUL TAB 274 PARIT OBAT - STANDAR Rp9.500 Rp14.000 TABLET 01/10/2016

GELANG BAYI 440 CITRA MEDICA ALKES 2 Rp1.000 Rp1.600 ALKES

GELANG BAYI 440 CITRA MEDICA ALKES KARYAWAN2 Rp1.000 Rp1.300 ALKES

GELANG BAYI 440 CITRA MEDICA ALKES OWNER Rp1.000 Rp1.100 ALKES

GELANG BAYI 440 CITRA MEDICA ALKES STANDAR ALKES

Gelang ID Dws ungu 405 CITRA MEDICA ALKES 2 Rp1.050 Rp2.000 ALKES

Gelang ID Dws ungu 405 CITRA MEDICA ALKES KARYAWAN2 Rp1.050 Rp1.500 ALKES

Gelang ID Dws ungu 405 CITRA MEDICA ALKES OWNER Rp1.050 Rp1.500 ALKES

Gelang ID Dws ungu 405 CITRA MEDICA ALKES STANDAR ALKES

GIRABLOC 500 35 TSJ OBAT - BEBAS Rp1.067 Rp1.500 TABLET 01/11/2019

GIRABLOC 500 35 TSJ OBAT - KARYAWAN Rp1.067 Rp1.300 TABLET 01/11/2019

GIRABLOC 500 35 TSJ OBAT - OWNER Rp1.067 Rp1.200 TABLET 01/11/2019

GIRABLOC 500 35 TSJ OBAT - STANDAR Rp1.067 Rp1.600 TABLET 01/11/2019

GONESTEN CAPSUL 467 UDC OBAT - BEBAS Rp4.000 Rp5.500 KAPSUL 01/11/2017

GONESTEN CAPSUL 467 UDC OBAT - KARYAWAN Rp4.000 Rp5.000 KAPSUL 01/11/2017

GONESTEN CAPSUL 467 UDC OBAT - OWNER Rp4.000 Rp4.500 KAPSUL 01/11/2017

GONESTEN CAPSUL 467 UDC OBAT - STANDAR Rp4.000 Rp6.000 KAPSUL 01/11/2017

HANDSCOON 6,5, GAMEX 415 CITRA MEDICA ALKES 1 Rp10.454 Rp15.000 ALKES

HANDSCOON 6,5, GAMEX 415 CITRA MEDICA ALKES KARYAWAN2 Rp10.454 Rp13.000 ALKES

HANDSCOON 6,5, GAMEX 415 CITRA MEDICA ALKES OWNER Rp10.454 Rp11.500 ALKES

HANDSCOON 6,5, GAMEX 415 CITRA MEDICA ALKES STANDAR ALKES

HANDSCOOND STERIL 7,5 395 CITRA MEDICA ALKES 1 Rp10.454 Rp15.000 ALKES

HANDSCOOND STERIL 7,5 395 CITRA MEDICA ALKES KARYAWAN2 Rp10.454 Rp13.000 ALKES

HANDSCOOND STERIL 7,5 395 CITRA MEDICA ALKES OWNER Rp10.454 Rp11.500 ALKES

HANDSCOOND STERIL 7,5 395 CITRA MEDICA ALKES STANDAR ALKES

HANSAPLAS ROL 1,25X4 542 BSP ALKES 1 Rp5.682 Rp8.500 ALKES

HANSAPLAS ROL 1,25X4 542 BSP ALKES KARYAWAN2 Rp5.682 Rp7.000 ALKES

HANSAPLAS ROL 1,25X4 542 BSP ALKES OWNER Rp5.682 Rp6.500 ALKES

HANSAPLAS ROL 1,25X4 542 BSP ALKES STANDAR ALKES

HERBAKOF SYR 472 AAM OBAT - BEBAS Rp11.000 Rp15.500 SIRUP 01/01/2018

HERBAKOF SYR 472 AAM OBAT - KARYAWAN Rp11.000 Rp13.500 SIRUP 01/01/2018

HERBAKOF SYR 472 AAM OBAT - OWNER Rp11.000 Rp12.500 SIRUP 01/01/2018

HERBAKOF SYR 472 AAM OBAT - STANDAR Rp11.000 Rp16.000 SIRUP 01/01/2018

HI BONE ACTIV 112 MBS OBAT - BEBAS Rp2.500 Rp3.500 TABLET 01/09/2017

HI BONE ACTIV 112 MBS OBAT - KARYAWAN Rp2.500 Rp3.100 TABLET 01/09/2017

HI BONE ACTIV 112 MBS OBAT - OWNER Rp2.500 Rp2.800 TABLET 01/09/2017

HI BONE ACTIV 112 MBS OBAT - STANDAR Rp2.500 Rp3.600 TABLET 01/09/2017

HI BOOSTER SYR 194 MERAPI OBAT - BEBAS Rp12.727 Rp17.500 SIRUP 01/08/2018

HI BOOSTER SYR 194 MERAPI OBAT - KARYAWAN Rp12.727 Rp15.500 SIRUP 01/08/2018

HI BOOSTER SYR 194 MERAPI OBAT - OWNER Rp12.727 Rp14.000 SIRUP 01/08/2018

HI BOOSTER SYR 194 MERAPI OBAT - STANDAR Rp12.727 Rp18.500 SIRUP 01/08/2018

23 September 2016 Page 18 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
HIBICET 5 L 427 PARIT ALKES 1 Rp850.000 Rp1.215.500 ALKES 01/01/2017

HIBICET 5 L 427 PARIT ALKES KARYAWAN2 Rp850.000 Rp1.028.500 ALKES 01/01/2017

HIBICET 5 L 427 PARIT ALKES OWNER Rp850.000 Rp935.000 ALKES 01/01/2017

HIBICET 5 L 427 PARIT ALKES STANDAR ALKES

HIDROFILM 451 PT SI ALKES JAKARTA PASIEN Rp35.700 Rp39.500 ALKES

HIDROFILM 451 PT SI ALKES KARYAWAN1 Rp35.700 Rp37.500 ALKES

HIDROFILM 451 PT SI ALKES OWNER Rp35.700 Rp36.000 ALKES

HIDROFILM 451 PT SI ALKES STANDAR ALKES

HIPAFIX 5X5 389 CITRA MEDICA ALKES 1 Rp53.252 Rp76.500 ALKES

HIPAFIX 5X5 389 CITRA MEDICA ALKES KARYAWAN2 Rp53.252 Rp64.500 ALKES

HIPAFIX 5X5 389 CITRA MEDICA ALKES OWNER Rp53.252 Rp59.000 ALKES

HIPAFIX 5X5 389 CITRA MEDICA ALKES STANDAR ALKES

HISTAPAN TAB 329 BSP OBAT - BEBAS Rp550 Rp800 TABLET 01/12/2018

HISTAPAN TAB 329 BSP OBAT - KARYAWAN Rp550 Rp700 TABLET 01/12/2018

HISTAPAN TAB 329 BSP OBAT - OWNER Rp550 Rp600 TABLET 01/12/2018

HISTAPAN TAB 329 BSP OBAT - STANDAR Rp550 Rp800 TABLET 01/12/2018

HOLISTICARE 308 AAM OBAT - BEBAS Rp1.063 Rp1.500 TABLET 01/06/2017

HOLISTICARE 308 AAM OBAT - KARYAWAN Rp1.063 Rp1.300 TABLET 01/06/2017

HOLISTICARE 308 AAM OBAT - OWNER Rp1.063 Rp1.200 TABLET 01/06/2017

HOLISTICARE 308 AAM OBAT - STANDAR Rp1.063 Rp1.600 TABLET 01/06/2017

HUFAGRIB PILEK 239 MERAPI OBAT - BEBAS Rp9.220 Rp13.000 SIRUP 01/03/2018

HUFAGRIB PILEK 239 MERAPI OBAT - KARYAWAN Rp9.220 Rp11.200 SIRUP 01/03/2018

HUFAGRIB PILEK 239 MERAPI OBAT - OWNER Rp9.220 Rp10.200 SIRUP 01/03/2018

HUFAGRIB PILEK 239 MERAPI OBAT - STANDAR Rp9.220 Rp13.500 SIRUP 01/03/2018

HUFAGRIP BP SYR 91 MERAPI OBAT - BEBAS Rp11.176 Rp15.500 SIRUP 01/10/2019

HUFAGRIP BP SYR 91 MERAPI OBAT - KARYAWAN Rp11.176 Rp13.500 SIRUP 01/10/2019

HUFAGRIP BP SYR 91 MERAPI OBAT - OWNER Rp11.176 Rp12.500 SIRUP 01/10/2019

HUFAGRIP BP SYR 91 MERAPI OBAT - STANDAR Rp11.176 Rp16.000 SIRUP 01/10/2019

HUFAGRIP FLU 90 MERAPI OBAT - BEBAS Rp11.594 Rp16.000 SIRUP 01/01/2018

HUFAGRIP FLU 90 MERAPI OBAT - KARYAWAN Rp11.594 Rp14.000 SIRUP 01/01/2018

HUFAGRIP FLU 90 MERAPI OBAT - OWNER Rp11.594 Rp13.000 SIRUP 01/01/2018

HUFAGRIP FLU 90 MERAPI OBAT - STANDAR Rp11.594 Rp17.000 SIRUP 01/01/2018

HUFAGRIP TM SYR 272 MERAPI OBAT - BEBAS Rp8.195 Rp11.500 SIRUP 01/07/2017

HUFAGRIP TM SYR 272 MERAPI OBAT - KARYAWAN Rp8.195 Rp10.000 SIRUP 01/07/2017

HUFAGRIP TM SYR 272 MERAPI OBAT - OWNER Rp8.195 Rp9.500 SIRUP 01/07/2017

HUFAGRIP TM SYR 272 MERAPI OBAT - STANDAR Rp8.195 Rp12.000 SIRUP 01/07/2017

HYSTOLAN TAB 347 AAM OBAT - BEBAS Rp4.500 Rp6.200 TABLET 01/10/2018

HYSTOLAN TAB 347 AAM OBAT - KARYAWAN Rp4.500 Rp5.500 TABLET 01/10/2018

HYSTOLAN TAB 347 AAM OBAT - OWNER Rp4.500 Rp5.000 TABLET 01/10/2018

HYSTOLAN TAB 347 AAM OBAT - STANDAR Rp4.500 Rp6.500 TABLET 01/10/2018

IMBOOST FORTE SYR 374 PARIT OBAT - BEBAS Rp52.500 Rp72.500 SIRUP 01/11/2017

IMBOOST FORTE SYR 374 PARIT OBAT - KARYAWAN Rp52.500 Rp64.000 SIRUP 01/11/2017

23 September 2016 Page 19 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
IMBOOST FORTE SYR 374 PARIT OBAT - OWNER Rp52.500 Rp58.000 SIRUP 01/11/2017

IMBOOST FORTE SYR 374 PARIT OBAT - STANDAR Rp52.500 Rp72.500 SIRUP 01/11/2017

IMBOOTS FORTE TAB 196 PARIT OBAT - BEBAS Rp5.500 Rp7.600 TABLET 01/10/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - BEBAS Rp5.500 Rp7.600 TABLET 01/05/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - KARYAWAN Rp5.500 Rp6.700 TABLET 01/10/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - KARYAWAN Rp5.500 Rp6.700 TABLET 01/05/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - OWNER Rp5.500 Rp6.100 TABLET 01/10/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - OWNER Rp5.500 Rp6.100 TABLET 01/05/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - STANDAR Rp5.500 Rp8.000 TABLET 01/05/2018

IMBOOTS FORTE TAB 196 PARIT OBAT - STANDAR Rp5.500 Rp8.000 TABLET 01/10/2018

IMBOS TAB 241 PARIT OBAT - BEBAS Rp2.750 Rp3.800 TABLET 01/10/2018

IMBOS TAB 241 PARIT OBAT - KARYAWAN Rp2.750 Rp3.500 TABLET 01/10/2018

IMBOS TAB 241 PARIT OBAT - OWNER Rp2.750 Rp3.200 TABLET 01/10/2018

IMBOS TAB 241 PARIT OBAT - STANDAR Rp2.750 Rp4.000 TABLET 01/10/2018

IMODIUM 237 PARIT OBAT - BEBAS Rp6.632 Rp9.200 TABLET 01/08/2018

IMODIUM 237 PARIT OBAT - KARYAWAN Rp6.632 Rp8.100 TABLET 01/08/2018

IMODIUM 237 PARIT OBAT - OWNER Rp6.632 Rp7.300 TABLET 01/08/2018

IMODIUM 237 PARIT OBAT - STANDAR Rp6.632 Rp9.500 TABLET 01/08/2018

INBION 56 MBS OBAT - BEBAS Rp14.400 Rp2.000 TABLET 01/04/2018

INBION 56 MBS OBAT - KARYAWAN Rp1.440 Rp1.800 TABLET 01/04/2018

INBION 56 MBS OBAT - OWNER Rp1.440 Rp1.600 TABLET 01/04/2018

INBION 56 MBS OBAT - STANDAR Rp1.440 Rp2.100 TABLET 01/04/2018

INDUXIN INJ 491 ENSEVAL OBAT - BEBAS Rp8.000 Rp11.000 AMPUL 01/01/2017

INDUXIN INJ 491 ENSEVAL OBAT - KARYAWAN Rp8.000 Rp10.000 AMPUL 01/01/2017

INDUXIN INJ 491 ENSEVAL OBAT - OWNER Rp8.000 Rp9.000 AMPUL 01/01/2017

INDUXIN INJ 491 ENSEVAL OBAT - STANDAR Rp8.000 Rp11.500 AMPUL 01/01/2017

INFUS SET BAYI TRUMO 420 CITRA MEDICA ALKES 1 Rp13.760 Rp20.000 ALKES

INFUS SET BAYI TRUMO 420 CITRA MEDICA ALKES KARYAWAN2 Rp13.750 Rp17.000 ALKES

INFUS SET BAYI TRUMO 420 CITRA MEDICA ALKES OWNER Rp13.750 Rp15.500 ALKES

INFUS SET BAYI TRUMO 420 CITRA MEDICA ALKES STANDAR ALKES

INFUS SET MAKRO TRUMO 409 GALLUR ALKES 1 Rp12.150 Rp16.000 ALKES

INFUS SET MAKRO TRUMO 409 GALLUR ALKES KARYAWAN2 Rp12.150 Rp13.500 ALKES

INFUS SET MAKRO TRUMO 409 GALLUR ALKES OWNER Rp12.150 Rp12.500 ALKES

INFUS SET MAKRO TRUMO 409 GALLUR ALKES STANDAR ALKES

INFUSAN D5 +1/4 NS 248 BSP OBAT - BEBAS Rp17.450 Rp24.000 INFUS 01/07/2018

INFUSAN D5 +1/4 NS 248 BSP OBAT - KARYAWAN Rp17.450 Rp21.500 INFUS 01/07/2018

INFUSAN D5 +1/4 NS 248 BSP OBAT - OWNER Rp17.450 Rp19.500 INFUS 01/07/2018

INFUSAN D5 +1/4 NS 248 BSP OBAT - STANDAR Rp17.450 Rp25.000 INFUS 01/07/2018

INJEKSI PAMP 378 MBS ALKES 1 Rp9.900 Rp14.500 ALKES

INJEKSI PAMP 378 MBS ALKES KARYAWAN2 Rp9.900 Rp12.000 ALKES

INJEKSI PAMP 378 MBS ALKES OWNER Rp9.900 Rp11.000 ALKES

INJEKSI PAMP 378 MBS ALKES STANDAR ALKES

23 September 2016 Page 20 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
INLACTA DHA 102 MBS OBAT - BEBAS Rp4.533 Rp6.300 KAPSUL 01/12/2017

INLACTA DHA 102 MBS OBAT - KARYAWAN Rp4.533 Rp5.500 KAPSUL 01/12/2017

INLACTA DHA 102 MBS OBAT - OWNER Rp4.533 Rp5.000 KAPSUL 01/12/2017

INLACTA DHA 102 MBS OBAT - STANDAR Rp4.533 Rp6.500 KAPSUL 01/12/2017

INPEPSA 49 PARIT OBAT - BEBAS Rp48.000 Rp66.000 SIRUP 01/05/2018

INPEPSA 49 PARIT OBAT - KARYAWAN Rp48.000 Rp58.000 SIRUP 01/05/2018

INPEPSA 49 PARIT OBAT - OWNER Rp48.000 Rp53.000 SIRUP 01/05/2018

INPEPSA 49 PARIT OBAT - STANDAR Rp48.000 Rp69.000 SIRUP 01/05/2018

INSTO 200 APL OBAT - BEBAS Rp8.782 Rp12.500 CAIRAN 01/08/2019

INSTO 200 APL OBAT - KARYAWAN Rp8.782 Rp11.000 CAIRAN 01/08/2019

INSTO 200 APL OBAT - OWNER Rp8.782 Rp10.000 CAIRAN 01/08/2019

INSTO 200 APL OBAT - STANDAR Rp8.782 Rp12.500 CAIRAN 01/08/2019

INTERISTIN TAB 144 ENSEVAL OBAT - BEBAS Rp660 Rp1.000 TABLET 01/01/2019

INTERISTIN TAB 144 ENSEVAL OBAT - KARYAWAN Rp660 Rp800 TABLET 01/01/2019

INTERISTIN TAB 144 ENSEVAL OBAT - OWNER Rp660 Rp800 TABLET 01/01/2019

INTERISTIN TAB 144 ENSEVAL OBAT - STANDAR Rp660 Rp1.000 TABLET 01/01/2019

INTERMIX INJ 208 MBS ALKES 1 Rp8.500 Rp9.500 AMPUL 01/03/2017

INTERMIX INJ 208 MBS OBAT - BEBAS Rp8.500 Rp12.000 AMPUL 01/03/2017

INTERMIX INJ 208 MBS OBAT - KARYAWAN Rp8.500 Rp10.500 AMPUL 01/03/2017

INTERMIX INJ 208 MBS OBAT - STANDAR Rp8.500 Rp12.500 AMPUL 01/03/2017

INTERZINK SYR 54 MBS OBAT - BEBAS Rp30.000 Rp41.500 SIRUP 01/07/2017

INTERZINK SYR 54 MBS OBAT - KARYAWAN Rp30.000 Rp36.500 SIRUP 01/07/2017

INTERZINK SYR 54 MBS OBAT - OWNER Rp30.000 Rp33.000 SIRUP 01/07/2017

INTERZINK SYR 54 MBS OBAT - STANDAR Rp30.000 Rp43.000 SIRUP 01/07/2017

INVITEX TAB 171 ENSEVAL OBAT - KARYAWAN Rp9.933 Rp12.500 TABLET 01/09/2016

INVITEX TAB 171 ENSEVAL OBAT - OWNER Rp9.933 Rp11.000 TABLET 01/09/2016

INVITEX TAB 171 ENSEVAL OBAT - STANDAR Rp9.933 Rp14.500 TABLET 01/09/2016

IODIN 30 ML / BETADIN 390 CITRA MEDICA ALKES 1 Rp3.348 Rp5.000 CAIRAN 01/09/2016

IODIN 30 ML / BETADIN 390 CITRA MEDICA ALKES KARYAWAN2 Rp3.348 Rp4.500 CAIRAN 01/09/2016

IODIN 30 ML / BETADIN 390 CITRA MEDICA ALKES OWNER Rp3.348 Rp4.000 CAIRAN 01/09/2016

IODIN 30 ML / BETADIN 390 CITRA MEDICA ALKES STANDAR CAIRAN

IUD NOVA T 101 DOSNI ALKES 1 Rp222.730 Rp319.000 ALKES 01/05/2018

IUD NOVA T 101 DOSNI ALKES KARYAWAN2 Rp222.730 Rp270.000 ALKES 01/05/2018

IUD NOVA T 101 DOSNI ALKES OWNER Rp222.730 Rp245.000 ALKES 01/05/2018

IUD NOVA T 101 DOSNI OBAT - STANDAR ALKES

IV CATT 18 TRUMO 494 PT SI ALKES 2 Rp9.500 Rp15.000 ALKES

IV CATT 18 TRUMO 494 PT SI ALKES KARYAWAN1 Rp9.500 Rp11.000 ALKES

IV CATT 18 TRUMO 494 PT SI ALKES OWNER Rp9.500 Rp10.500 ALKES

IV CATT 18 TRUMO 494 PT SI ALKES STANDAR ALKES

IV CATT 20 TRUMO 413 CITRA MEDICA ALKES 3 Rp8.909 Rp15.000 ALKES

IV CATT 20 TRUMO 413 CITRA MEDICA ALKES KARYAWAN2 Rp8.909 Rp11.000 ALKES

IV CATT 20 TRUMO 413 CITRA MEDICA ALKES OWNER Rp8.909 Rp10.000 ALKES

23 September 2016 Page 21 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
IV CATT 20 TRUMO 413 CITRA MEDICA ALKES STANDAR ALKES

IV CHATETER 22 398 GALLUR ALKES 3 Rp13.310 Rp20.000 ALKES

IV CHATETER 22 398 GALLUR ALKES KARYAWAN2 Rp13.310 Rp15.000 ALKES

IV CHATETER 22 398 GALLUR ALKES OWNER Rp13.310 Rp13.500 ALKES

IV CHATETER 22 398 GALLUR ALKES STANDAR ALKES

IV CHATETER 24 393 CITRA MEDICA ALKES 3 Rp9.817 Rp17.000 ALKES

IV CHATETER 24 393 CITRA MEDICA ALKES KARYAWAN2 Rp9.817 Rp12.000 ALKES

IV CHATETER 24 393 CITRA MEDICA ALKES OWNER Rp9.817 Rp11.000 ALKES

IV CHATETER 24 393 CITRA MEDICA ALKES STANDAR ALKES

JELLY USG ULTRASONIC 5 L 418 CITRA MEDICA ALKES 1 Rp145.454 Rp208.000 CAIRAN

JELLY USG ULTRASONIC 5 L 418 CITRA MEDICA ALKES KARYAWAN2 Rp145.454 Rp176.000 CAIRAN

JELLY USG ULTRASONIC 5 L 418 CITRA MEDICA ALKES OWNER Rp145.454 Rp160.000 CAIRAN

JELLY USG ULTRASONIC 5 L 418 CITRA MEDICA ALKES STANDAR CAIRAN

KAEN 1 B 98 MERAPI OBAT - BEBAS Rp18.500 Rp25.500 CAIRAN 01/05/2018

KAEN 1 B 98 MERAPI OBAT - KARYAWAN Rp18.500 Rp22.500 CAIRAN 01/05/2018

KAEN 1 B 98 MERAPI OBAT - OWNER Rp18.500 Rp20.500 CAIRAN 01/05/2018

KAEN 1 B 98 MERAPI OBAT - STANDAR Rp18.500 Rp26.500 CAIRAN 01/05/2018

KAEN MG 3 99 MERAPI OBAT - BEBAS Rp20.000 Rp27.500 CAIRAN 01/10/2020

KAEN MG 3 99 MERAPI OBAT - KARYAWAN Rp20.000 Rp24.500 CAIRAN 01/10/2020

KAEN MG 3 99 MERAPI OBAT - OWNER Rp20.000 Rp22.000 CAIRAN 01/10/2020

KAEN MG 3 99 MERAPI OBAT - STANDAR Rp20.000 Rp29.000 CAIRAN 01/10/2020

KALBION TAB 232 TSJ OBAT - BEBAS Rp330 Rp500 TABLET 01/04/2018

KALBION TAB 232 TSJ OBAT - KARYAWAN Rp330 Rp400 TABLET 01/04/2018

KALBION TAB 232 TSJ OBAT - OWNER Rp330 Rp400 TABLET 01/04/2018

KALBION TAB 232 TSJ OBAT - STANDAR Rp330 Rp500 TABLET 01/04/2018

KALMETHASON TAB 348 ENSEVAL OBAT - BEBAS Rp88 Rp200 TABLET 01/11/2017

KALMETHASON TAB 348 ENSEVAL OBAT - KARYAWAN Rp88 Rp100 TABLET 01/11/2017

KALMETHASON TAB 348 ENSEVAL OBAT - OWNER Rp88 Rp100 TABLET 01/11/2017

KALMETHASON TAB 348 ENSEVAL OBAT - STANDAR Rp88 Rp200 TABLET 01/11/2017

KALMICETIN SALAP 518 ENSEVAL OBAT - BEBAS Rp10.000 Rp14.000 SALEP 01/01/2018

KALMICETIN SALAP 518 ENSEVAL OBAT - KARYAWAN Rp10.000 Rp12.500 SALEP 01/01/2018

KALMICETIN SALAP 518 ENSEVAL OBAT - OWNER Rp10.000 Rp11.000 SALEP 01/01/2018

KALMICETIN SALAP 518 ENSEVAL OBAT - STANDAR Rp10.000 Rp14.500 SALEP 01/01/2018

KALPEPSA SYR 468 ENSEVAL OBAT - BEBAS Rp35.000 Rp48.500 SIRUP 01/12/2017

KALPEPSA SYR 468 ENSEVAL OBAT - KARYAWAN Rp35.000 Rp42.500 SIRUP 01/12/2017

KALPEPSA SYR 468 ENSEVAL OBAT - OWNER Rp35.000 Rp38.500 SIRUP 01/12/2017

KALPEPSA SYR 468 ENSEVAL OBAT - STANDAR Rp35.000 Rp50.500 SIRUP 01/12/2017

KALTROFEN SUPOS 60 ENSEVAL OBAT - BEBAS Rp12.500 Rp17.500 SUPPOS 01/10/2017

KALTROFEN SUPOS 60 ENSEVAL OBAT - KARYAWAN Rp12.500 Rp15.500 SUPPOS 01/10/2017

KALTROFEN SUPOS 60 ENSEVAL OBAT - OWNER Rp12.500 Rp14.000 SUPPOS 01/10/2017

KALTROFEN SUPOS 60 ENSEVAL OBAT - STANDAR Rp12.500 Rp18.000 SUPPOS 01/10/2017

KAPAS 1 KG 434 CITRA MEDICA ALKES 1 Rp60.016 Rp86.000 ALKES

23 September 2016 Page 22 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
KAPAS 1 KG 434 CITRA MEDICA ALKES KARYAWAN2 Rp60.016 Rp73.000 ALKES

KAPAS 1 KG 434 CITRA MEDICA ALKES OWNER Rp60.016 Rp66.500 ALKES

KAPAS 1 KG 434 CITRA MEDICA ALKES STANDAR ALKES

KASA BUNDA 5 CM 410 CITRA MEDICA ALKES 4 Rp778 Rp1.500 ALKES

KASA BUNDA 5 CM 410 CITRA MEDICA ALKES KARYAWAN2 Rp778 Rp1.000 ALKES

KASA BUNDA 5 CM 410 CITRA MEDICA ALKES OWNER Rp778 Rp900 ALKES

KASA BUNDA 5 CM 410 CITRA MEDICA ALKES STANDAR ALKES

KASA DWIPA 428 CITRA MEDICA ALKES 1 Rp166.363 Rp238.000 ALKES

KASA DWIPA 428 CITRA MEDICA ALKES KARYAWAN2 Rp166.363 Rp201.500 ALKES

KASA DWIPA 428 CITRA MEDICA ALKES OWNER Rp166.363 Rp183.000 ALKES

KASA DWIPA 428 CITRA MEDICA ALKES STANDAR ALKES

KASA HIDROFIL 4X5 OM 406 CITRA MEDICA ALKES 3 Rp866 Rp1.500 ALKES

KASA HIDROFIL 4X5 OM 406 CITRA MEDICA ALKES KARYAWAN2 Rp866 Rp1.100 ALKES

KASA HIDROFIL 4X5 OM 406 CITRA MEDICA ALKES OWNER Rp866 Rp1.000 ALKES

KASA HIDROFIL 4X5 OM 406 CITRA MEDICA ALKES STANDAR ALKES

KASA LAMANG TAMA 40X80 381 CITRA MEDICA ALKES 1 Rp104.545 Rp150.000 ALKES

KASA LAMANG TAMA 40X80 381 CITRA MEDICA ALKES KARYAWAN2 Rp104.545 Rp126.500 ALKES

KASA LAMANG TAMA 40X80 381 CITRA MEDICA ALKES OWNER Rp104.545 Rp115.000 ALKES

KASA LAMANG TAMA 40X80 381 CITRA MEDICA ALKES STANDAR ALKES

KASSA STERIL 383 GALLUR ALKES 1 Rp4.200 Rp6.000 ALKES

KASSA STERIL 383 GALLUR ALKES KARYAWAN2 Rp4.200 Rp5.500 ALKES

KASSA STERIL 383 GALLUR ALKES OWNER Rp4.200 Rp5.000 ALKES

KASSA STERIL 383 GALLUR ALKES STANDAR ALKES

KCL INJ 368 MERAPI OBAT - BEBAS Rp3.080 Rp4.500 CAIRAN 22/06/2019

KCL INJ 368 MERAPI OBAT - KARYAWAN Rp3.080 Rp3.800 CAIRAN 22/06/2019

KCL INJ 368 MERAPI OBAT - OWNER Rp3.080 Rp3.500 CAIRAN 22/06/2019

KCL INJ 368 MERAPI OBAT - STANDAR Rp3.080 Rp4.500 CAIRAN 22/06/2019

KENALOG IN ORABASE 539 PARIT OBAT - BEBAS Rp46.900 Rp64.500 SALEP 01/06/2018

KENALOG IN ORABASE 539 PARIT OBAT - KARYAWAN Rp46.900 Rp57.000 SALEP 01/06/2018

KENALOG IN ORABASE 539 PARIT OBAT - OWNER Rp46.900 Rp52.000 SALEP 01/06/2018

KENALOG IN ORABASE 539 PARIT OBAT - STANDAR Rp46.900 Rp67.000 SALEP 01/06/2018

KERTAS CTG 441 PT SI ALKES JAKARTA PASIEN Rp250.000 Rp275.000 ALKES

KERTAS CTG 441 PT SI ALKES KARYAWAN1 Rp250.000 Rp262.500 ALKES

KERTAS CTG 441 PT SI ALKES OWNER Rp250.000 Rp250.000 ALKES

KERTAS CTG 441 PT SI ALKES STANDAR ALKES

KERTAS PUYER 416 CITRA MEDICA ALKES 1 Rp5.909 Rp8.500 ALKES

KERTAS PUYER 520 PT SI ALKES JAKARTA KARYAWAN Rp400 Rp500 ALKES

KERTAS PUYER 520 PT SI ALKES JAKARTA PASIEN Rp400 Rp500 ALKES

KERTAS PUYER 416 CITRA MEDICA ALKES KARYAWAN2 Rp5.909 Rp7.500 ALKES

KERTAS PUYER 520 PT SI ALKES OWNER Rp400 Rp400 ALKES

KERTAS PUYER 416 CITRA MEDICA ALKES OWNER Rp5.909 Rp6.500 ALKES

KERTAS PUYER 520 PT SI ALKES STANDAR ALKES

23 September 2016 Page 23 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
KERTAS PUYER 416 CITRA MEDICA ALKES STANDAR ALKES

KERTAS USG 444 PT SI ALKES JAKARTA PASIEN Rp418.000 Rp460.000 ALKES

KERTAS USG 444 PT SI ALKES KARYAWAN1 Rp418.000 Rp439.000 ALKES

KERTAS USG 444 PT SI ALKES OWNER Rp418.000 Rp418.000 ALKES

KERTAS USG 444 PT SI ALKES STANDAR ALKES

KETEROLAK INJ 155 AAM OBAT - BEBAS Rp12.758 Rp18.000 AMPUL 01/11/2017

KETEROLAK INJ 155 AAM OBAT - KARYAWAN Rp12.758 Rp15.500 AMPUL 01/11/2017

KETEROLAK INJ 155 AAM OBAT - OWNER Rp12.758 Rp14.500 AMPUL 01/11/2017

KETEROLAK INJ 155 AAM OBAT - STANDAR Rp12.758 Rp18.500 AMPUL 01/11/2017

KETOKONAZOL 309 AAM OBAT - BEBAS Rp391 Rp600 TABLET 01/05/2017

KETOKONAZOL 309 AAM OBAT - KARYAWAN Rp391 Rp500 TABLET 01/05/2017

KETOKONAZOL 309 AAM OBAT - OWNER Rp391 Rp500 TABLET 01/05/2017

KETOKONAZOL 309 AAM OBAT - STANDAR Rp391 Rp700 TABLET 01/05/2017

KTM 303 PENTA VALEN OBAT - BEBAS Rp19.360 Rp27.000 CAIRAN 01/10/2016

KTM 303 PENTA VALEN OBAT - KARYAWAN Rp19.360 Rp23.500 CAIRAN 01/10/2016

KTM 303 PENTA VALEN OBAT - OWNER Rp19.360 Rp21.300 CAIRAN 01/10/2016

KTM 303 PENTA VALEN OBAT - STANDAR Rp19.360 Rp28.000 CAIRAN 01/10/2016

LACTACYD BEBY 121 PARIT OBAT - BEBAS Rp18.900 Rp26.000 CAIRAN 01/10/2017

LACTACYD BEBY 121 PARIT OBAT - KARYAWAN Rp18.900 Rp23.000 CAIRAN 01/10/2017

LACTACYD BEBY 121 PARIT OBAT - OWNER Rp18.900 Rp21.000 CAIRAN 01/10/2017

LACTACYD BEBY 121 PARIT OBAT - STANDAR Rp18.900 Rp27.000 CAIRAN 01/10/2017

LACTAMOR TAB 93 ENSEVAL OBAT - BEBAS Rp1.933 Rp2.700 TABLET 01/10/2017

LACTAMOR TAB 93 ENSEVAL OBAT - KARYAWAN Rp1.933 Rp2.400 TABLET 01/10/2017

LACTAMOR TAB 93 ENSEVAL OBAT - OWNER Rp1.933 Rp2.200 TABLET 01/10/2017

LACTAMOR TAB 93 ENSEVAL OBAT - STANDAR Rp1.933 Rp2.800 TABLET 01/10/2017

LACTAVAR CAP 266 PARIT OBAT - BEBAS Rp3.800 Rp5.500 KAPSUL 01/09/2016

LACTAVAR CAP 266 PARIT OBAT - KARYAWAN Rp3.800 Rp4.600 KAPSUL 01/09/2016

LACTAVAR CAP 266 PARIT OBAT - OWNER Rp3.800 Rp4.200 KAPSUL 01/09/2016

LACTAVAR CAP 266 PARIT OBAT - STANDAR Rp3.800 Rp5.500 KAPSUL 01/09/2016

LAMBUCIT TAB 478 ENSEVAL OBAT - BEBAS Rp231 Rp400 TABLET 01/12/2019

LAMBUCIT TAB 478 ENSEVAL OBAT - KARYAWAN Rp231 Rp300 TABLET 01/12/2019

LAMBUCIT TAB 478 ENSEVAL OBAT - OWNER Rp231 Rp300 TABLET 01/12/2019

LAMBUCIT TAB 478 ENSEVAL OBAT - STANDAR Rp231 Rp400 TABLET 01/12/2019

LANAKELOID CREAM 317 MBS OBAT - BEBAS Rp56.000 Rp77.000 SALEP 01/01/2018

LANAKELOID CREAM 317 MBS OBAT - KARYAWAN Rp56.000 Rp68.000 SALEP 01/01/2018

LANAKELOID CREAM 317 MBS OBAT - OWNER Rp56.000 Rp62.000 SALEP 01/01/2018

LANAKELOID CREAM 317 MBS OBAT - STANDAR Rp56.000 Rp80.000 SALEP 01/01/2018

LANSOPRAZOL 76 AMS OBAT - BEBAS Rp1.229 Rp1.700 KAPSUL 01/04/2018

LANSOPRAZOL 76 AMS OBAT - KARYAWAN Rp1.229 Rp1.500 KAPSUL 01/04/2018

LANSOPRAZOL 76 AMS OBAT - OWNER Rp1.229 Rp1.400 KAPSUL 01/04/2018

LANSOPRAZOL 76 AMS OBAT - STANDAR Rp1.229 Rp1.800 KAPSUL 01/04/2018

LANSOPRAZOL CAP 460 PENTA VALEN OBAT - BEBAS Rp1.351 Rp1.900 KAPSUL 01/05/2018

23 September 2016 Page 24 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
LANSOPRAZOL CAP 512 ENSEVAL OBAT - BEBAS Rp910 Rp1.300 KAPSUL 01/03/2018

LANSOPRAZOL CAP 460 PENTA VALEN OBAT - KARYAWAN Rp1.351 Rp1.700 KAPSUL 01/05/2018

LANSOPRAZOL CAP 512 ENSEVAL OBAT - KARYAWAN Rp910 Rp1.200 KAPSUL 01/03/2018

LANSOPRAZOL CAP 512 ENSEVAL OBAT - OWNER Rp910 Rp1.100 KAPSUL 01/03/2018

LANSOPRAZOL CAP 460 PENTA VALEN OBAT - OWNER Rp1.351 Rp1.500 KAPSUL 01/05/2018

LANSOPRAZOL CAP 512 ENSEVAL OBAT - STANDAR Rp910 Rp1.400 KAPSUL 01/03/2018

LANSOPRAZOL CAP 460 PENTA VALEN OBAT - STANDAR Rp1.351 Rp2.000 KAPSUL 01/05/2018

LAXADIN SYR 103 AMS OBAT - BEBAS Rp33.000 Rp45.500 CAIRAN 01/12/2019

LAXADIN SYR 103 AMS OBAT - KARYAWAN Rp33.000 Rp40.000 CAIRAN 01/12/2019

LAXADIN SYR 103 AMS OBAT - OWNER Rp33.000 Rp36.500 CAIRAN 01/12/2019

LAXADIN SYR 103 AMS OBAT - STANDAR Rp33.000 Rp47.500 CAIRAN 01/12/2019

LAXTO B 107 AMS OBAT - BEBAS Rp4.375 Rp6.000 SACHET 01/04/2017

LAXTO B 107 AMS OBAT - KARYAWAN Rp4.375 Rp5.500 SACHET 01/04/2017

LAXTO B 107 AMS OBAT - OWNER Rp4.375 Rp5.000 SACHET 01/04/2017

LAXTO B 107 AMS OBAT - STANDAR Rp4.375 Rp6.300 SACHET 01/04/2017

LEUKOFIK 412 CITRA MEDICA ALKES 1 Rp13.109 Rp19.000 ALKES

LEUKOFIK 412 CITRA MEDICA ALKES KARYAWAN2 Rp13.109 Rp16.000 ALKES

LEUKOFIK 412 CITRA MEDICA ALKES OWNER Rp13.109 Rp14.500 ALKES

LEUKOFIK 412 CITRA MEDICA ALKES STANDAR ALKES

LEUKOPLAS 2,5X1 429 CITRA MEDICA ALKES 1 Rp4.986 Rp7.500 ALKES

LEUKOPLAS 2,5X1 429 CITRA MEDICA ALKES KARYAWAN2 Rp4.986 Rp6.500 ALKES

LEUKOPLAS 2,5X1 429 CITRA MEDICA ALKES OWNER Rp4.986 Rp5.500 ALKES

LEUKOPLAS 2,5X1 429 CITRA MEDICA ALKES STANDAR ALKES

LEUKOPLAS 7,5X4,5 407 CITRA MEDICA ALKES 1 Rp37.285 Rp53.500 ALKES

LEUKOPLAS 7,5X4,5 407 CITRA MEDICA ALKES KARYAWAN2 Rp37.285 Rp45.500 ALKES

LEUKOPLAS 7,5X4,5 407 CITRA MEDICA ALKES OWNER Rp37.285 Rp41.500 ALKES

LEUKOPLAS 7,5X4,5 407 CITRA MEDICA ALKES STANDAR ALKES

LIBROCEF CAP 470 TSJ OBAT - BEBAS Rp1.500 Rp2.100 KAPSUL 01/12/2019

LIBROCEF CAP 470 TSJ OBAT - KARYAWAN Rp1.500 Rp1.900 KAPSUL 01/12/2019

LIBROCEF CAP 470 TSJ OBAT - OWNER Rp1.500 Rp1.700 KAPSUL 01/12/2019

LIBROCEF CAP 470 TSJ OBAT - STANDAR Rp1.500 Rp2.200 KAPSUL 01/12/2019

LIDOCAIN INJ 499 APOTIK METRO OBAT - BEBAS Rp2.500 Rp3.500 AMPUL 01/04/2019

LIDOCAIN INJ 499 APOTIK METRO OBAT - KARYAWAN Rp2.500 Rp3.000 AMPUL 01/04/2019

LIDOCAIN INJ 499 APOTIK METRO OBAT - OWNER Rp2.500 Rp2.500 AMPUL 01/04/2019

LIDOCAIN INJ 499 APOTIK METRO OBAT - STANDAR Rp2.500 Rp3.500 AMPUL 01/04/2019

LIKURMIN SYR 527 ENSEVAL OBAT - BEBAS Rp39.000 Rp54.000 SIRUP 01/07/2018

LIKURMIN SYR 527 ENSEVAL OBAT - KARYAWAN Rp39.000 Rp47.500 SIRUP 01/07/2018

LIKURMIN SYR 527 ENSEVAL OBAT - OWNER Rp39.000 Rp43.000 SIRUP 01/07/2018

LIKURMIN SYR 527 ENSEVAL OBAT - STANDAR Rp39.000 Rp56.000 SIRUP 01/07/2018

LORATADIN TAB 351 MERAPI OBAT - BEBAS Rp327 Rp500 TABLET 01/05/2017

LORATADIN TAB 351 MERAPI OBAT - KARYAWAN Rp327 Rp400 TABLET 01/05/2017

LORATADIN TAB 351 MERAPI OBAT - OWNER Rp327 Rp400 TABLET 01/05/2017

23 September 2016 Page 25 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
LORATADIN TAB 351 MERAPI OBAT - STANDAR Rp327 Rp500 TABLET 01/05/2017

LUMINAL 30 MG TAB 349 APOTIK RENO SARI OBAT - BEBAS Rp900 Rp1.200 TABLET 01/01/2017

LUMINAL 30 MG TAB 349 APOTIK RENO SARI OBAT - KARYAWAN Rp900 Rp1.000 TABLET 01/01/2017

LUMINAL 30 MG TAB 349 APOTIK RENO SARI OBAT - OWNER Rp900 Rp1.000 TABLET 01/01/2017

LUMINAL 30 MG TAB 349 APOTIK RENO SARI OBAT - STANDAR Rp900 Rp1.200 TABLET 01/01/2017

LUTENYL 80 AAM OBAT - BEBAS Rp8.900 Rp12.500 TABLET 01/11/2019

LUTENYL 80 AAM OBAT - KARYAWAN Rp8.900 Rp11.000 TABLET 01/11/2019

LUTENYL 80 AAM OBAT - OWNER Rp8.900 Rp10.000 TABLET 01/11/2019

LUTENYL 80 AAM OBAT - STANDAR Rp8.900 Rp13.000 TABLET 01/11/2019

LYCALVIT TAB 230 MBS OBAT - BEBAS Rp850 Rp1.200 TABLET 01/04/2017

LYCALVIT TAB 230 MBS OBAT - KARYAWAN Rp850 Rp1.100 TABLET 01/04/2017

LYCALVIT TAB 230 MBS OBAT - OWNER Rp850 Rp1.000 TABLET 01/04/2017

LYCALVIT TAB 230 MBS OBAT - STANDAR Rp850 Rp1.300 TABLET 01/04/2017

MADU TJ 100 ML 459 MBS OBAT - BEBAS Rp12.750 Rp18.000 CAIRAN 01/08/2018

MADU TJ 100 ML 459 MBS OBAT - KARYAWAN Rp12.750 Rp15.500 CAIRAN 01/08/2018

MADU TJ 100 ML 459 MBS OBAT - OWNER Rp12.750 Rp14.500 CAIRAN 01/08/2018

MADU TJ 100 ML 459 MBS OBAT - STANDAR Rp12.750 Rp18.500 CAIRAN 01/08/2018

MADU TJ 250 ML 229 MBS OBAT - BEBAS Rp19.550 Rp27.000 CAIRAN 01/06/2018

MADU TJ 250 ML 229 MBS OBAT - KARYAWAN Rp19.550 Rp24.000 CAIRAN 01/06/2018

MADU TJ 250 ML 229 MBS OBAT - OWNER Rp19.550 Rp21.500 CAIRAN 01/06/2018

MADU TJ 250 ML 229 MBS OBAT - STANDAR Rp19.550 Rp28.000 CAIRAN 01/06/2018

MASKER 394 CITRA MEDICA ALKES 1 Rp381 Rp600 ALKES

MASKER 394 CITRA MEDICA ALKES KARYAWAN2 Rp381 Rp500 ALKES

MASKER 394 CITRA MEDICA ALKES OWNER Rp381 Rp500 ALKES

MASKER 394 CITRA MEDICA ALKES STANDAR ALKES

MASKER KARET SENSI 411 GALLUR ALKES 1 Rp520 Rp700 ALKES

MASKER KARET SENSI 411 GALLUR ALKES KARYAWAN2 Rp520 Rp600 ALKES

MASKER KARET SENSI 411 GALLUR ALKES OWNER Rp520 Rp600 ALKES

MASKER KARET SENSI 411 GALLUR ALKES STANDAR ALKES

MASKER N 95 417 CITRA MEDICA ALKES 1 Rp16.363 Rp23.500 ALKES

MASKER N 95 417 CITRA MEDICA ALKES KARYAWAN2 Rp16.363 Rp20.000 ALKES

MASKER N 95 417 CITRA MEDICA ALKES OWNER Rp16.363 Rp18.000 ALKES

MASKER N 95 417 CITRA MEDICA ALKES STANDAR ALKES

MASKER NEBU ANAK 474 CITRA MEDICA ALKES 1 Rp31.818 Rp45.500 ALKES

MASKER NEBU ANAK 474 CITRA MEDICA ALKES KARYAWAN2 Rp31.818 Rp38.500 ALKES

MASKER NEBU ANAK 474 CITRA MEDICA ALKES OWNER Rp31.818 Rp35.000 ALKES

MASKER NEBU ANAK 474 CITRA MEDICA ALKES STANDAR ALKES

MAXIMUS CAP 356 AMS OBAT - BEBAS Rp1.400 Rp2.000 KAPSUL 01/07/2016

MAXIMUS CAP 356 AMS OBAT - KARYAWAN Rp1.400 Rp1.700 KAPSUL 01/07/2016

MAXIMUS CAP 356 AMS OBAT - OWNER Rp1.400 Rp1.600 KAPSUL 01/07/2016

MAXIMUS CAP 356 AMS OBAT - STANDAR Rp1.400 Rp2.000 KAPSUL 01/07/2016

MEDIAMER B6 129 APL OBAT - BEBAS Rp2.572 Rp3.600 TABLET 01/10/2018

23 September 2016 Page 26 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
MEDIAMER B6 129 APL OBAT - KARYAWAN Rp2.572 Rp3.200 TABLET 01/10/2018

MEDIAMER B6 129 APL OBAT - OWNER Rp2.572 Rp3.000 TABLET 01/10/2018

MEDIAMER B6 129 APL OBAT - STANDAR Rp2.572 Rp3.700 TABLET 01/10/2018

MEFENTAN 36 TSJ OBAT - BEBAS Rp270 Rp500 TABLET 01/04/2020

MEFENTAN 36 TSJ OBAT - KARYAWAN Rp270 Rp400 TABLET 01/04/2020

MEFENTAN 36 TSJ OBAT - OWNER Rp270 Rp300 TABLET 01/04/2020

MEFENTAN 36 TSJ OBAT - STANDAR Rp270 Rp500 TABLET 01/04/2020

MELOXICAM 15 MG TAB 352 ENSEVAL OBAT - BEBAS Rp1.090 Rp1.500 TABLET 01/05/2017

MELOXICAM 15 MG TAB 352 ENSEVAL OBAT - KARYAWAN Rp1.090 Rp1.400 TABLET 01/05/2017

MELOXICAM 15 MG TAB 352 ENSEVAL OBAT - OWNER Rp1.090 Rp1.200 TABLET 01/05/2017

MELOXICAM 15 MG TAB 352 ENSEVAL OBAT - STANDAR Rp1.090 Rp1.600 TABLET 01/05/2017

MESS B BROUN 121 425 CITRA MEDICA ALKES 2 Rp1.998 Rp3.100 ALKES

MESS B BROUN 121 425 CITRA MEDICA ALKES KARYAWAN2 Rp1.998 Rp2.500 ALKES

MESS B BROUN 121 425 CITRA MEDICA ALKES OWNER Rp1.998 Rp2.200 ALKES

MESS B BROUN 121 425 CITRA MEDICA ALKES STANDAR ALKES

METFORMIN TAB 258 AAM OBAT - BEBAS Rp165 Rp300 TABLET 01/11/2018

METFORMIN TAB 258 AAM OBAT - KARYAWAN Rp165 Rp200 TABLET 01/11/2018

METFORMIN TAB 258 AAM OBAT - OWNER Rp165 Rp200 TABLET 01/11/2018

METFORMIN TAB 258 AAM OBAT - STANDAR Rp165 Rp300 TABLET 01/11/2018

METHYL PREDNISOLON INJ 473 MBS OBAT - BEBAS Rp28.000 Rp38.500 VIAL 01/06/2017

METHYL PREDNISOLON INJ 473 MBS OBAT - KARYAWAN Rp28.000 Rp34.000 VIAL 01/06/2017

METHYL PREDNISOLON INJ 473 MBS OBAT - OWNER Rp28.000 Rp31.000 VIAL 01/06/2017

METHYL PREDNISOLON INJ 473 MBS OBAT - STANDAR Rp28.000 Rp40.000 VIAL 01/06/2017

METHYLPREDNISOLON 4 MG 79 AAM OBAT - BEBAS Rp421 Rp600 TABLET 01/10/2017

METHYLPREDNISOLON 4 MG 79 AAM OBAT - KARYAWAN Rp421 Rp500 TABLET 01/10/2017

METHYLPREDNISOLON 4 MG 79 AAM OBAT - OWNER Rp421 Rp500 TABLET 01/10/2017

METHYLPREDNISOLON 4 MG 79 AAM OBAT - STANDAR Rp421 Rp700 TABLET 01/10/2017

METHYLPREDNISOLON INJ 401 AAM OBAT - BEBAS Rp33.863 Rp47.000 VIAL 01/10/2017

METHYLPREDNISOLON INJ 401 AAM OBAT - KARYAWAN Rp33.863 Rp41.000 VIAL 01/10/2017

METHYLPREDNISOLON INJ 401 AAM OBAT - OWNER Rp33.863 Rp37.500 VIAL 01/10/2017

METHYLPREDNISOLON INJ 401 AAM OBAT - STANDAR Rp33.863 Rp48.500 VIAL 01/10/2017

METRONIDAZOL 371 PARAZELSUS OBAT - BEBAS Rp32.182 Rp45.000 INFUS 31/05/2016

METRONIDAZOL 371 PARAZELSUS OBAT - KARYAWAN Rp32.182 Rp39.000 INFUS 31/05/2016

METRONIDAZOL 371 PARAZELSUS OBAT - OWNER Rp32.182 Rp35.500 INFUS 31/05/2016

METRONIDAZOL 371 PARAZELSUS OBAT - STANDAR Rp32.182 Rp46.000 INFUS 31/05/2016

METRONIDAZOL 500 TAB 195 BSP OBAT - BEBAS Rp216 Rp300 TABLET 01/12/2019

METRONIDAZOL 500 TAB 195 BSP OBAT - KARYAWAN Rp216 Rp300 TABLET 01/12/2019

METRONIDAZOL 500 TAB 195 BSP OBAT - OWNER Rp216 Rp300 TABLET 01/12/2019

METRONIDAZOL 500 TAB 195 BSP OBAT - STANDAR Rp216 Rp500 TABLET 01/12/2019

METRONIDAZOL INFUS 492 AAM OBAT - BEBAS Rp28.159 Rp40.000 INFUS 01/10/2017

METRONIDAZOL INFUS 492 AAM OBAT - KARYAWAN Rp28.159 Rp34.500 INFUS 01/10/2017

METRONIDAZOL INFUS 492 AAM OBAT - OWNER Rp28.159 Rp31.000 INFUS 01/10/2017

23 September 2016 Page 27 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
METRONIDAZOL INFUS 492 AAM OBAT - STANDAR Rp28.159 Rp40.500 INFUS 01/10/2017

MGSO4 20 % 538 MERAPI OBAT - BEBAS Rp7.200 Rp10.000 CAIRAN 01/11/2016

MGSO4 20 % 538 MERAPI OBAT - KARYAWAN Rp7.200 Rp9.000 CAIRAN 01/11/2016

MGSO4 20 % 538 MERAPI OBAT - OWNER Rp7.200 Rp8.000 CAIRAN 01/11/2016

MGSO4 20 % 538 MERAPI OBAT - STANDAR CAIRAN

MGSO4 INJ 162 MERAPI OBAT - BEBAS Rp7.200 Rp10.000 CAIRAN 01/09/2017

MGSO4 INJ 162 MERAPI OBAT - KARYAWAN Rp7.200 Rp9.000 CAIRAN 01/09/2017

MGSO4 INJ 162 MERAPI OBAT - OWNER Rp7.200 Rp8.000 CAIRAN 01/09/2017

MGSO4 INJ 162 MERAPI OBAT - STANDAR Rp7.200 Rp10.500 CAIRAN 01/09/2017

MICROLAC SUPP 318 AMS OBAT - BEBAS Rp17.500 Rp24.500 SUPPOS 01/01/2018

MICROLAC SUPP 318 AMS OBAT - KARYAWAN Rp17.500 Rp22.000 SUPPOS 01/01/2018

MICROLAC SUPP 318 AMS OBAT - OWNER Rp17.500 Rp19.500 SUPPOS 01/01/2018

MICROLAC SUPP 318 AMS OBAT - STANDAR Rp17.500 Rp25.500 SUPPOS 01/01/2018

MIDAZOLAM INJ 509 AMS OBAT - BEBAS Rp40.000 Rp550.000 AMPUL 01/06/2017

MIDAZOLAM INJ 509 AMS OBAT - KARYAWAN Rp40.000 Rp48.500 AMPUL 01/06/2017

MIDAZOLAM INJ 509 AMS OBAT - OWNER Rp40.000 Rp44.000 AMPUL 01/06/2017

MIDAZOLAM INJ 509 AMS OBAT - STANDAR Rp40.000 Rp57.500 AMPUL 01/06/2017

MILANTA CAIR 235 TSJ OBAT - BEBAS Rp6.670 Rp9.500 CAIRAN 01/03/2018

MILANTA CAIR 235 TSJ OBAT - KARYAWAN Rp6.670 Rp8.500 CAIRAN 01/03/2018

MILANTA CAIR 235 TSJ OBAT - OWNER Rp6.670 Rp7.500 CAIRAN 01/03/2018

MILANTA CAIR 235 TSJ OBAT - STANDAR Rp6.670 Rp10.000 CAIRAN 01/03/2018

MILMOR TAB 154 AMS OBAT - BEBAS Rp1.892 Rp2.700 TABLET 01/05/2017

MILMOR TAB 154 AMS OBAT - KARYAWAN Rp1.892 Rp2.300 TABLET 01/05/2017

MILMOR TAB 154 AMS OBAT - OWNER Rp1.892 Rp2.100 TABLET 01/05/2017

MILMOR TAB 154 AMS OBAT - STANDAR Rp1.892 Rp2.800 TABLET 01/05/2017

MINYAK KAYU PUITH 30 ML 481 TSJ OBAT - BEBAS Rp7.367 Rp10.500 CAIRAN 01/01/2021

MINYAK KAYU PUITH 30 ML 481 TSJ OBAT - KARYAWAN Rp7.367 Rp9.000 CAIRAN 01/01/2021

MINYAK KAYU PUITH 30 ML 481 TSJ OBAT - OWNER Rp7.367 Rp8.500 CAIRAN 01/01/2021

MINYAK KAYU PUITH 30 ML 481 TSJ OBAT - STANDAR Rp7.367 Rp11.000 CAIRAN 01/01/2021

MINYAK KAYU PUTIH 60 ML 480 TSJ OBAT - BEBAS Rp14.000 Rp19.500 CAIRAN 01/01/2021

MINYAK KAYU PUTIH 60 ML 480 TSJ OBAT - KARYAWAN Rp14.000 Rp17.000 CAIRAN 01/01/2021

MINYAK KAYU PUTIH 60 ML 480 TSJ OBAT - OWNER Rp14.000 Rp15.500 CAIRAN 01/01/2021

MINYAK KAYU PUTIH 60 ML 480 TSJ OBAT - STANDAR Rp14.000 Rp20.500 CAIRAN 01/01/2021

MINYAK TELON 30 ML 482 TSJ OBAT - BEBAS Rp6.750 Rp9.500 CAIRAN 01/01/2021

MINYAK TELON 30 ML 482 TSJ OBAT - KARYAWAN Rp6.750 Rp8.500 CAIRAN 01/01/2021

MINYAK TELON 30 ML 482 TSJ OBAT - OWNER Rp6.750 Rp7.500 CAIRAN 01/01/2021

MINYAK TELON 30 ML 482 TSJ OBAT - STANDAR Rp6.750 Rp10.000 CAIRAN 01/01/2021

MOLEXFLU 228 MBS OBAT - BEBAS Rp360 Rp500 TABLET 01/06/2017

MOLEXFLU 228 MBS OBAT - KARYAWAN Rp360 Rp500 TABLET 01/06/2017

MOLEXFLU 228 MBS OBAT - OWNER Rp360 Rp400 TABLET 01/06/2017

MOLEXFLU 228 MBS OBAT - STANDAR Rp360 Rp600 TABLET 01/06/2017

MOLOCO B12 TAB 128 APL OBAT - BEBAS Rp3.049 Rp4.200 TABLET 01/10/2017

23 September 2016 Page 28 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
MOLOCO B12 TAB 128 APL OBAT - KARYAWAN Rp3.049 Rp3.700 TABLET 01/10/2017

MOLOCO B12 TAB 128 APL OBAT - OWNER Rp3.049 Rp3.500 TABLET 01/10/2017

MOLOCO B12 TAB 128 APL OBAT - STANDAR Rp3.049 Rp4.500 TABLET 01/10/2017

MUCERA DROP 167 MBS OBAT - BEBAS Rp32.000 Rp44.000 DROP 01/07/2018

MUCERA DROP 167 MBS OBAT - KARYAWAN Rp32.000 Rp39.000 DROP 01/07/2018

MUCERA DROP 167 MBS OBAT - OWNER Rp32.000 Rp35.500 DROP 01/07/2018

MUCERA DROP 167 MBS OBAT - STANDAR Rp32.000 Rp46.000 DROP 01/07/2018

MUCERA SYR 111 MBS OBAT - BEBAS Rp17.000 Rp24.000 SIRUP 01/08/2018

MUCERA SYR 111 MBS OBAT - KARYAWAN Rp17.000 Rp20.500 SIRUP 01/08/2018

MUCERA SYR 111 MBS OBAT - OWNER Rp17.000 Rp19.000 SIRUP 01/08/2018

MUCERA SYR 111 MBS OBAT - STANDAR Rp17.000 Rp24.500 SIRUP 01/08/2018

MUCERA TAB 205 MBS OBAT - BEBAS Rp800 Rp1.100 TABLET 01/05/2017

MUCERA TAB 205 MBS OBAT - KARYAWAN Rp800 Rp1.000 TABLET 01/05/2017

MUCERA TAB 205 MBS OBAT - OWNER Rp800 Rp900 TABLET 01/05/2017

MUCERA TAB 205 MBS OBAT - STANDAR Rp800 Rp1.200 TABLET 01/05/2017

MUCIN SYR 465 MBS OBAT - BEBAS Rp50.000 Rp69.000 SIRUP 01/12/2017

MUCIN SYR 465 MBS OBAT - KARYAWAN Rp50.000 Rp60.500 SIRUP 01/12/2017

MUCIN SYR 465 MBS OBAT - OWNER Rp50.000 Rp55.000 SIRUP 01/12/2017

MUCIN SYR 465 MBS OBAT - STANDAR Rp50.000 Rp71.500 SIRUP 01/12/2017

MUCIN TAB 466 MBS OBAT - BEBAS Rp825 Rp1.200 TABLET 01/06/2017

MUCIN TAB 466 MBS OBAT - KARYAWAN Rp825 Rp1.000 TABLET 01/06/2017

MUCIN TAB 466 MBS OBAT - OWNER Rp825 Rp1.000 TABLET 01/06/2017

MUCIN TAB 466 MBS OBAT - STANDAR Rp825 Rp1.200 TABLET 01/06/2017

MUCOPEC SYR 315 TEMPO OBAT - BEBAS Rp46.754 Rp64.500 SIRUP 01/06/2018

MUCOPEC SYR 315 TEMPO OBAT - KARYAWAN Rp46.754 Rp57.000 SIRUP 01/06/2018

MUCOPEC SYR 315 TEMPO OBAT - OWNER Rp46.754 Rp51.500 SIRUP 01/06/2018

MUCOPEC SYR 315 TEMPO OBAT - STANDAR Rp46.754 Rp67.000 SIRUP 01/06/2018

MUCOPECT DROP 32 TEMPO OBAT - BEBAS Rp55.660 Rp77.000 SIRUP 01/06/2017

MUCOPECT DROP 32 TEMPO OBAT - KARYAWAN Rp55.660 Rp67.500 SIRUP 01/06/2017

MUCOPECT DROP 32 TEMPO OBAT - OWNER Rp55.660 Rp61.500 SIRUP 01/06/2017

MUCOPECT DROP 32 TEMPO OBAT - STANDAR Rp55.660 Rp80.000 SIRUP 01/06/2017

MYCODERM SALAP 297 MBS OBAT - BEBAS Rp11.000 Rp15.500 SALEP 01/07/2017

MYCODERM SALAP 297 MBS OBAT - KARYAWAN Rp11.000 Rp13.500 SALEP 01/07/2017

MYCODERM SALAP 297 MBS OBAT - OWNER Rp11.000 Rp12.500 SALEP 01/07/2017

MYCODERM SALAP 297 MBS OBAT - STANDAR Rp11.000 Rp16.000 SALEP 01/07/2017

MYLANTA TAB 324 TSJ OBAT - BEBAS Rp401 Rp600 TABLET 01/04/2016

MYLANTA TAB 324 TSJ OBAT - KARYAWAN Rp401 Rp500 TABLET 01/04/2016

MYLANTA TAB 324 TSJ OBAT - OWNER Rp401 Rp500 TABLET 01/04/2016

MYLANTA TAB 324 TSJ OBAT - STANDAR Rp401 Rp600 TABLET 01/04/2017

NACL OTSU INF 174 MERAPI OBAT - BEBAS Rp12.000 Rp16.500 INFUS 01/07/2020

NACL OTSU INF 174 MERAPI OBAT - KARYAWAN Rp12.000 Rp15.000 INFUS 01/07/2020

NACL OTSU INF 174 MERAPI OBAT - OWNER Rp12.000 Rp13.500 INFUS 01/07/2020

23 September 2016 Page 29 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
NACL OTSU INF 174 MERAPI OBAT - STANDAR Rp12.000 Rp17.500 INFUS 01/07/2020

NALD MANY SE TH 50 422 GALLUR ALKES 1 Rp10.300 Rp13.500 ALKES

NALD MANY SE TH 50 422 GALLUR ALKES KARYAWAN2 Rp10.300 Rp11.500 ALKES

NALD MANY SE TH 50 422 GALLUR ALKES OWNER Rp10.300 Rp10.500 ALKES

NALD MANY SE TH 50 422 GALLUR ALKES STANDAR ALKES

NALD MANY SE TH 55 436 GALLUR ALKES 1 Rp8.538 Rp11.500 ALKES

NALD MANY SE TH 55 436 GALLUR ALKES KARYAWAN2 Rp8.538 Rp9.500 ALKES

NALD MANY SE TH 55 436 GALLUR ALKES OWNER Rp8.538 Rp9.000 ALKES

NALD MANY SE TH 55 436 GALLUR ALKES STANDAR ALKES

NALD MANY SE TH 60 421 GALLUR ALKES 1 Rp10.300 Rp13.500 ALKES

NALD MANY SE TH 60 421 GALLUR ALKES KARYAWAN2 Rp10.300 Rp11.500 ALKES

NALD MANY SE TH 60 421 GALLUR ALKES OWNER Rp10.300 Rp10.500 ALKES

NALD MANY SE TH 60 421 GALLUR ALKES STANDAR ALKES

NALD SE TH 45 432 CITRA MEDICA ALKES 1 Rp8.083 Rp12.000 ALKES

NALD SE TH 45 432 CITRA MEDICA ALKES KARYAWAN2 Rp8.083 Rp10.000 ALKES

NALD SE TH 45 432 CITRA MEDICA ALKES OWNER Rp8.083 Rp9.000 ALKES

NALD SE TH 45 432 CITRA MEDICA ALKES STANDAR ALKES

NAPREX DROP 50 APL OBAT - BEBAS Rp30.350 Rp42.000 SIRUP 01/11/2017

NAPREX DROP 50 APL OBAT - KARYAWAN Rp30.350 Rp37.000 SIRUP 01/11/2017

NAPREX DROP 50 APL OBAT - OWNER Rp30.350 Rp33.500 SIRUP 01/11/2017

NAPREX DROP 50 APL OBAT - STANDAR Rp30.350 Rp43.500 SIRUP 01/11/2017

NAPREX SYR 51 APL OBAT - BEBAS Rp28.300 Rp39.000 SIRUP 01/09/2017

NAPREX SYR 51 APL OBAT - KARYAWAN Rp28.300 Rp34.500 SIRUP 01/09/2017

NAPREX SYR 51 APL OBAT - OWNER Rp28.300 Rp31.500 SIRUP 01/09/2017

NAPREX SYR 51 APL OBAT - STANDAR Rp28.300 Rp40.500 SIRUP 01/09/2017

NASAL HUDSON L 535 INVOICE ALKES 1 Rp880.000 Rp1.258.500 ALKES

NASAL HUDSON L 535 INVOICE ALKES KARYAWAN2 Rp880.000 Rp1.065.000 ALKES

NASAL HUDSON L 535 INVOICE ALKES OWNER Rp880.000 Rp968.000 ALKES

NASAL HUDSON L 535 INVOICE ALKES STANDAR ALKES

NASAL MASK L 533 INVOICE ALKES 1 Rp350.000 Rp500.000 ALKES

NASAL MASK L 533 INVOICE ALKES KARYAWAN2 Rp350.000 Rp423.500 ALKES

NASAL MASK L 533 INVOICE ALKES OWNER Rp350.000 Rp385.000 ALKES

NASAL MASK L 533 INVOICE ALKES STANDAR ALKES

NASAL MASK M 534 INVOICE ALKES 1 Rp350.000 Rp500.000 ALKES

NASAL MASK M 534 INVOICE ALKES KARYAWAN2 Rp350.000 Rp423.500 ALKES

NASAL MASK M 534 INVOICE ALKES OWNER Rp350.000 Rp385.000 ALKES

NASAL MASK M 534 INVOICE ALKES STANDAR Rp350.000 Rp385.000 ALKES

NATAVIT CAP 475 UDC OBAT - BEBAS Rp2.750 Rp3.800 KAPSUL 01/10/2018

NATAVIT CAP 475 UDC OBAT - KARYAWAN Rp2.750 Rp3.400 KAPSUL 01/10/2018

NATAVIT CAP 475 UDC OBAT - OWNER Rp2.750 Rp3.100 KAPSUL 01/10/2018

NATAVIT CAP 475 UDC OBAT - STANDAR Rp2.750 Rp4.000 KAPSUL 01/10/2018

NATRIUM DICLOFENAT TAB 125 DOSNI OBAT - BEBAS Rp238 Rp500 TABLET 01/04/2018

23 September 2016 Page 30 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
NATRIUM DICLOFENAT TAB 125 DOSNI OBAT - KARYAWAN Rp238 Rp300 TABLET 01/04/2018

NATRIUM DICLOFENAT TAB 125 DOSNI OBAT - OWNER Rp238 Rp300 TABLET 01/04/2018

NATRIUM DICLOFENAT TAB 125 DOSNI OBAT - STANDAR Rp238 Rp400 TABLET 01/04/2018

NATUR E TAB 201 APL OBAT - BEBAS Rp860 Rp1.200 TABLET 01/12/2018

NATUR E TAB 201 APL OBAT - KARYAWAN Rp860 Rp1.100 TABLET 01/12/2018

NATUR E TAB 201 APL OBAT - OWNER Rp860 Rp1.000 TABLET 01/12/2018

NATUR E TAB 201 APL OBAT - STANDAR Rp860 Rp1.300 TABLET 01/12/2018

NEBACETIN OIL 292 PARIT OBAT - BEBAS Rp17.000 Rp23.500 SALEP 01/10/2017

NEBACETIN OIL 292 PARIT OBAT - KARYAWAN Rp17.000 Rp21.000 SALEP 01/10/2017

NEBACETIN OIL 292 PARIT OBAT - OWNER Rp17.000 Rp19.000 SALEP 01/10/2017

NEBACETIN OIL 292 PARIT OBAT - STANDAR Rp17.000 Rp24.500 SALEP 01/10/2017

NEBACETIN POWDER 291 PARIT OBAT - BEBAS Rp18.500 Rp25.500 ALKES 01/07/2019

NEBACETIN POWDER 212 AMS OBAT - BEBAS Rp18.500 Rp25.500 ALKES 01/06/2019

NEBACETIN POWDER 291 PARIT OBAT - KARYAWAN Rp18.500 Rp22.500 ALKES 01/07/2019

NEBACETIN POWDER 212 AMS OBAT - KARYAWAN Rp18.500 Rp22.500 ALKES 01/06/2019

NEBACETIN POWDER 291 PARIT OBAT - OWNER Rp18.500 Rp20.500 ALKES 01/07/2019

NEBACETIN POWDER 212 AMS OBAT - OWNER Rp18.500 Rp20.500 ALKES 01/06/2019

NEBACETIN POWDER 291 PARIT OBAT - STANDAR Rp18.500 Rp26.500 ALKES 01/07/2019

NEBACETIN POWDER 212 AMS OBAT - STANDAR Rp18.500 Rp26.500 ALKES 01/06/2019

NEO GYNOSA 61 ENSEVAL OBAT - BEBAS Rp13.800 Rp19.000 SUPPOS 01/09/2017

NEO GYNOSA 61 ENSEVAL OBAT - KARYAWAN Rp13.800 Rp17.000 SUPPOS 01/09/2017

NEO GYNOSA 61 ENSEVAL OBAT - OWNER Rp13.800 Rp15.500 SUPPOS 01/09/2017

NEO GYNOSA 61 ENSEVAL OBAT - STANDAR Rp13.800 Rp20.000 SUPPOS 01/09/2017

NEO VIT K INJ 152 APL OBAT - BEBAS Rp12.320 Rp17.000 AMPUL 01/08/2017

NEO VIT K INJ 152 APL OBAT - KARYAWAN Rp12.320 Rp15.000 AMPUL 01/08/2017

NEO VIT K INJ 152 APL OBAT - OWNER Rp12.320 Rp14.000 AMPUL 01/08/2017

NEO VIT K INJ 152 APL OBAT - STANDAR Rp12.320 Rp18.000 AMPUL 01/08/2017

NEOROBION TAB 130 APL OBAT - BEBAS Rp1.247 Rp1.800 TABLET 01/03/2018

NEOROBION TAB 130 APL OBAT - KARYAWAN Rp1.247 Rp1.600 TABLET 01/03/2018

NEOROBION TAB 130 APL OBAT - OWNER Rp1.247 Rp1.400 TABLET 01/03/2018

NEOROBION TAB 130 APL OBAT - STANDAR Rp1.247 Rp1.800 TABLET 01/03/2018

NEOZEP FORTE 53 APL OBAT - BEBAS Rp416 Rp600 TABLET 01/08/2019

NEOZEP FORTE 53 APL OBAT - KARYAWAN Rp416 Rp500 TABLET 01/08/2019

NEOZEP FORTE 53 APL OBAT - OWNER Rp416 Rp500 TABLET 01/08/2019

NEOZEP FORTE 53 APL OBAT - STANDAR Rp416 Rp600 TABLET 01/08/2019

NEUROBION FORTE TAB 209 APL OBAT - BEBAS Rp2.339 Rp3.300 TABLET 01/10/2017

NEUROBION FORTE TAB 209 APL OBAT - KARYAWAN Rp2.339 Rp2.900 TABLET 01/10/2017

NEUROBION FORTE TAB 209 APL OBAT - OWNER Rp2.339 Rp2.600 TABLET 01/10/2017

NEUROBION FORTE TAB 209 APL OBAT - STANDAR Rp2.339 Rp3.400 TABLET 01/10/2017

NEURODEK TAB 238 AAM OBAT - BEBAS Rp1.100 Rp1.500 TABLET 01/04/2017

NEURODEK TAB 238 AAM OBAT - KARYAWAN Rp1.100 Rp1.400 TABLET 01/04/2017

NEURODEK TAB 238 AAM OBAT - OWNER Rp1.100 Rp1.300 TABLET 01/04/2017

23 September 2016 Page 31 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
NEURODEK TAB 238 AAM OBAT - STANDAR Rp1.100 Rp1.600 TABLET 01/04/2017

NEUROSANBE INJ 140 BSP OBAT - BEBAS Rp4.600 Rp6.500 AMPUL 01/02/2017

NEUROSANBE INJ 140 BSP OBAT - KARYAWAN Rp4.600 Rp6.000 AMPUL 01/02/2017

NEUROSANBE INJ 140 BSP OBAT - OWNER Rp4.600 Rp5.500 AMPUL 01/02/2017

NEUROSANBE INJ 140 BSP OBAT - STANDAR Rp4.600 Rp7.000 AMPUL 01/02/2017

NEUROSANBE PLUS TAB 69 BSP OBAT - BEBAS Rp950 Rp1.400 TABLET 03/11/2018

NEUROSANBE PLUS TAB 69 BSP OBAT - KARYAWAN Rp950 Rp1.200 TABLET 03/11/2018

NEUROSANBE PLUS TAB 69 BSP OBAT - OWNER Rp950 Rp1.100 TABLET 03/11/2018

NEUROSANBE PLUS TAB 69 BSP OBAT - STANDAR Rp950 Rp1.400 TABLET 03/11/2018

NEXA TAB 500 MG 22 TSJ OBAT - BEBAS Rp1.700 Rp2.400 TABLET 01/12/2019

NEXA TAB 500 MG 22 TSJ OBAT - KARYAWAN Rp1.700 Rp2.100 TABLET 01/12/2019

NEXA TAB 500 MG 22 TSJ OBAT - OWNER Rp1.700 Rp1.900 TABLET 01/12/2019

NEXA TAB 500 MG 22 TSJ OBAT - STANDAR Rp1.700 Rp2.500 TABLET 01/12/2019

NGT 12 TRUMO 431 CITRA MEDICA ALKES 1 Rp19.899 Rp26.000 ALKES

NGT 12 TRUMO 431 CITRA MEDICA ALKES KARYAWAN2 Rp19.899 Rp22.000 ALKES

NGT 12 TRUMO 431 CITRA MEDICA ALKES OWNER Rp19.899 Rp20.000 ALKES

NGT 12 TRUMO 431 CITRA MEDICA ALKES STANDAR ALKES

NGT 3,5 TRUMO 438 CITRA MEDICA ALKES 1 Rp16.929 Rp24.500 ALKES

NGT 3,5 TRUMO 438 CITRA MEDICA ALKES KARYAWAN Rp16.929 Rp20.500 ALKES

NGT 3,5 TRUMO 438 CITRA MEDICA ALKES OWNER Rp16.929 Rp19.000 ALKES

NGT 3,5 TRUMO 438 CITRA MEDICA ALKES STANDAR ALKES

NGT 5 TRUMO 437 CITRA MEDICA ALKES 1 Rp15.048 Rp22.000 ALKES

NGT 5 TRUMO 437 CITRA MEDICA ALKES KARYAWAN2 Rp15.048 Rp18.500 ALKES

NGT 5 TRUMO 437 CITRA MEDICA ALKES OWNER Rp15.048 Rp17.000 ALKES

NGT 5 TRUMO 437 CITRA MEDICA ALKES STANDAR ALKES

NGT 8 385 CITRA MEDICA ALKES 1 Rp15.390 Rp22.000 ALKES

NGT 8 385 CITRA MEDICA ALKES KARYAWAN2 Rp15.390 Rp19.000 ALKES

NGT 8 385 CITRA MEDICA ALKES OWNER Rp15.390 Rp17.000 ALKES

NGT 8 385 CITRA MEDICA ALKES STANDAR ALKES

NIFEDIPIN TAB 126 AAM OBAT - BEBAS Rp124 Rp300 TABLET 01/03/2019

NIFEDIPIN TAB 126 AAM OBAT - KARYAWAN Rp124 Rp200 TABLET 01/03/2019

NIFEDIPIN TAB 126 AAM OBAT - OWNER Rp124 Rp200 TABLET 01/03/2019

NIFEDIPIN TAB 126 AAM OBAT - STANDAR Rp124 Rp300 TABLET 01/03/2019

NORMASTIN TAB 354 TSJ OBAT - BEBAS Rp193 Rp300 TABLET 01/07/2017

NORMASTIN TAB 354 TSJ OBAT - KARYAWAN Rp193 Rp300 TABLET 01/07/2017

NORMASTIN TAB 354 TSJ OBAT - OWNER Rp193 Rp300 TABLET 01/07/2017

NORMASTIN TAB 354 TSJ OBAT - STANDAR Rp193 Rp500 TABLET 01/07/2017

OBH COMBI BATUK ANK SYR 164 APL OBAT - BEBAS Rp8.190 Rp11.500 SIRUP 01/09/2017

OBH COMBI BATUK ANK SYR 164 APL OBAT - KARYAWAN Rp8.190 Rp10.000 SIRUP 01/09/2017

OBH COMBI BATUK ANK SYR 164 APL OBAT - OWNER Rp8.190 Rp9.000 SIRUP 01/09/2017

OBH COMBI BATUK ANK SYR 164 APL OBAT - STANDAR Rp8.190 Rp12.000 SIRUP 01/09/2017

OBH COMBI BATUK FLU 100 MG 52 APL OBAT - BEBAS Rp11.603 Rp16.000 SIRUP 01/09/2017

23 September 2016 Page 32 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
OBH COMBI BATUK FLU 100 MG 52 APL OBAT - KARYAWAN Rp11.603 Rp14.000 SIRUP 01/09/2017

OBH COMBI BATUK FLU 100 MG 52 APL OBAT - OWNER Rp11.603 Rp13.000 SIRUP 01/09/2017

OBH COMBI BATUK FLU 100 MG 52 APL OBAT - STANDAR Rp11.603 Rp17.000 SIRUP 01/09/2017

OBH COMBI SYR 199 APL OBAT - BEBAS Rp7.000 Rp10.000 SIRUP 01/06/2017

OBH COMBI SYR 199 APL OBAT - KARYAWAN Rp7.000 Rp8.500 SIRUP 01/06/2017

OBH COMBI SYR 199 APL OBAT - OWNER Rp7.000 Rp8.000 SIRUP 01/06/2017

OBH COMBI SYR 199 APL OBAT - STANDAR Rp7.000 Rp10.000 SIRUP 01/06/2017

OBIPLUZ 240 APL OBAT - BEBAS Rp2.857 Rp4.000 TABLET 01/10/2016

OBIPLUZ 240 APL OBAT - KARYAWAN Rp2.857 Rp3.500 TABLET 01/10/2016

OBIPLUZ 240 APL OBAT - OWNER Rp2.857 Rp3.200 TABLET 01/10/2016

OBIPLUZ 240 APL OBAT - STANDAR Rp2.857 Rp4.000 TABLET 01/10/2016

OMEPRAZOL 20 MG 313 ENSEVAL OBAT - BEBAS Rp389 Rp600 TABLET 01/06/2017

OMEPRAZOL 20 MG 313 ENSEVAL OBAT - KARYAWAN Rp389 Rp500 TABLET 01/06/2017

OMEPRAZOL 20 MG 313 ENSEVAL OBAT - OWNER Rp389 Rp500 TABLET 01/06/2017

OMEPRAZOL 20 MG 313 ENSEVAL OBAT - STANDAR Rp389 Rp600 TABLET 01/06/2017

OMEPRAZOL INJ 402 AAM OBAT - BEBAS Rp71.400 Rp98.500 VIAL 01/11/2017

OMEPRAZOL INJ 402 AAM OBAT - KARYAWAN Rp71.400 Rp86.500 VIAL 01/11/2017

OMEPRAZOL INJ 402 AAM OBAT - OWNER Rp71.400 Rp78.500 VIAL 01/11/2017

OMEPRAZOL INJ 402 AAM OBAT - STANDAR Rp71.400 Rp102.500 VIAL 01/11/2017

ONDANSENTRON INJ 500 MERAPI OBAT - BEBAS Rp3.500 Rp5.000 AMPUL 01/03/2018

ONDANSENTRON INJ 500 MERAPI OBAT - KARYAWAN Rp3.500 Rp4.300 AMPUL 01/03/2018

ONDANSENTRON INJ 500 MERAPI OBAT - OWNER Rp3.500 Rp3.900 AMPUL 01/03/2018

ONDANSENTRON INJ 500 MERAPI OBAT - STANDAR Rp3.500 Rp5.500 AMPUL 01/03/2018

ONDANSENTRON TAB 161 MERAPI OBAT - BEBAS Rp1.167 Rp1.700 TABLET 01/11/2016

ONDANSENTRON TAB 161 MERAPI OBAT - KARYAWAN Rp1.167 Rp1.500 TABLET 01/11/2016

ONDANSENTRON TAB 161 MERAPI OBAT - OWNER Rp1.167 Rp1.300 TABLET 01/11/2016

ONDANSENTRON TAB 161 MERAPI OBAT - STANDAR Rp1.167 Rp1.700 TABLET 01/11/2016

ONDANSETRON INJ 78 AAM OBAT - BEBAS Rp5.250 Rp7.500 CAIRAN 15/10/2017

ONDANSETRON INJ 78 AAM OBAT - KARYAWAN Rp5.250 Rp6.500 CAIRAN 15/10/2017

ONDANSETRON INJ 78 AAM OBAT - OWNER Rp5.250 Rp6.000 CAIRAN 15/10/2017

ONDANSETRON INJ 78 AAM OBAT - STANDAR Rp5.250 Rp7.500 CAIRAN 15/10/2017

ONE SCRUB 5 L 426 CITRA MEDICA ALKES 1 Rp484.600 Rp693.500 CAIRAN 01/01/2017

ONE SCRUB 5 L 426 CITRA MEDICA ALKES KARYAWAN2 Rp484.600 Rp587.000 CAIRAN 01/01/2017

ONE SCRUB 5 L 426 CITRA MEDICA ALKES OWNER Rp484.600 Rp533.500 CAIRAN 01/01/2017

ONE SCRUB 5 L 426 CITRA MEDICA ALKES STANDAR CAIRAN

OPIMOX SYR 353 MBS OBAT - BEBAS Rp18.500 Rp25.500 SIRUP 01/08/2016

OPIMOX SYR 353 MBS OBAT - KARYAWAN Rp18.500 Rp22.500 SIRUP 01/08/2016

OPIMOX SYR 353 MBS OBAT - OWNER Rp18.500 Rp20.500 SIRUP 01/08/2016

OPIMOX SYR 353 MBS OBAT - STANDAR Rp18.500 Rp26.500 SIRUP 01/08/2016

OSFIT DHA 24 ENSEVAL OBAT - BEBAS Rp3.833 Rp5.300 TABLET 01/07/2017

OSFIT DHA 24 ENSEVAL OBAT - KARYAWAN Rp3.833 Rp4.700 TABLET 01/07/2017

OSFIT DHA 24 ENSEVAL OBAT - OWNER Rp3.833 Rp4.300 TABLET 01/07/2017

23 September 2016 Page 33 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
OSFIT DHA 24 ENSEVAL OBAT - STANDAR Rp3.833 Rp5.500 TABLET 01/07/2017

OSUTRAN INF 66 MERAPI OBAT - BEBAS Rp89.000 Rp122.500 INFUS 12/09/2019

OSUTRAN INF 66 MERAPI OBAT - KARYAWAN Rp89.000 Rp108.000 INFUS 12/09/2019

OSUTRAN INF 66 MERAPI OBAT - OWNER Rp89.000 Rp98.000 INFUS 12/09/2019

OSUTRAN INF 66 MERAPI OBAT - STANDAR Rp89.000 Rp127.500 INFUS 12/09/2019

OTTOPAN DROP 110 MBS OBAT - BEBAS Rp18.000 Rp25.000 DROP 01/05/2017

OTTOPAN DROP 110 MBS OBAT - KARYAWAN Rp18.000 Rp22.000 DROP 01/05/2017

OTTOPAN DROP 110 MBS OBAT - OWNER Rp18.000 Rp20.000 DROP 01/05/2017

OTTOPAN DROP 110 MBS OBAT - STANDAR Rp18.000 Rp26.000 DROP 01/05/2017

OTTOPAN SYR 113 MBS OBAT - BEBAS Rp11.000 Rp15.500 SIRUP 01/08/2017

OTTOPAN SYR 113 MBS OBAT - KARYAWAN Rp11.000 Rp13.500 SIRUP 01/08/2017

OTTOPAN SYR 113 MBS OBAT - OWNER Rp11.000 Rp12.500 SIRUP 01/08/2017

OTTOPAN SYR 113 MBS OBAT - STANDAR Rp11.000 Rp16.000 SIRUP 01/08/2017

PANADOL BIRU 281 TSJ OBAT - BEBAS Rp500 Rp700 TABLET 01/05/2017

PANADOL BIRU 281 TSJ OBAT - KARYAWAN Rp500 Rp600 TABLET 01/05/2017

PANADOL BIRU 281 TSJ OBAT - OWNER Rp500 Rp600 TABLET 01/05/2017

PANADOL BIRU 281 TSJ OBAT - STANDAR Rp500 Rp800 TABLET 01/05/2017

PANADOL EXT 306 TSJ OBAT - BEBAS Rp553 Rp1.000 TABLET 01/04/2016

PANADOL EXT 306 TSJ OBAT - KARYAWAN Rp553 Rp700 TABLET 01/04/2016

PANADOL EXT 306 TSJ OBAT - OWNER Rp553 Rp600 TABLET 01/04/2016

PANADOL EXT 306 TSJ OBAT - STANDAR Rp553 Rp1.000 TABLET 01/04/2016

PANAMIN G INF 267 MERAPI OBAT - BEBAS Rp50.000 Rp69.000 INFUS 01/09/2017

PANAMIN G INF 267 MERAPI OBAT - KARYAWAN Rp50.000 Rp60.500 INFUS 01/09/2017

PANAMIN G INF 267 MERAPI OBAT - OWNER Rp50.000 Rp55.000 INFUS 01/09/2017

PANAMIN G INF 267 MERAPI OBAT - STANDAR Rp50.000 Rp71.500 INFUS 01/09/2017

PANTOTIS INJ 4 UDC OBAT - BEBAS Rp115.000 Rp158.500 AMPUL 01/08/2018

PANTOTIS INJ 4 UDC OBAT - KARYAWAN Rp115.000 Rp139.500 AMPUL 01/08/2018

PANTOTIS INJ 4 UDC OBAT - OWNER Rp115.000 Rp126.500 AMPUL 01/08/2018

PANTOTIS INJ 4 UDC OBAT - STANDAR Rp115.000 Rp165.000 AMPUL 01/08/2018

PARACETAMOL SYR 123 DOSNI OBAT - BEBAS Rp5.000 Rp7.000 SIRUP 01/05/2019

PARACETAMOL SYR 123 DOSNI OBAT - KARYAWAN Rp5.000 Rp6.500 SIRUP 01/05/2019

PARACETAMOL SYR 123 DOSNI OBAT - OWNER Rp5.000 Rp5.500 SIRUP 01/05/2019

PARACETAMOL SYR 123 DOSNI OBAT - STANDAR Rp5.000 Rp7.500 SIRUP 01/05/2019

PASPARGIN INJEKSI 497 ENSEVAL OBAT - BEBAS Rp5.500 Rp7.600 AMPUL 01/01/2017

PASPARGIN INJEKSI 497 ENSEVAL OBAT - KARYAWAN Rp5.500 Rp6.700 AMPUL 01/01/2017

PASPARGIN INJEKSI 497 ENSEVAL OBAT - OWNER Rp5.500 Rp6.100 AMPUL 01/01/2017

PASPARGIN INJEKSI 497 ENSEVAL OBAT - STANDAR Rp5.500 Rp800 AMPUL 01/01/2017

PASQUAM CEAM 135 BSP OBAT - BEBAS Rp24.405 Rp34.000 SALEP 01/09/2018

PASQUAM CEAM 135 BSP OBAT - KARYAWAN Rp24.405 Rp30.000 SALEP 01/09/2018

PASQUAM CEAM 135 BSP OBAT - OWNER Rp24.405 Rp27.000 SALEP 01/09/2018

PASQUAM CEAM 135 BSP OBAT - STANDAR Rp24.405 Rp35.000 SALEP 01/09/2018

PHARMATON TAB 150 APL OBAT - BEBAS Rp3.192 Rp4.500 TABLET 01/10/2016

23 September 2016 Page 34 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
PHARMATON TAB 150 APL OBAT - KARYAWAN Rp3.192 Rp3.900 TABLET 01/10/2016

PHARMATON TAB 150 APL OBAT - OWNER Rp3.192 Rp3.600 TABLET 01/10/2016

PHARMATON TAB 150 APL OBAT - STANDAR Rp3.192 Rp4.600 TABLET 01/10/2016

PHAROLIT SASET 294 AMS OBAT - BEBAS Rp840 Rp1.500 SACHET 01/04/2018

PHAROLIT SASET 294 AMS OBAT - KARYAWAN Rp840 Rp1.000 SACHET 01/04/2018

PHAROLIT SASET 294 AMS OBAT - OWNER Rp840 Rp1.000 SACHET 01/04/2018

PHAROLIT SASET 294 AMS OBAT - STANDAR Rp840 Rp1.200 SACHET 01/04/2018

PLASTIK OBAT 13X8,7 382 CITRA MEDICA ALKES 1 Rp8.636 Rp12.500 ALKES

PLASTIK OBAT 13X8,7 382 CITRA MEDICA ALKES KARYAWAN2 Rp8.636 Rp10.500 ALKES

PLASTIK OBAT 13X8,7 382 CITRA MEDICA ALKES OWNER Rp8.636 Rp9.500 ALKES

PLASTIK OBAT 13X8,7 382 CITRA MEDICA ALKES STANDAR ALKES

PLESTER BETADIN 357 MERAPI OBAT - BEBAS Rp193 Rp500 ALKES 01/05/2017

PLESTER BETADIN 357 MERAPI OBAT - KARYAWAN Rp193 Rp300 ALKES 01/05/2017

PLESTER BETADIN 357 MERAPI OBAT - OWNER Rp193 Rp300 ALKES 01/05/2017

PLESTER BETADIN 357 MERAPI OBAT - STANDAR Rp193 Rp500 ALKES 01/05/2017

POLYSILAN SYR 286 AMS OBAT - BEBAS Rp18.500 Rp25.500 SIRUP 01/01/2019

POLYSILAN SYR 286 AMS OBAT - KARYAWAN Rp18.500 Rp22.500 SIRUP 01/01/2019

POLYSILAN SYR 286 AMS OBAT - OWNER Rp18.500 Rp20.500 SIRUP 01/01/2019

POLYSILAN SYR 286 AMS OBAT - STANDAR Rp18.500 Rp26.500 SIRUP 01/01/2019

POLYSILAN TAB 214 AMS OBAT - BEBAS Rp800 Rp1.100 TABLET 01/06/2017

POLYSILAN TAB 214 AMS OBAT - KARYAWAN Rp800 Rp1.000 TABLET 01/09/2017

POLYSILAN TAB 214 AMS OBAT - OWNER Rp800 Rp900 TABLET 01/09/2017

POLYSILAN TAB 214 AMS OBAT - STANDAR Rp800 Rp1.500 TABLET 01/09/2017

PONSTAN 183 TSJ OBAT - BEBAS Rp2.074 Rp3.000 TABLET 01/01/2017

PONSTAN 183 TSJ OBAT - KARYAWAN Rp2.074 Rp2.500 TABLET 01/01/2017

PONSTAN 183 TSJ OBAT - OWNER Rp2.074 Rp2.300 TABLET 01/01/2017

PONSTAN 183 TSJ OBAT - STANDAR Rp2.074 Rp3.000 TABLET 01/01/2017

POVIDON / BETADIN 1L 384 GALLUR ALKES 1 Rp85.000 Rp122.000 CAIRAN 09/10/2017

POVIDON / BETADIN 1L 384 GALLUR ALKES KARYAWAN2 Rp85.000 Rp103.000 CAIRAN 09/10/2017

POVIDON / BETADIN 1L 384 GALLUR ALKES OWNER Rp85.000 Rp93.500 CAIRAN 09/10/2017

POVIDON / BETADIN 1L 384 GALLUR ALKES STANDAR CAIRAN

POVIDON IODIN 1 L OM 408 CITRA MEDICA ALKES 1 Rp59.091 Rp84.500 CAIRAN 01/10/2018

POVIDON IODIN 1 L OM 408 CITRA MEDICA ALKES KARYAWAN2 Rp59.091 Rp71.500 CAIRAN 01/10/2018

POVIDON IODIN 1 L OM 408 CITRA MEDICA ALKES OWNER Rp59.091 Rp65.000 CAIRAN 01/10/2018

POVIDON IODIN 1 L OM 408 CITRA MEDICA ALKES STANDAR CAIRAN

POVIDON IODIN I LTR 34 CITRA MEDICA ALKES 1 Rp69.545 Rp99.500 CAIRAN 01/10/2017

POVIDON IODIN I LTR 34 CITRA MEDICA ALKES KARYAWAN2 Rp69.545 Rp84.500 CAIRAN 01/10/2017

POVIDON IODIN I LTR 34 CITRA MEDICA ALKES OWNER Rp69.545 Rp76.500 CAIRAN 01/10/2017

POVIDON IODIN I LTR 34 CITRA MEDICA ALKES STANDAR CAIRAN

PRAXION DROP 206 AMS OBAT - BEBAS Rp18.000 Rp25.000 DROP 01/07/2017

PRAXION DROP 206 AMS OBAT - KARYAWAN Rp18.000 Rp22.000 DROP 01/07/2017

PRAXION DROP 206 AMS OBAT - OWNER Rp18.000 Rp20.000 DROP 01/07/2017

23 September 2016 Page 35 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
PRAXION DROP 206 AMS OBAT - STANDAR Rp18.000 Rp26.000 DROP 01/07/2017

PRAXION SYR 39 AMS OBAT - BEBAS Rp19.500 Rp27.000 SIRUP 01/11/2019

PRAXION SYR 39 AMS OBAT - KARYAWAN Rp19.500 Rp24.000 SIRUP 01/01/2019

PRAXION SYR 39 AMS OBAT - OWNER Rp19.500 Rp21.500 SIRUP 01/11/2019

PRAXION SYR 39 AMS OBAT - STANDAR Rp19.500 Rp28.000 SIRUP 01/11/2019

PRAXION SYR FORTE 40 AMS OBAT - BEBAS Rp24.000 Rp33.000 SIRUP 01/07/2017

PRAXION SYR FORTE 170 PARIT OBAT - BEBAS Rp24.000 Rp33.000 SIRUP 01/10/2017

PRAXION SYR FORTE 40 AMS OBAT - KARYAWAN Rp24.000 Rp29.500 SIRUP 01/07/2017

PRAXION SYR FORTE 170 PARIT OBAT - KARYAWAN Rp24.000 Rp29.500 SIRUP 01/10/2017

PRAXION SYR FORTE 40 AMS OBAT - OWNER Rp24.000 Rp26.500 SIRUP 01/07/2017

PRAXION SYR FORTE 170 PARIT OBAT - OWNER Rp24.000 Rp26.500 SIRUP 01/10/2017

PRAXION SYR FORTE 40 AMS OBAT - STANDAR Rp24.000 Rp34.500 SIRUP 01/07/2017

PRAXION SYR FORTE 170 PARIT OBAT - STANDAR Rp24.000 Rp34.500 SIRUP 01/10/2017

PREABOR TAB 159 BSP OBAT - BEBAS Rp3.100 Rp4.300 TABLET 01/03/2018

PREABOR TAB 159 BSP OBAT - KARYAWAN Rp3.100 Rp3.800 TABLET 01/03/2018

PREABOR TAB 159 BSP OBAT - OWNER Rp3.100 Rp3.500 TABLET 01/03/2018

PREABOR TAB 159 BSP OBAT - STANDAR Rp3.100 Rp4.500 TABLET 01/03/2018

PREDNISON 5 MG TAB 514 APOTIK METRO OBAT - BEBAS Rp750 Rp1.000 TABLET 01/05/2017

PREDNISON 5 MG TAB 514 APOTIK METRO OBAT - KARYAWAN Rp750 Rp900 TABLET 01/05/2017

PREDNISON 5 MG TAB 514 APOTIK METRO OBAT - OWNER Rp750 Rp800 TABLET 01/05/2017

PREDNISON 5 MG TAB 514 APOTIK METRO OBAT - STANDAR Rp750 Rp1.000 TABLET 01/05/2017

PREGCY CEK 358 UDC OBAT - BEBAS Rp18.000 Rp25.000 ALKES 01/10/2016

PREGCY CEK 358 UDC OBAT - KARYAWAN Rp18.000 Rp22.000 ALKES 01/10/2016

PREGCY CEK 358 UDC OBAT - OWNER Rp18.000 Rp20.000 ALKES 01/10/2016

PREGCY CEK 358 UDC OBAT - STANDAR Rp18.000 Rp26.000 ALKES 01/06/2016

PREGVOMIT TAB 485 PARIT OBAT - BEBAS Rp2.000 Rp2.800 TABLET 01/11/2016

PREGVOMIT TAB 485 PARIT OBAT - KARYAWAN Rp2.000 Rp2.500 TABLET 01/11/2016

PREGVOMIT TAB 485 PARIT OBAT - OWNER Rp2.000 Rp2.200 TABLET 01/11/2016

PREGVOMIT TAB 485 PARIT OBAT - STANDAR Rp2.000 Rp3.000 TABLET 01/11/2016

PREMASTON 227 ENSEVAL OBAT - BEBAS Rp3.667 Rp5.000 TABLET 01/04/2018

PREMASTON 227 ENSEVAL OBAT - KARYAWAN Rp3.667 Rp4.500 TABLET 01/04/2018

PREMASTON 227 ENSEVAL OBAT - OWNER Rp3.667 Rp4.000 TABLET 01/04/2018

PREMASTON 227 ENSEVAL OBAT - STANDAR Rp3.667 Rp5.500 TABLET 01/04/2018

PRIMPERAN INJ 204 PARIT OBAT - BEBAS Rp9.833 Rp14.000 AMPUL 01/06/2019

PRIMPERAN INJ 204 PARIT OBAT - KARYAWAN Rp9.833 Rp12.000 AMPUL 01/06/2019

PRIMPERAN INJ 204 PARIT OBAT - OWNER Rp9.833 Rp11.000 AMPUL 01/06/2019

PRIMPERAN INJ 204 PARIT OBAT - STANDAR Rp9.833 Rp14.500 AMPUL 01/06/2019

PROFERTIL 62 ENSEVAL OBAT - BEBAS Rp14.000 Rp19.500 TABLET 01/09/2020

PROFERTIL 62 ENSEVAL OBAT - KARYAWAN Rp14.000 Rp17.000 TABLET 01/09/2020

PROFERTIL 62 ENSEVAL OBAT - OWNER Rp14.000 Rp15.500 TABLET 01/09/2020

PROFERTIL 62 ENSEVAL OBAT - STANDAR Rp14.000 Rp20.500 TABLET 01/09/2020

PROMAG 301 ENSEVAL OBAT - BEBAS Rp139 Rp200 TABLET 01/02/2017

23 September 2016 Page 36 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
PROMAG 301 ENSEVAL OBAT - KARYAWAN Rp139 Rp150 TABLET 01/02/2017

PROMAG 301 ENSEVAL OBAT - OWNER Rp139 Rp150 TABLET 01/02/2017

PROMAG 301 ENSEVAL OBAT - STANDAR Rp139 Rp200 TABLET 01/02/2017

PROMAVIT TAB 166 PENTA VALEN OBAT - BEBAS Rp2.200 Rp3.500 TABLET 01/03/2017

PROMAVIT TAB 166 PENTA VALEN OBAT - KARYAWAN Rp2.200 Rp2.700 TABLET 01/03/2017

PROMAVIT TAB 166 PENTA VALEN OBAT - OWNER Rp2.200 Rp2.500 TABLET 01/03/2017

PROMAVIT TAB 166 PENTA VALEN OBAT - STANDAR Rp2.200 Rp3.500 TABLET 01/03/2017

PRORIS SYR 197 PARIT OBAT - BEBAS Rp19.500 Rp27.000 SIRUP 01/04/2017

PRORIS SYR 197 PARIT OBAT - KARYAWAN Rp19.500 Rp24.000 SIRUP 01/04/2017

PRORIS SYR 197 PARIT OBAT - OWNER Rp19.500 Rp21.500 SIRUP 01/04/2017

PRORIS SYR 197 PARIT OBAT - STANDAR Rp19.500 Rp28.000 SIRUP 01/04/2017

PRORIS SYR FORTE 213 AMS OBAT - BEBAS Rp22.000 Rp30.500 SIRUP 01/07/2017

PRORIS SYR FORTE 213 AMS OBAT - KARYAWAN Rp22.000 Rp27.000 SIRUP 01/07/2017

PRORIS SYR FORTE 213 AMS OBAT - OWNER Rp22.000 Rp24.500 SIRUP 01/07/2017

PRORIS SYR FORTE 213 AMS OBAT - STANDAR Rp22.000 Rp31.500 SIRUP 01/07/2017

PRORIS TAB 285 AMS OBAT - BEBAS Rp880 Rp1.300 TABLET 01/09/2017

PRORIS TAB 285 AMS OBAT - KARYAWAN Rp880 Rp1.100 TABLET 01/09/2017

PRORIS TAB 285 AMS OBAT - OWNER Rp880 Rp1.000 TABLET 01/09/2017

PRORIS TAB 285 AMS OBAT - STANDAR Rp880 Rp1.300 TABLET 01/09/2017

PYCIN 750 MG INJ 3 UDC OBAT - BEBAS Rp75.000 Rp103.500 AMPUL 01/09/2018

PYCIN 750 MG INJ 3 UDC OBAT - KARYAWAN Rp75.000 Rp91.000 AMPUL 01/09/2018

PYCIN 750 MG INJ 3 UDC OBAT - OWNER Rp75.000 Rp82.500 AMPUL 01/09/2018

PYCIN 750 MG INJ 3 UDC OBAT - STANDAR Rp75.000 Rp107.500 AMPUL 01/09/2018

RANITIDIN INJ 106 AAM OBAT - BEBAS Rp2.454 Rp3.400 AMPUL 01/07/2017

RANITIDIN INJ 106 AAM OBAT - KARYAWAN Rp2.454 Rp3.000 AMPUL 01/07/2017

RANITIDIN INJ 106 AAM OBAT - OWNER Rp2.454 Rp2.700 AMPUL 01/07/2017

RANITIDIN INJ 106 AAM OBAT - STANDAR Rp2.454 Rp3.500 AMPUL 01/07/2017

RANITIDIN TAB 127 AAM OBAT - BEBAS Rp210 Rp300 TABLET 01/11/2017

RANITIDIN TAB 127 AAM OBAT - KARYAWAN Rp210 Rp300 TABLET 01/11/2017

RANITIDIN TAB 127 AAM OBAT - OWNER Rp210 Rp300 TABLET 01/11/2017

RANITIDIN TAB 127 AAM OBAT - STANDAR Rp210 Rp400 TABLET 01/11/2017

RANIVEL SYR 296 AMS OBAT - BEBAS Rp42.500 Rp58.500 SIRUP 01/11/2016

RANIVEL SYR 296 AMS OBAT - KARYAWAN Rp42.500 Rp51.500 SIRUP 01/11/2016

RANIVEL SYR 296 AMS OBAT - OWNER Rp42.500 Rp47.000 SIRUP 01/11/2016

RANIVEL SYR 296 AMS OBAT - STANDAR Rp42.500 Rp61.000 SIRUP 01/11/2016

RECOFOL N INJ 498 AAM OBAT - BEBAS Rp90.000 Rp124.000 AMPUL 01/06/2017

RECOFOL N INJ 498 AAM OBAT - KARYAWAN Rp90.000 Rp109.000 AMPUL 01/06/2017

RECOFOL N INJ 498 AAM OBAT - OWNER Rp90.000 Rp99.000 AMPUL 01/06/2017

RECOFOL N INJ 498 AAM OBAT - STANDAR Rp90.000 Rp130.000 AMPUL 01/06/2017

RECOLFAR TAB 219 PARIT OBAT - BEBAS Rp4.300 Rp6.000 TABLET 01/12/2017

RECOLFAR TAB 219 PARIT OBAT - KARYAWAN Rp4.300 Rp5.300 TABLET 01/12/2017

RECOLFAR TAB 219 PARIT OBAT - OWNER Rp4.300 Rp4.800 TABLET 01/12/2017

23 September 2016 Page 37 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
RECOLFAR TAB 219 PARIT OBAT - STANDAR Rp4.300 Rp6.200 TABLET 01/12/2017

REDOXON EFF TAB 321 DOSNI OBAT - BEBAS Rp30.550 Rp42.000 TABLET 01/09/2016

REDOXON EFF TAB 321 DOSNI OBAT - KARYAWAN Rp30.550 Rp37.000 TABLET 01/09/2016

REDOXON EFF TAB 321 DOSNI OBAT - OWNER Rp30.550 Rp34.000 TABLET 01/09/2016

REDOXON EFF TAB 321 DOSNI OBAT - STANDAR Rp30.550 Rp44.000 TABLET 01/09/2016

REGUMEN TAB 71 BSP OBAT - BEBAS Rp3.100 Rp4.300 TABLET 01/02/2018

REGUMEN TAB 71 BSP OBAT - KARYAWAN Rp3.100 Rp3.800 TABLET 01/02/2018

REGUMEN TAB 71 BSP OBAT - OWNER Rp3.100 Rp3.500 TABLET 01/02/2018

REGUMEN TAB 71 BSP OBAT - STANDAR Rp3.100 Rp4.500 TABLET 01/02/2018

RENADINAC 50 304 PARIT OBAT - BEBAS Rp550 Rp1.000 TABLET 01/09/2018

RENADINAC 50 304 PARIT OBAT - KARYAWAN Rp550 Rp700 TABLET 01/09/2018

RENADINAC 50 304 PARIT OBAT - OWNER Rp550 Rp600 TABLET 01/09/2018

RENADINAC 50 304 PARIT OBAT - STANDAR Rp550 Rp1.000 TABLET 01/09/2018

RENALIT BTL 488 PARIT OBAT - BEBAS Rp14.000 Rp19.500 CAIRAN 01/09/2018

RENALIT BTL 488 PARIT OBAT - KARYAWAN Rp14.000 Rp17.000 CAIRAN 01/09/2018

RENALIT BTL 488 PARIT OBAT - OWNER Rp14.000 Rp15.500 CAIRAN 01/09/2018

RENALIT BTL 488 PARIT OBAT - STANDAR Rp14.000 Rp20.500 CAIRAN 01/09/2018

RILLUS TAB 254 ENSEVAL OBAT - BEBAS Rp6.533 Rp9.000 TABLET 01/09/2017

RILLUS TAB 254 ENSEVAL OBAT - KARYAWAN Rp6.533 Rp8.000 TABLET 01/09/2017

RILLUS TAB 254 ENSEVAL OBAT - OWNER Rp6.533 Rp7.500 TABLET 01/09/2017

RILLUS TAB 254 ENSEVAL OBAT - STANDAR Rp6.533 Rp9.500 TABLET 01/09/2017

RING PRESARIUM 452 PT SI ALKES JAKARTA PASIEN Rp350.000 Rp385.000 ALKES

RING PRESARIUM 452 PT SI ALKES KARYAWAN1 Rp350.000 Rp368.000 ALKES

RING PRESARIUM 452 PT SI ALKES OWNER Rp350.000 Rp350.000 ALKES

RING PRESARIUM 452 PT SI ALKES STANDAR ALKES

RL OTSU INF 100 MERAPI OBAT - BEBAS Rp12.000 Rp16.500 CAIRAN 01/10/2020

RL OTSU INF 100 MERAPI OBAT - KARYAWAN Rp12.000 Rp14.500 CAIRAN 01/10/2020

RL OTSU INF 100 MERAPI OBAT - OWNER Rp12.000 Rp13.500 CAIRAN 01/10/2020

RL OTSU INF 100 MERAPI OBAT - STANDAR Rp12.000 Rp17.500 CAIRAN 01/10/2020

RL SANBE INF 108 BSP OBAT - BEBAS Rp15.900 Rp22.000 CAIRAN 01/09/2018

RL SANBE INF 108 BSP OBAT - KARYAWAN Rp15.900 Rp19.500 CAIRAN 01/09/2018

RL SANBE INF 108 BSP OBAT - OWNER Rp15.900 Rp17.500 CAIRAN 01/09/2018

RL SANBE INF 108 BSP OBAT - STANDAR Rp15.900 Rp23.000 CAIRAN 01/09/2018

SA INJ 293 PARIT OBAT - BEBAS Rp1.818 Rp2.500 AMPUL 01/11/2018

SA INJ 293 PARIT OBAT - KARYAWAN Rp1.818 Rp500 AMPUL 01/11/2018

SA INJ 293 PARIT OBAT - OWNER Rp1.818 Rp2.000 AMPUL 01/11/2018

SA INJ 293 PARIT OBAT - STANDAR Rp1.818 Rp3.000 AMPUL 01/11/2018

SACTION CATTETER NO 8 388 GALLUR ALKES 1 Rp10.500 Rp14.000 ALKES 01/06/2019

SACTION CATTETER NO 8 388 GALLUR ALKES KARYAWAN2 Rp10.500 Rp12.000 ALKES 01/06/2019

SACTION CATTETER NO 8 388 GALLUR ALKES OWNER Rp10.500 Rp10.500 ALKES 01/06/2019

SACTION CATTETER NO 8 388 GALLUR ALKES STANDAR ALKES

SAFE CARE 188 AAM OBAT - BEBAS Rp12.364 Rp17.000 CAIRAN 01/05/2018

23 September 2016 Page 38 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
SAFE CARE 188 AAM OBAT - KARYAWAN Rp12.364 Rp15.000 CAIRAN 01/05/2018

SAFE CARE 188 AAM OBAT - OWNER Rp12.364 Rp14.000 CAIRAN 01/05/2018

SAFE CARE 188 AAM OBAT - STANDAR Rp12.364 Rp18.000 CAIRAN 01/05/2018

SAGESTAM CREM 147 BSP OBAT - BEBAS Rp11.050 Rp15.500 SALEP 01/09/2018

SAGESTAM CREM 147 BSP OBAT - KARYAWAN Rp11.050 Rp13.500 SALEP 01/09/2018

SAGESTAM CREM 147 BSP OBAT - OWNER Rp11.050 Rp12.500 SALEP 01/09/2018

SAGESTAM CREM 147 BSP OBAT - STANDAR Rp11.050 Rp16.000 SALEP 01/09/2018

SAGESTAM INJ 464 BSP OBAT - BEBAS Rp8.800 Rp12.500 AMPUL 01/10/2018

SAGESTAM INJ 464 BSP OBAT - KARYAWAN Rp8.800 Rp11.000 AMPUL 01/10/2018

SAGESTAM INJ 464 BSP OBAT - OWNER Rp8.800 Rp10.000 AMPUL 01/10/2018

SAGESTAM INJ 464 BSP OBAT - STANDAR Rp8.800 Rp13.000 AMPUL 01/10/2018

SALBUTAMOL TAB 202 PARIT OBAT - BEBAS Rp76 Rp200 TABLET 01/07/2017

SALBUTAMOL TAB 202 PARIT OBAT - KARYAWAN Rp76 Rp100 TABLET 01/07/2017

SALBUTAMOL TAB 202 PARIT OBAT - OWNER Rp76 Rp100 TABLET 01/07/2017

SALBUTAMOL TAB 202 PARIT OBAT - STANDAR Rp76 Rp200 TABLET 01/07/2017

SALOMPAS KOYO 255 MERAPI OBAT - BEBAS Rp4.642 Rp6.500 SACHET 01/02/2018

SALOMPAS KOYO 255 MERAPI OBAT - KARYAWAN Rp4.642 Rp6.000 SACHET 01/02/2018

SALOMPAS KOYO 255 MERAPI OBAT - OWNER Rp4.642 Rp5.500 SACHET 01/02/2018

SALOMPAS KOYO 255 MERAPI OBAT - STANDAR Rp4.642 Rp7.000 SACHET 01/02/2018

SALONPAS GEL 256 MERAPI OBAT - BEBAS Rp9.510 Rp13.000 SALEP 01/01/2019

SALONPAS GEL 256 MERAPI OBAT - KARYAWAN Rp9.510 Rp11.500 SALEP 01/01/2019

SALONPAS GEL 256 MERAPI OBAT - OWNER Rp9.510 Rp10.500 SALEP 01/01/2019

SALONPAS GEL 256 MERAPI OBAT - STANDAR Rp9.510 Rp13.500 SALEP 01/01/2019

SAN B PLEX DROP 10 BSP OBAT - BEBAS Rp15.600 Rp21.500 DROP 01/02/2017

SAN B PLEX DROP 10 BSP OBAT - KARYAWAN Rp15.600 Rp19.000 DROP 01/02/2017

SAN B PLEX DROP 10 BSP OBAT - OWNER Rp15.600 Rp17.500 DROP 01/02/2017

SAN B PLEX DROP 10 BSP OBAT - STANDAR Rp15.600 Rp22.500 DROP 01/02/2017

SANADRIL DMP 44 BSP OBAT - BEBAS Rp9.450 Rp13.000 SIRUP 01/05/2018

SANADRIL DMP 44 BSP OBAT - KARYAWAN Rp9.450 Rp11.500 SIRUP 01/05/2018

SANADRIL DMP 44 BSP OBAT - OWNER Rp9.450 Rp10.500 SIRUP 01/05/2018

SANADRIL DMP 44 BSP OBAT - STANDAR Rp9.450 Rp13.500 SIRUP 01/05/2018

SANADRYL EXP SYR 60 ML 70 BSP OBAT - BEBAS Rp8.800 Rp12.500 SIRUP 01/11/2018

SANADRYL EXP SYR 60 ML 70 BSP OBAT - KARYAWAN Rp8.800 Rp11.000 SIRUP 01/11/2018

SANADRYL EXP SYR 60 ML 70 BSP OBAT - OWNER Rp8.800 Rp10.000 SIRUP 01/11/2018

SANADRYL EXP SYR 60 ML 70 BSP OBAT - STANDAR Rp8.800 Rp13.000 SIRUP 01/11/2018

SANBE HEST 200 INF 156 BSP OBAT - BEBAS Rp173.900 Rp239.500 INFUS 01/03/2017

SANBE HEST 200 INF 156 BSP OBAT - KARYAWAN Rp173.900 Rp210.500 INFUS 01/03/2017

SANBE HEST 200 INF 156 BSP OBAT - OWNER Rp173.900 Rp191.500 INFUS 01/03/2017

SANBE HEST 200 INF 156 BSP OBAT - STANDAR Rp173.900 Rp249.000 INFUS 01/03/2017

SANEXON TAB 180 BSP OBAT - BEBAS Rp2.000 Rp3.000 TABLET 12/05/2017

SANEXON TAB 180 BSP OBAT - KARYAWAN Rp2.000 Rp2.500 TABLET 12/05/2017

SANEXON TAB 180 BSP OBAT - OWNER Rp2.000 Rp2.200 TABLET 12/05/2017

23 September 2016 Page 39 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
SANEXON TAB 180 BSP OBAT - STANDAR Rp2.000 Rp3.000 TABLET 12/05/2017

SANGOBION TAB 172 APL OBAT - BEBAS Rp906 Rp1.300 TABLET 01/08/2018

SANGOBION TAB 172 APL OBAT - KARYAWAN Rp906 Rp1.100 TABLET 01/08/2018

SANGOBION TAB 172 APL OBAT - OWNER Rp906 Rp1.000 TABLET 01/08/2018

SANGOBION TAB 172 APL OBAT - STANDAR Rp906 Rp1.300 TABLET 01/08/2018

SANGOBION VITA TONIK SYR 198 APL OBAT - BEBAS Rp18.496 Rp25.500 SIRUP 01/06/2017

SANGOBION VITA TONIK SYR 198 APL OBAT - KARYAWAN Rp18.496 Rp22.500 SIRUP 01/06/2017

SANGOBION VITA TONIK SYR 198 APL OBAT - OWNER Rp18.496 Rp20.500 SIRUP 01/06/2017

SANGOBION VITA TONIK SYR 198 APL OBAT - STANDAR Rp18.496 Rp26.500 SIRUP 01/06/2017

SANMAG TABLET 541 BSP OBAT - BEBAS Rp700 Rp1.000 TABLET 01/05/2018

SANMAG TABLET 541 BSP OBAT - KARYAWAN Rp700 Rp900 TABLET 01/05/2018

SANMAG TABLET 541 BSP OBAT - OWNER Rp700 Rp800 TABLET 01/05/2018

SANMAG TABLET 541 BSP OBAT - STANDAR Rp700 Rp1.000 TABLET 01/05/2018

SANMOL DROP 27 BSP OBAT - BEBAS Rp14.100 Rp19.500 SIRUP 01/11/2018

SANMOL DROP 27 BSP OBAT - KARYAWAN Rp14.100 Rp17.000 SIRUP 01/11/2018

SANMOL DROP 27 BSP OBAT - OWNER Rp14.100 Rp15.500 SIRUP 01/11/2018

SANMOL DROP 27 BSP OBAT - STANDAR Rp14.100 Rp20.500 SIRUP 01/11/2018

SANMOL INF 168 BSP OBAT - BEBAS Rp55.200 Rp76.000 INFUS 01/07/2017

SANMOL INF 168 BSP OBAT - KARYAWAN Rp55.200 Rp67.000 INFUS 01/07/2017

SANMOL INF 168 BSP OBAT - OWNER Rp55.200 Rp61.000 INFUS 01/07/2017

SANMOL INF 168 BSP OBAT - STANDAR Rp55.200 Rp79.000 INFUS 01/07/2017

SANMOL SYR 45 BSP OBAT - BEBAS Rp10.450 Rp14.500 SIRUP 01/10/2020

SANMOL SYR 45 BSP OBAT - KARYAWAN Rp10.450 Rp13.000 SIRUP 01/10/2020

SANMOL SYR 45 BSP OBAT - OWNER Rp10.450 Rp11.500 SIRUP 01/10/2020

SANMOL SYR 45 BSP OBAT - STANDAR Rp10.450 Rp15.000 SIRUP 01/10/2020

SANMOL TAB 9 BSP OBAT - BEBAS Rp250 Rp400 TABLET 01/10/2018

SANMOL TAB 9 BSP OBAT - KARYAWAN Rp250 Rp400 TABLET 01/10/2018

SANMOL TAB 9 BSP OBAT - OWNER Rp250 Rp300 TABLET 01/10/2018

SANMOL TAB 9 BSP OBAT - STANDAR Rp250 Rp500 TABLET 01/10/2018

SANPRIMA SYR 86 BSP OBAT - BEBAS Rp23.000 Rp32.000 SIRUP 27/05/2018

SANPRIMA SYR 86 BSP OBAT - KARYAWAN Rp23.000 Rp28.000 SIRUP 27/05/2018

SANPRIMA SYR 86 BSP OBAT - OWNER Rp23.000 Rp25.500 SIRUP 27/05/2018

SANPRIMA SYR 86 BSP OBAT - STANDAR Rp23.000 Rp33.000 SIRUP 27/05/2018

SANTA E TAB 191 BSP OBAT - BEBAS Rp1.750 Rp2.500 TABLET 01/01/2018

SANTA E TAB 191 BSP OBAT - KARYAWAN Rp1.750 Rp2.200 TABLET 01/01/2018

SANTA E TAB 191 BSP OBAT - OWNER Rp1.750 Rp2.000 TABLET 01/01/2018

SANTA E TAB 191 BSP OBAT - OWNER Rp1.750 Rp2.000 TABLET 01/01/2018

SANTOCYN INJ 72 BSP OBAT - BEBAS Rp10.400 Rp14.500 AMPUL 01/09/2017

SANTOCYN INJ 72 BSP OBAT - KARYAWAN Rp10.400 Rp13.000 AMPUL 01/09/2017

SANTOCYN INJ 72 BSP OBAT - OWNER Rp10.400 Rp11.500 AMPUL 01/09/2017

SANTOCYN INJ 72 BSP OBAT - STANDAR Rp10.400 Rp15.000 AMPUL 01/09/2017

SELANG O2 BAYI 439 GALLUR ALKES 1 Rp9.500 Rp12.500 ALKES

23 September 2016 Page 40 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
SELANG O2 BAYI 439 GALLUR ALKES KARYAWAN2 Rp9.500 Rp10.500 ALKES

SELANG O2 BAYI 439 GALLUR ALKES OWNER Rp9.500 Rp9.500 ALKES

SELANG O2 BAYI 439 GALLUR ALKES STANDAR ALKES

SELANG O2 DEWASA 454 CITRA MEDICA ALKES 1 Rp11.550 Rp15.000 ALKES

SELANG O2 DEWASA 454 CITRA MEDICA ALKES KARYAWAN2 Rp11.550 Rp13.000 ALKES

SELANG O2 DEWASA 454 CITRA MEDICA ALKES OWNER Rp11.550 Rp12.000 ALKES

SELANG O2 DEWASA 454 CITRA MEDICA ALKES STANDAR ALKES

SINVASTATIN 10 MG 182 DOSNI OBAT - BEBAS Rp560 Rp800 TABLET 01/01/2018

SINVASTATIN 10 MG 182 DOSNI OBAT - KARYAWAN Rp560 Rp700 TABLET 01/01/2018

SINVASTATIN 10 MG 182 DOSNI OBAT - OWNER Rp560 Rp600 TABLET 01/01/2018

SINVASTATIN 10 MG 182 DOSNI OBAT - STANDAR Rp560 Rp1.000 TABLET 01/01/2018

SOFTA MEN 0,5 L 526 GALLUR ALKES 1 Rp115.500 Rp155.500 CAIRAN

SOFTA MEN 0,5 L 526 GALLUR ALKES KARYAWAN2 Rp115.500 Rp127.500 CAIRAN

SOFTA MEN 0,5 L 526 GALLUR ALKES OWNER Rp115.500 Rp115.500 CAIRAN

SOFTA MEN 0,5 L 526 GALLUR ALKES STANDAR CAIRAN

SOFTA MEN 1 L 424 GALLUR ALKES 1 Rp172.000 Rp224.000 CAIRAN 01/02/2020

SOFTA MEN 1 L 424 GALLUR ALKES KARYAWAN2 Rp172.000 Rp189.500 CAIRAN 01/02/2020

SOFTA MEN 1 L 424 GALLUR ALKES OWNER Rp172.000 Rp172.000 CAIRAN 01/02/2020

SOFTA MEN 1 L 424 GALLUR ALKES STANDAR CAIRAN

SOHOBION INJ 242 PARIT OBAT - BEBAS Rp5.000 Rp7.000 CAIRAN 01/03/2017

SOHOBION INJ 242 PARIT OBAT - KARYAWAN Rp5.000 Rp6.000 CAIRAN 01/03/2017

SOHOBION INJ 242 PARIT OBAT - OWNER Rp5.000 Rp5.500 CAIRAN 01/03/2017

SOHOBION INJ 242 PARIT OBAT - STANDAR Rp5.000 Rp7.500 CAIRAN 01/03/2017

SORLEX HOT 30 MG CREAM 319 AMS OBAT - BEBAS Rp21.000 Rp29.000 SALEP 01/09/2016

SORLEX HOT 30 MG CREAM 319 AMS OBAT - KARYAWAN Rp21.000 Rp25.500 SALEP 01/09/2016

SORLEX HOT 30 MG CREAM 319 AMS OBAT - OWNER Rp21.000 Rp23.500 SALEP 01/09/2016

SORLEX HOT 30 MG CREAM 319 AMS OBAT - STANDAR Rp21.000 Rp30.000 SALEP 01/09/2016

SPATEL 18 CM 455 CITRA MEDICA ALKES 1 Rp18.000 Rp23.500 ALKES

SPATEL 18 CM 455 CITRA MEDICA ALKES KARYAWAN2 Rp18.000 Rp20.000 ALKES

SPATEL 18 CM 455 CITRA MEDICA ALKES OWNER Rp18.000 Rp18.000 ALKES

SPATEL 18 CM 455 CITRA MEDICA ALKES STANDAR ALKES

SPINOCEN NO 27&25 391 CITRA MEDICA ALKES 2 Rp28.600 Rp44.500 ALKES

SPINOCEN NO 27&25 391 CITRA MEDICA ALKES KARYAWAN2 Rp28.600 Rp35.000 ALKES

SPINOCEN NO 27&25 391 CITRA MEDICA ALKES OWNER Rp28.600 Rp31.500 ALKES

SPINOCEN NO 27&25 391 CITRA MEDICA ALKES STANDAR ALKES

SPUIT 1 CC 392 CITRA MEDICA ALKES 3 Rp2.688 Rp4.500 ALKES

SPUIT 1 CC 392 CITRA MEDICA ALKES KARYAWAN2 Rp2.688 Rp3.500 ALKES

SPUIT 1 CC 392 CITRA MEDICA ALKES OWNER Rp2.688 Rp3.000 ALKES

SPUIT 1 CC 392 CITRA MEDICA ALKES STANDAR ALKES

SPUIT 10 CC 397 GALLUR ALKES 2 Rp3.388 Rp5.000 ALKES

SPUIT 10 CC 397 GALLUR ALKES KARYAWAN2 Rp3.388 Rp4.000 ALKES

SPUIT 10 CC 397 GALLUR ALKES OWNER Rp3.388 Rp3.500 ALKES

23 September 2016 Page 41 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
SPUIT 10 CC 397 GALLUR ALKES STANDAR ALKES

SPUIT 20 CC TRUMO 506 APOTIK RSUD ALKES 1 Rp12.000 Rp16.000 ALKES

SPUIT 20 CC TRUMO 506 APOTIK RSUD ALKES KARYAWAN2 Rp12.000 Rp13.500 ALKES

SPUIT 20 CC TRUMO 506 APOTIK RSUD ALKES OWNER Rp12.000 Rp12.000 ALKES

SPUIT 20 CC TRUMO 506 APOTIK RSUD ALKES STANDAR ALKES

SPUIT 3 CC 396 CITRA MEDICA ALKES 2 Rp2.760 Rp4.500 ALKES

SPUIT 3 CC 396 CITRA MEDICA ALKES KARYAWAN2 Rp2.760 Rp3.500 ALKES

SPUIT 3 CC 396 CITRA MEDICA ALKES STANDAR ALKES

SPUIT 3 CC 396 CITRA MEDICA OBAT - OWNER Rp2.760 Rp3.100 ALKES

SPUIT 3 CC BD 528 CITRA MEDICA ALKES 4 Rp818 Rp1.500 ALKES

SPUIT 3 CC BD 528 CITRA MEDICA ALKES KARYAWAN2 Rp818 Rp1.000 ALKES

SPUIT 3 CC BD 528 CITRA MEDICA ALKES OWNER Rp818 Rp900 ALKES

SPUIT 3 CC BD 528 CITRA MEDICA ALKES STANDAR ALKES

SPUIT 5 CC TRUMO 423 GALLUR ALKES 2 Rp2.359 Rp3.500 ALKES

SPUIT 5 CC TRUMO 423 GALLUR ALKES KARYAWAN2 Rp2.359 Rp2.600 ALKES

SPUIT 5 CC TRUMO 423 GALLUR ALKES OWNER Rp2.359 Rp2.400 ALKES

SPUIT 5 CC TRUMO 423 GALLUR ALKES STANDAR ALKES

SPUIT 50 CC TRUMO 505 CITRA MEDICA ALKES 3 Rp12.054 Rp20.000 ALKES

SPUIT 50 CC TRUMO 505 CITRA MEDICA ALKES KARYAWAN2 Rp12.054 Rp15.000 ALKES

SPUIT 50 CC TRUMO 505 CITRA MEDICA ALKES OWNER Rp12.054 Rp13.500 ALKES

SPUIT 50 CC TRUMO 505 CITRA MEDICA ALKES STANDAR ALKES

STABIXIN INJ 375 PARIT OBAT - BEBAS Rp150.000 Rp206.500 AMPUL 01/01/2018

STABIXIN INJ 375 PARIT OBAT - KARYAWAN Rp150.000 Rp181.500 AMPUL 01/01/2018

STABIXIN INJ 375 PARIT OBAT - OWNER Rp150.000 Rp165.000 AMPUL 01/01/2018

STABIXIN INJ 375 PARIT OBAT - STANDAR Rp150.000 Rp214.500 AMPUL 01/01/2018

STESOLID SUPP 5 MG 350 APOTIK RENO SARI OBAT - BEBAS Rp29.000 Rp36.500 SUPPOS 01/01/2017

STESOLID SUPP 5 MG 350 APOTIK RENO SARI OBAT - KARYAWAN Rp29.000 Rp32.000 SUPPOS 01/01/2017

STESOLID SUPP 5 MG 350 APOTIK RENO SARI OBAT - OWNER Rp29.000 Rp29.000 SUPPOS 01/01/2017

STESOLID SUPP 5 MG 350 APOTIK RENO SARI OBAT - STANDAR Rp29.000 Rp38.000 SUPPOS 01/01/2017

STIMONO CAP 187 AAM OBAT - BEBAS Rp50.000 Rp69.000 KAPSUL 01/07/2017

STIMONO CAP 525 AAM OBAT - BEBAS Rp2.140 Rp3.000 KAPSUL 01/12/2017

STIMONO CAP 187 AAM OBAT - KARYAWAN Rp50.000 Rp60.500 KAPSUL 01/07/2017

STIMONO CAP 525 AAM OBAT - KARYAWAN Rp2.140 Rp2.600 KAPSUL 01/12/2017

STIMONO CAP 187 AAM OBAT - OWNER Rp50.000 Rp55.000 KAPSUL 01/07/2017

STIMONO CAP 525 AAM OBAT - OWNER Rp2.140 Rp2.400 KAPSUL 01/12/2017

STIMONO CAP 187 AAM OBAT - STANDAR Rp50.000 Rp71.500 KAPSUL 01/07/2017

STIMONO CAP 525 AAM OBAT - STANDAR Rp2.140 Rp3.100 KAPSUL 01/12/2017

STRIP GLUCO DR 419 GALLUR ALKES 1 Rp4.500 Rp6.500 ALKES

STRIP GLUCO DR 419 GALLUR ALKES KARYAWAN2 Rp4.500 Rp5.500 ALKES

STRIP GLUCO DR 419 GALLUR ALKES OWNER Rp4.500 Rp5.000 ALKES

STRIP GLUCO DR 419 GALLUR ALKES STANDAR ALKES

TAKANA SYR 64 MERAPI OBAT - BEBAS Rp25.000 Rp34.500 SIRUP 01/03/2017

23 September 2016 Page 42 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
TAKANA SYR 64 MERAPI OBAT - KARYAWAN Rp25.000 Rp30.500 SIRUP 01/03/2017

TAKANA SYR 64 MERAPI OBAT - OWNER Rp25.000 Rp27.500 SIRUP 01/03/2017

TAKANA SYR 64 MERAPI OBAT - STANDAR Rp25.000 Rp36.000 SIRUP 01/03/2017

TALKUM 430 CITRA MEDICA ALKES 1 Rp13.626 Rp22.000 ALKES

TALKUM 430 CITRA MEDICA ALKES KARYAWAN2 Rp13.626 Rp16.500 ALKES

TALKUM 430 CITRA MEDICA ALKES OWNER Rp13.626 Rp15.000 ALKES

TALKUM 430 CITRA MEDICA ALKES STANDAR ALKES

TANFUSI SET TRUMO 414 CITRA MEDICA ALKES 1 Rp20.400 Rp30.000 ALKES

TANFUSI SET TRUMO 414 CITRA MEDICA ALKES KARYAWAN2 Rp20.400 Rp25.000 ALKES

TANFUSI SET TRUMO 414 CITRA MEDICA ALKES OWNER Rp20.400 Rp22.500 ALKES

TANFUSI SET TRUMO 414 CITRA MEDICA ALKES STANDAR ALKES

TENSOSREPE 3 531 CITRA MEDICA ALKES 1 Rp52.575 Rp75.500 ALKES

TENSOSREPE 3 531 CITRA MEDICA ALKES KARYAWAN2 Rp52.575 Rp64.000 ALKES

TENSOSREPE 3 531 CITRA MEDICA ALKES OWNER Rp52.575 Rp58.000 ALKES

TENSOSREPE 3 531 CITRA MEDICA ALKES STANDAR ALKES

TENSOSREPE 4 532 CITRA MEDICA ALKES 1 Rp63.267 Rp90.500 ALKES

TENSOSREPE 4 532 CITRA MEDICA ALKES KARYAWAN2 Rp63.267 Rp77.000 ALKES

TENSOSREPE 4 532 CITRA MEDICA ALKES OWNER Rp63.267 Rp70.000 ALKES

TENSOSREPE 4 532 CITRA MEDICA ALKES STANDAR ALKES

TERDICEF INJ 231 UDC OBAT - BEBAS Rp115.000 Rp158.500 CAIRAN 01/06/2017

TERDICEF INJ 231 UDC OBAT - KARYAWAN Rp115.000 Rp139.500 CAIRAN 01/06/2017

TERDICEF INJ 231 UDC OBAT - OWNER Rp115.000 Rp126.500 CAIRAN 01/06/2017

TERDICEF INJ 231 UDC OBAT - STANDAR Rp115.000 Rp165.500 CAIRAN 01/06/2017

TERMODIGITAL ALPHA 373 CITRA MEDICA ALKES 2 Rp18.000 Rp28.000 ALKES

TERMODIGITAL ALPHA 373 CITRA MEDICA ALKES KARYAWAN2 Rp18.000 Rp22.000 ALKES

TERMODIGITAL ALPHA 373 CITRA MEDICA ALKES OWNER Rp18.000 Rp20.000 ALKES

TERMODIGITAL ALPHA 373 CITRA MEDICA ALKES STANDAR ALKES

TES PEK SIKLUS 360 CITRA MEDICA OBAT - BEBAS Rp10.000 Rp12.500 ALKES 01/03/2017

TES PEK SIKLUS 360 CITRA MEDICA OBAT - KARYAWAN Rp10.000 Rp11.000 ALKES 01/03/2017

TES PEK SIKLUS 360 CITRA MEDICA OBAT - OWNER Rp10.000 Rp10.000 ALKES 01/03/2017

TES PEK SIKLUS 360 CITRA MEDICA OBAT - STANDAR Rp10.000 Rp13.000 ALKES 01/03/2017

TIRDICEF INJ 495 UDC OBAT - BEBAS Rp115.000 Rp160.000 VIAL 01/06/2017

TIRDICEF INJ 495 UDC OBAT - KARYAWAN Rp115.000 Rp139.500 VIAL 01/06/2017

TIRDICEF INJ 495 UDC OBAT - OWNER Rp115.000 Rp126.500 VIAL 01/06/2017

TIRDICEF INJ 495 UDC OBAT - STANDAR Rp115.000 Rp165.000 VIAL 01/06/2017

TISSU MEGIC MAN C 523 AMS OBAT - BEBAS Rp1.333 Rp2.000 ALKES 01/01/2020

TISSU MEGIC MAN C 523 AMS OBAT - KARYAWAN Rp1.333 Rp2.000 ALKES 01/01/120

TISSU MEGIC MAN C 523 AMS OBAT - OWNER Rp1.333 Rp1.500 ALKES 01/01/2020

TISSU MEGIC MAN C 523 AMS OBAT - STANDAR Rp1.333 Rp2.000 ALKES 01/01/2020

TISSU MEGIC SUPER 522 AMS OBAT - BEBAS Rp1.167 Rp2.000 ALKES 01/10/2017

TISSU MEGIC SUPER 522 AMS OBAT - KARYAWAN Rp1.167 Rp1.500 ALKES 01/10/2017

TISSU MEGIC SUPER 522 AMS OBAT - OWNER Rp1.167 Rp1.500 ALKES 01/10/2017

23 September 2016 Page 43 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
TISSU MEGIC SUPER 522 AMS OBAT - STANDAR Rp1.167 Rp2.000 ALKES 01/10/2017

TOFEDEX TAB 504 APOTIK F TOMENDRA OBAT - BEBAS Rp6.000 Rp7.500 TABLET 01/01/2017

TOFEDEX TAB 504 APOTIK F TOMENDRA OBAT - KARYAWAN Rp6.000 Rp6.600 TABLET 01/01/2017

TOFEDEX TAB 504 APOTIK F TOMENDRA OBAT - OWNER Rp6.000 Rp6.000 TABLET 01/01/2017

TOFEDEX TAB 504 APOTIK F TOMENDRA OBAT - STANDAR Rp6.000 Rp8.000 TABLET 01/01/2017

TOPCILIN 314 TSJ OBAT - BEBAS Rp550 Rp800 TABLET 01/05/2018

TOPCILIN 314 TSJ OBAT - KARYAWAN Rp550 Rp700 TABLET 01/05/2018

TOPCILIN 314 TSJ OBAT - OWNER Rp550 Rp600 TABLET 01/05/2018

TOPCILIN 314 TSJ OBAT - STANDAR Rp550 Rp900 TABLET 01/05/2018

TREMENZA TAB 233 BSP OBAT - BEBAS Rp1.050 Rp1.500 TABLET 01/06/2018

TREMENZA TAB 233 BSP OBAT - KARYAWAN Rp1.050 Rp1.300 TABLET 01/06/2018

TREMENZA TAB 233 BSP OBAT - OWNER Rp1.050 Rp1.200 TABLET 01/06/2018

TREMENZA TAB 233 BSP OBAT - STANDAR Rp1.050 Rp1.500 TABLET 01/06/2018

TRIDEX PLAIN INF 8 BSP OBAT - BEBAS Rp17.650 Rp24.500 INFUS 01/12/2017

TRIDEX PLAIN INF 8 BSP OBAT - KARYAWAN Rp17.650 Rp21.500 INFUS 01/12/2017

TRIDEX PLAIN INF 8 BSP OBAT - OWNER Rp17.650 Rp19.500 INFUS 01/12/2017

TRIDEX PLAIN INF 8 BSP OBAT - STANDAR Rp17.650 Rp25.500 INFUS 01/12/2017

TRIWAY TRUMO 507 PT SI ALKES JAKARTA KARYAWAN Rp12.000 Rp13.000 ALKES

TRIWAY TRUMO 507 PT SI ALKES JAKARTA PASIEN Rp12.000 Rp13.500 ALKES

TRIWAY TRUMO 507 PT SI ALKES OWNER Rp12.000 Rp12.000 ALKES

TRIWAY TRUMO 507 PT SI ALKES STANDAR ALKES

TROGYL SYR 302 MBS OBAT - BEBAS Rp37.000 Rp51.000 SIRUP 01/03/2017

TROGYL SYR 302 MBS OBAT - KARYAWAN Rp37.000 Rp45.000 SIRUP 01/03/2017

TROGYL SYR 302 MBS OBAT - OWNER Rp37.000 Rp41.000 SIRUP 01/03/2017

TROGYL SYR 302 MBS OBAT - STANDAR Rp37.000 Rp53.000 SIRUP 01/03/2017

TROMBOBPHOB OINTMENT 184 TSJ OBAT - BEBAS Rp36.750 Rp50.500 SALEP 01/03/2020

TROMBOBPHOB OINTMENT 184 TSJ OBAT - KARYAWAN Rp36.750 Rp44.500 SALEP 01/03/2020

TROMBOBPHOB OINTMENT 184 TSJ OBAT - OWNER Rp36.750 Rp40.500 SALEP 01/03/2020

TROMBOBPHOB OINTMENT 184 TSJ OBAT - STANDAR Rp36.750 Rp52.500 SALEP 01/03/2020

TROVENSIS INJ 501 BSP OBAT - BEBAS Rp30.550 Rp42.500 AMPUL 01/12/2017

TROVENSIS INJ 501 BSP OBAT - KARYAWAN Rp30.550 Rp37.000 AMPUL 01/12/2017

TROVENSIS INJ 501 BSP OBAT - OWNER Rp30.550 Rp34.000 AMPUL 01/12/2017

TROVENSIS INJ 501 BSP OBAT - STANDAR Rp30.550 Rp44.000 AMPUL 01/12/2017

ULTRAVITA TAB 298 BSP OBAT - BEBAS Rp1.050 Rp1.500 TABLET 01/07/2017

ULTRAVITA TAB 298 BSP OBAT - KARYAWAN Rp1.050 Rp1.300 TABLET 01/07/2017

ULTRAVITA TAB 298 BSP OBAT - OWNER Rp1.050 Rp1.200 TABLET 01/07/2017

ULTRAVITA TAB 298 BSP OBAT - STANDAR Rp1.050 Rp1.500 TABLET 01/07/2017

UNDER PED 435 CITRA MEDICA ALKES 3 Rp2.900 Rp5.000 ALKES

UNDER PED 435 CITRA MEDICA ALKES KARYAWAN2 Rp2.900 Rp3.500 ALKES

UNDER PED 435 CITRA MEDICA ALKES OWNER Rp2.900 Rp3.200 ALKES

UNDER PED 435 CITRA MEDICA ALKES STANDAR ALKES

URESIK TAB 543 BSP OBAT - BEBAS Rp800 Rp1.100 TABLET 01/01/2018

23 September 2016 Page 44 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
URESIK TAB 543 BSP OBAT - KARYAWAN Rp800 Rp1.000 TABLET 01/01/2018

URESIK TAB 543 BSP OBAT - OWNER Rp800 Rp900 TABLET 01/01/2018

URESIK TAB 543 BSP OBAT - STANDAR Rp800 Rp1.200 TABLET 01/01/2018

URIN BAG 386 CITRA MEDICA ALKES 2 Rp3.182 Rp5.000 ALKES

URIN BAG 386 CITRA MEDICA ALKES KARYAWAN2 Rp3.182 Rp4.000 ALKES

URIN BAG 386 CITRA MEDICA ALKES OWNER Rp3.182 Rp3.500 ALKES

URIN BAG 386 CITRA MEDICA ALKES STANDAR ALKES

URINTER CAP 529 APOTIK F TOMENDRA OBAT - BEBAS Rp5.500 Rp6.900 KAPSUL

URINTER CAP 529 APOTIK F TOMENDRA OBAT - KARYAWAN Rp5.500 Rp6.100 KAPSUL

URINTER CAP 529 APOTIK F TOMENDRA OBAT - OWNER Rp5.500 Rp5.500 KAPSUL

URINTER CAP 529 APOTIK F TOMENDRA OBAT - STANDAR Rp5.500 Rp7.200 KAPSUL

UTROGESTAN 100 MG TAB 109 TSJ OBAT - BEBAS Rp8.500 Rp12.000 TABLET 01/05/2017

UTROGESTAN 100 MG TAB 109 TSJ OBAT - KARYAWAN Rp8.500 Rp10.500 TABLET 01/05/2017

UTROGESTAN 100 MG TAB 109 TSJ OBAT - OWNER Rp8.500 Rp9.500 TABLET 01/05/2017

UTROGESTAN 100 MG TAB 109 TSJ OBAT - STANDAR Rp8.500 Rp12.500 TABLET 01/05/2017

UTROGESTAN 200 MG 268 PENTA VALEN OBAT - BEBAS Rp15.947 Rp22.000 KAPSUL 01/05/2017

UTROGESTAN 200 MG 268 PENTA VALEN OBAT - KARYAWAN Rp15.947 Rp19.500 KAPSUL 01/05/2017

UTROGESTAN 200 MG 268 PENTA VALEN OBAT - OWNER Rp15.947 Rp18.000 KAPSUL 01/05/2017

UTROGESTAN 200 MG 268 PENTA VALEN OBAT - STANDAR Rp15.947 Rp23.000 KAPSUL 01/05/2017

VALAMIN INF 157 BSP OBAT - BEBAS Rp63.750 Rp88.000 INFUS 01/07/2017

VALAMIN INF 157 BSP OBAT - KARYAWAN Rp63.750 Rp77.500 INFUS 01/07/2017

VALAMIN INF 157 BSP OBAT - OWNER Rp63.750 Rp70.500 INFUS 01/07/2017

VALAMIN INF 157 BSP OBAT - STANDAR Rp63.750 Rp91.500 INFUS 01/07/2017

VALISANBE INJ 222 BSP OBAT - BEBAS Rp13.100 Rp18.500 AMPUL 01/06/2017

VALISANBE INJ 222 BSP OBAT - KARYAWAN Rp13.100 Rp16.000 AMPUL 01/06/2017

VALISANBE INJ 222 BSP OBAT - OWNER Rp13.100 Rp14.500 AMPUL 01/06/2017

VALISANBE INJ 222 BSP OBAT - STANDAR Rp13.100 Rp19.000 AMPUL 01/06/2017

VALISANBE TAB 221 BSP OBAT - BEBAS Rp160 Rp500 TABLET 01/05/2020

VALISANBE TAB 221 BSP OBAT - KARYAWAN Rp160 Rp200 TABLET 01/05/2020

VALISANBE TAB 221 BSP OBAT - OWNER Rp160 Rp200 TABLET 01/05/2020

VALISANBE TAB 221 BSP OBAT - STANDAR Rp160 Rp500 TABLET 01/05/2020

VAPORIN CAP 295 AMS OBAT - BEBAS Rp4.100 Rp6.000 KAPSUL 01/09/2016

VAPORIN CAP 295 AMS OBAT - KARYAWAN Rp4.100 Rp5.000 KAPSUL 01/09/2016

VAPORIN CAP 295 AMS OBAT - OWNER Rp4.100 Rp4.500 KAPSUL 01/09/2016

VAPORIN CAP 295 AMS OBAT - STANDAR Rp4.100 Rp6.000 KAPSUL 01/09/2016

VEGE BRAND JR CAP 332 AMS OBAT - BEBAS Rp90.000 Rp124.000 KAPSUL 01/10/2016

VEGE BRAND JR CAP 332 AMS OBAT - KARYAWAN Rp90.000 Rp110.000 KAPSUL 01/10/2016

VEGE BRAND JR CAP 332 AMS OBAT - OWNER Rp90.000 Rp99.000 KAPSUL 01/10/2016

VEGE BRAND JR CAP 332 AMS OBAT - STANDAR Rp90.000 Rp129.000 KAPSUL 01/10/2016

VENTOLIN EXP SYR 137 APL OBAT - BEBAS Rp47.355 Rp65.500 SIRUP 01/09/2017

VENTOLIN EXP SYR 137 APL OBAT - KARYAWAN Rp47.355 Rp57.500 SIRUP 01/09/2017

VENTOLIN EXP SYR 137 APL OBAT - OWNER Rp47.355 Rp52.500 SIRUP 01/09/2017

23 September 2016 Page 45 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
VENTOLIN EXP SYR 137 APL OBAT - STANDAR Rp47.355 Rp68.000 SIRUP 01/09/2017

VENTOLIN NEBU 151 APL OBAT - BEBAS Rp8.560 Rp12.000 CAIRAN 01/04/2018

VENTOLIN NEBU 151 APL OBAT - KARYAWAN Rp8.560 Rp10.500 CAIRAN 01/04/2018

VENTOLIN NEBU 151 APL OBAT - OWNER Rp8.560 Rp9.500 CAIRAN 01/04/2018

VENTOLIN NEBU 151 APL OBAT - STANDAR Rp8.560 Rp12.500 CAIRAN 01/04/2018

VENTOLIN TAB 211 APL OBAT - BEBAS Rp2.205 Rp3.500 TABLET 01/03/2018

VENTOLIN TAB 211 APL OBAT - KARYAWAN Rp2.205 Rp2.700 TABLET 01/03/2018

VENTOLIN TAB 211 APL OBAT - OWNER Rp2.205 Rp2.500 TABLET 01/03/2018

VENTOLIN TAB 211 APL OBAT - STANDAR Rp2.205 Rp3.500 TABLET 01/03/2018

VESTEIN CAP 462 ENSEVAL OBAT - BEBAS Rp4.000 Rp5.500 KAPSUL 01/04/2017

VESTEIN CAP 462 ENSEVAL OBAT - KARYAWAN Rp4.000 Rp5.000 KAPSUL 01/04/2017

VESTEIN CAP 462 ENSEVAL OBAT - OWNER Rp4.000 Rp4.500 KAPSUL 01/04/2017

VESTEIN CAP 462 ENSEVAL OBAT - STANDAR Rp4.000 Rp6.000 KAPSUL 01/04/2017

VESTEIN SYR 207 ENSEVAL OBAT - BEBAS Rp35.000 Rp48.500 SIRUP 01/06/2017

VESTEIN SYR 207 ENSEVAL OBAT - KARYAWAN Rp35.000 Rp42.500 SIRUP 01/06/2017

VESTEIN SYR 207 ENSEVAL OBAT - OWNER Rp35.000 Rp38.500 SIRUP 01/06/2017

VESTEIN SYR 207 ENSEVAL OBAT - STANDAR Rp35.000 Rp50.500 SIRUP 01/06/2017

VICE 362 APL OBAT - BEBAS Rp545 Rp800 TABLET 31/08/2016

VICE 362 APL OBAT - KARYAWAN Rp545 Rp700 TABLET 31/08/2016

VICE 362 APL OBAT - OWNER Rp545 Rp600 TABLET 31/08/2016

VICE 362 APL OBAT - STANDAR Rp545 Rp800 TABLET 31/08/2016

VIO EPISIOTOMI 2/0 SASET 450 PT SI ALKES JAKARTA PASIEN Rp96.000 Rp106.000 ALKES

VIO EPISIOTOMI 2/0 SASET 450 PT SI ALKES KARYAWAN1 Rp96.000 Rp101.000 ALKES

VIO EPISIOTOMI 2/0 SASET 450 PT SI ALKES OWNER Rp96.000 Rp96.000 ALKES

VIO EPISIOTOMI 2/0 SASET 450 PT SI ALKES STANDAR ALKES

VIOSTIN DS 363 AMS OBAT - BEBAS Rp5.684 Rp8.000 TABLET 01/06/2017

VIOSTIN DS 363 AMS OBAT - KARYAWAN Rp5.684 Rp7.000 TABLET 01/06/2017

VIOSTIN DS 363 AMS OBAT - OWNER Rp5.684 Rp6.500 TABLET 01/06/2017

VIOSTIN DS 363 AMS OBAT - STANDAR Rp5.684 Rp8.500 TABLET 01/06/2017

VISANCORT CEAM SALEP 115 BSP OBAT - BEBAS Rp7.725 Rp11.000 SALEP 01/10/2020

VISANCORT CEAM SALEP 115 BSP OBAT - KARYAWAN Rp7.725 Rp9.500 SALEP 01/10/2020

VISANCORT CEAM SALEP 115 BSP OBAT - OWNER Rp7.725 Rp8.500 SALEP 01/10/2020

VISANCORT CEAM SALEP 115 BSP OBAT - STANDAR Rp7.725 Rp11.500 SALEP 01/10/2020

VIT C IPI TAB 404 TEMPO OBAT - BEBAS Rp3.450 Rp5.000 TABLET 01/12/2017

VIT C IPI TAB 404 TEMPO OBAT - KARYAWAN Rp3.450 Rp4.500 TABLET 01/12/2017

VIT C IPI TAB 404 TEMPO OBAT - OWNER Rp3.450 Rp4.000 TABLET 01/12/2017

VIT C IPI TAB 404 TEMPO OBAT - STANDAR Rp3.450 Rp5.000 TABLET 01/12/2017

VITACIMIN TAB 253 UDC OBAT - BEBAS Rp562 Rp800 TABLET 01/04/2018

VITACIMIN TAB 253 UDC OBAT - KARYAWAN Rp562 Rp700 TABLET 01/04/2018

VITACIMIN TAB 253 UDC OBAT - OWNER Rp562 Rp700 TABLET 01/04/2018

VITACIMIN TAB 253 UDC OBAT - STANDAR Rp562 Rp800 TABLET 01/04/2018

VITAPLEX SYR 249 UDC OBAT - BEBAS Rp32.375 Rp45.000 SIRUP 01/07/2017

23 September 2016 Page 46 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
VITAPLEX SYR 249 UDC OBAT - KARYAWAN Rp32.375 Rp39.500 SIRUP 01/07/2017

VITAPLEX SYR 249 UDC OBAT - OWNER Rp32.375 Rp36.000 SIRUP 01/07/2017

VITAPLEX SYR 249 UDC OBAT - STANDAR Rp32.375 Rp46.500 SIRUP 01/07/2017

VOLTAREN 20 G SALEP 359 TSJ OBAT - BEBAS Rp40.700 Rp56.000 SALEP 01/06/2016

VOLTAREN 20 G SALEP 359 TSJ OBAT - KARYAWAN Rp40.700 Rp49.500 SALEP 01/06/2016

VOLTAREN 20 G SALEP 359 TSJ OBAT - OWNER Rp40.700 Rp45.000 SALEP 01/06/2016

VOLTAREN 20 G SALEP 359 TSJ OBAT - STANDAR Rp40.700 Rp58.500 SALEP 01/06/2016

VOMILAT 132 ENSEVAL OBAT - BEBAS Rp833 Rp1.200 TABLET 01/03/2017

VOMILAT 132 ENSEVAL OBAT - KARYAWAN Rp833 Rp1.000 TABLET 01/03/2017

VOMILAT 132 ENSEVAL OBAT - OWNER Rp833 Rp1.000 TABLET 01/03/2017

VOMILAT 132 ENSEVAL OBAT - STANDAR Rp833 Rp1.200 TABLET 01/03/2017

VOMINA TAB 138 TSJ OBAT - BEBAS Rp650 Rp900 TABLET 01/06/2018

VOMINA TAB 138 TSJ OBAT - KARYAWAN Rp650 Rp800 TABLET 01/06/2018

VOMINA TAB 138 TSJ OBAT - OWNER Rp650 Rp800 TABLET 01/06/2018

VOMINA TAB 138 TSJ OBAT - STANDAR Rp650 Rp1.000 TABLET 01/06/2018

VOMITAS 25 ENSEVAL OBAT - BEBAS Rp3.334 Rp4.600 TABLET 01/10/2017

VOMITAS 25 ENSEVAL OBAT - KARYAWAN Rp3.334 Rp4.100 TABLET 01/10/2017

VOMITAS 25 ENSEVAL OBAT - OWNER Rp3.334 Rp3.700 TABLET 01/10/2017

VOMITAS 25 ENSEVAL OBAT - STANDAR Rp3.334 Rp4.800 TABLET 01/10/2017

VOMITAS FDT 530 ENSEVAL OBAT - BEBAS Rp3.700 Rp5.100 TABLET 01/01/2018

VOMITAS FDT 530 ENSEVAL OBAT - KARYAWAN Rp3.700 Rp4.500 TABLET 01/01/2018

VOMITAS FDT 530 ENSEVAL OBAT - OWNER Rp3.700 Rp4.100 TABLET 01/01/2018

VOMITAS FDT 530 ENSEVAL OBAT - STANDAR Rp3.700 Rp5.300 TABLET 01/01/2018

VOSEDON SYR 85 BSP OBAT - BEBAS Rp26.300 Rp36.500 SIRUP 04/06/2018

VOSEDON SYR 85 BSP OBAT - KARYAWAN Rp26.300 Rp32.000 SIRUP 04/06/2018

VOSEDON SYR 85 BSP OBAT - OWNER Rp26.300 Rp29.000 SIRUP 04/06/2018

VOSEDON SYR 85 BSP OBAT - STANDAR Rp26.300 Rp38.000 SIRUP 04/06/2018

VOSTEM FORTE TAB 502 APOTIK F TOMENDRA OBAT - BEBAS Rp6.000 Rp7.500 TABLET 01/01/2018

VOSTEM FORTE TAB 502 APOTIK F TOMENDRA OBAT - KARYAWAN Rp6.000 Rp6.600 TABLET 01/01/2018

VOSTEM FORTE TAB 502 APOTIK F TOMENDRA OBAT - OWNER Rp6.000 Rp6.000 TABLET 01/01/2018

VOSTEM FORTE TAB 502 APOTIK F TOMENDRA OBAT - STANDAR Rp6.000 Rp8.000 TABLET 01/01/2018

VOSTRIN SYR 287 AMS OBAT - BEBAS Rp30.000 Rp41.500 SIRUP 01/11/2016

VOSTRIN SYR 287 AMS OBAT - KARYAWAN Rp30.000 Rp36.500 SIRUP 01/11/2016

VOSTRIN SYR 287 AMS OBAT - OWNER Rp30.000 Rp33.000 SIRUP 01/11/2016

VOSTRIN SYR 287 AMS OBAT - STANDAR Rp30.000 Rp43.000 SIRUP 01/11/2016

VYCRYIL SASET 449 PT SI ALKES 5 Rp115.200 Rp127.000 ALKES

VYCRYIL SASET 449 PT SI ALKES KARYAWAN1 Rp115.200 Rp121.000 ALKES

VYCRYIL SASET 449 PT SI ALKES STANDAR ALKES

VYCRYIL SASET 449 PT SI OBAT - OWNER Rp115.200 Rp115.500 ALKES

WOMEN COIS 74 DOSNI OBAT - BEBAS Rp16.000 Rp22.000 ALKES 01/06/2018

WOMEN COIS 74 DOSNI OBAT - KARYAWAN Rp16.000 Rp19.500 ALKES 01/06/2018

WOMEN COIS 74 DOSNI OBAT - OWNER Rp16.000 Rp18.000 ALKES 01/06/2018

23 September 2016 Page 47 of 48


NAMA OBAT KODE OBAT NAMA VENDOR TARGET HARGA BELI HARGA JUAL SATUAN EXPIRED
WOMEN COIS 74 DOSNI OBAT - STANDAR Rp16.000 Rp23.000 ALKES 01/06/2018

YASMIN TAB 143 DOSNI OBAT - BEBAS Rp161.000 Rp221.500 TABLET 01/11/2017

YASMIN TAB 143 DOSNI OBAT - KARYAWAN Rp161.000 Rp195.000 TABLET 01/11/2017

YASMIN TAB 143 DOSNI OBAT - OWNER Rp161.000 Rp177.500 TABLET 01/11/2017

YASMIN TAB 143 DOSNI OBAT - STANDAR Rp161.000 Rp230.500 TABLET 01/11/2017

ZAMEL DROP 42 AMS OBAT - BEBAS Rp30.000 Rp41.500 SIRUP 01/07/2017

ZAMEL DROP 42 AMS OBAT - KARYAWAN Rp30.000 Rp36.500 SIRUP 01/07/2017

ZAMEL DROP 42 AMS OBAT - OWNER Rp30.000 Rp33.000 SIRUP 01/07/2017

ZAMEL DROP 42 AMS OBAT - STANDAR Rp30.000 Rp43.000 SIRUP 01/07/2017

ZAMEL SYR 104 AMS OBAT - BEBAS Rp30.000 Rp41.500 SIRUP 01/10/2016

ZAMEL SYR 104 AMS OBAT - KARYAWAN Rp30.000 Rp36.500 SIRUP 01/10/2016

ZAMEL SYR 104 AMS OBAT - OWNER Rp30.000 Rp33.000 SIRUP 01/10/2016

ZAMEL SYR 104 AMS OBAT - STANDAR Rp30.000 Rp43.000 SIRUP 01/10/2016

ZEGAS TAB 149 ENSEVAL OBAT - BEBAS Rp2.300 Rp3.100 TABLET 01/10/2018

ZEGAS TAB 149 ENSEVAL OBAT - KARYAWAN Rp2.300 Rp2.800 TABLET 01/10/2018

ZEGAS TAB 149 ENSEVAL OBAT - OWNER Rp2.300 Rp2.600 TABLET 01/10/2018

ZEGAS TAB 149 ENSEVAL OBAT - STANDAR Rp2.300 Rp3.300 TABLET 01/10/2018

23 September 2016 Page 48 of 48

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