FORMAT LAPORAN KELUHAN KETERSEDIAAN OBAT

KEPEMILIKAN ACCOUNT E-
MONEV

No. Divre KC JENIS FASKES NAMA FASKES

YA

1 2 3 4 5 6
1 IV CIKARANG FKRTL RS ANNISA (JST)

2 IV CIKARANG FKRTL RS BHAKTI HUSADA (JST)

3 IV CIKARANG FKRTL RS HOSANA MEDICA LIPPO (JST)

4 IV CIKARANG FKRTL RS KARTIKA HUSADA

5 IV CIKARANG FKRTL RS KARYA MEDIKA (JST)

6 IV CIKARANG FKRTL RS MITRA MEDIKA
7 IV CIKARANG FKRTL RS Asri Medika
8 IV CIKARANG FKRTL RS AMANDA (JST)
9 IV CIKARANG FKRTL RS CIKARANG MEDIKA (JST)
10 IV CIKARANG FKRTL RS CIBITUNG MEDIKA (JST)
11 IV CIKARANG FKRTL RS TIARA BEKASI (JST)
12 IV CIKARANG FKRTL RS HARAPAN MULIA (JST)
13 IV CIKARANG FKRTL RS MEDIROSSA 2
14 IV CIKARANG FKRTL RS HERMINA GRAND WISATA
15 IV CIKARANG FKRTL Siloam Hospital Lippo Cikarang
 16 IV CIKARANG FKRTL kartika husada setu
17 IV CIKARANG FKRTL RS Ridhoka Salma
18 IV CIKARANG FKRTL RS OMNI CIKARANG
19 IV CIKARANG FKRTL RS BUNDA MULIA
20 IV CIKARANG FKRTL RS Amanda Cikarang
21 IV CIKARANG FKRTL RS Hosana Cikarang Baru
22 IV CIKARANG FKRTL RS Multazam Medika
23 IV CIKARANG FKRTL RS KARYA MEDIKA 2
24 IV CIKARANG FKRTL RS SENTRA MEDIKA (JST)
25 IV CIKARANG FKRTL RSUD KAB BEKASI
26 IV CIKARANG FKRTL RS MEDIROSA BEKASI

Keterangan:
1 Nomor Urut
2 Nama Divre
3 Nama Kantor Cabang
4 Jenis Faskes, apakah Faskes termasuk FKTP, FKRTL atau Apotek
5 Nama Faskes
6 Kepemilikan account e-Monev, apakah Faskes sudah melakukan registrasi
7 Nama Obat (Generik, Sediaan dan Kekuatan)
8 Akar Permasalahan Obat (agar di ceklist)
PEMILIKAN ACCOUNT E- Akar Permasalahan Ketersediaan Obat
MONEV

NAMA OBAT Harga tidak

TIDAK Kosong Pabrik Kosong sesuai e-
Distributor katalog

7 8
Obat A (contoh)
Obat B

V SUCRALFAT SYR 100 ML V

V NOVORAPID Flex Pen V
V DOPAMET 250 MG TAB V
V PROVERA 100 MG TAB V
V CEFTRIAXONE 1 GR INJ V
V INH 100 MG TAB V
V INH 300 MG TAB V
V DEKSAMETASON INJ V
V DEXTROSE 5% 500 ML V
V GENTAMYCIN INJ V
V FUROSEMID INJ V
V ONDANSENTRON 4 MG TAB V
V ONDANSENTRON 4 MG TAB V
V ANTASIDA SYR V
V PHENOBARBITAL 30 MG TAB V
at
Jumlah obat
Account di-lock Pengiriman yang dikirim
oleh tidak sesuai Lainnya
terlambat
distributor dengan Surat
Pesanan

8
FASKES MILIK SWASTA YANG SUDAH MENYAMPAIKAN RENCANA KEBUTUHAN OBAT SECARA ONLINE melalui web
PERIODE APRIL - DESEMBER 2017

NO NAMA KC NAMA FKRTL WAKTU PENYAMPAIAN DATA

1 CIKARANG RS AMANDA (JST) 01 November 2016

2 CIKARANG RS ANNISA (JST)
3 CIKARANG RS BHAKTI HUSADA (JST)
4 CIKARANG RS CIBITUNG MEDIKA (JST)
5 CIKARANG RS ASRI MEDIKA
6 CIKARANG RS HOSANA MEDICA LIPPO (JST)
7 CIKARANG RS KARTIKA HUSADA
8 CIKARANG RS KARYA MEDIKA (JST)
9 CIKARANG RS MEDIROSA BEKASI
10 CIKARANG RS MITRA MEDIKA
11 CIKARANG RS SENTRA MEDIKA (JST)
12 CIKARANG RS TIARA BEKASI (JST)
13 CIKARANG RS CIKARANG MEDIKA
14 CIKARANG RS HARAPAN MULIA
15 CIKARANG RSUD KAB BEKASI
16 CIKARANG RS HERMINA GRAND WISATA
17 CIKARANG RS SILOAM LIPPO CIKARANG
18 CIKARANG RS MEDIROSA CIBARUSAH
19 CIKARANG RS KARTIKA HUSADA SETU
20 CIKARANG RS RIDHOKA SALMA
21 CIKARANG RS OMNI CIKARANG
22 CIKARANG RS Bunda Mulia
23 CIKARANG RS AMANDA CIKARANG
24 CIKARANG RS HOSANA CIKARANG BARU
25 CIKARANG RS MULTAZAM MEDIKA
26 CIKARANG RS KARYA MEDIKA 2

Ket: waktu penyampaian data diisi tanggal pelaporan Rencana Kebutuhan Obat secara online melalui website http://monevk
Jika belum melakukan pelaporan maka diisi "belum melaporkan"
BAT SECARA ONLINE melalui website KEMENKES http://monevkatalogobat.kemkes.go.id

online melalui website http://monevkatalogobat.kemkes.go.id

 1 Adefovir dipivoksil tab 10 mg 2,000
2 Air untuk injeksi amp 25 ml 1,879,200
3 Air untuk irigasi lar inf 1000 ml 4,500
4 Akarbose tab 100 mg 737,320
5 Akarbose tab 50 mg 1,062,351
6 Albendazol susp 200 mg/5 ml 1,530
7 Albendazol tab 400 mg 12,844,389

8 Albumin serum normal (human albumin) inj 20% 100 ml 28,823

9 Albumin serum normal (human albumin) inj 20% 50 ml 3,512

10 Albumin serum normal (human albumin) inj 25% 100 ml 20,281

11 Albumin serum normal (human albumin) inj 25% 20 ml 1,000

12 Albumin serum normal (human albumin) inj 25% 50 ml 3,522

13 Albumin serum normal (human albumin) inj 5% 250 ml 510

14 Albumin serum normal (human albumin) inj 5% 50 ml 1,000

15 Alprazolam tab 0,25 mg 223,620
16 Alprazolam tab 0,5 mg 17,500,000
17 Alprazolam tab 1 mg 8,000,000
18 Alteplase serb inj 50 mg/vial 102
19 Amikasin inj 250 mg/ml 14,585
20 Amlodipin tab 10 mg 3,665,796
21 Amoksisilin sir forte 250 mg/5 ml 1,112,518
22 Amoksisilin sir kering 125 mg/5 ml 20,932,000
23 Amoksisilin tab 250 mg 4,000,000
24 Amoksisilin tab 500 mg 39,736,215
Analog insulin : fast acting inj 100 UI/ml (kemasan vial,
25 cartridge disposible, penfil cartridge) 2,817,150
26 Analog insulin : long acting (inj 100 UI/ml ) 66,240
27 Analog insulin : long acting (inj 100 UI/ml) 2,200,000
28 Analog insulin : mix insulin (inj 100 UI/ml) 2,800,000
29 Anastrozol tab 1 mg 45,751
Antasida, kombinasi : aluminium hidroksida 200 mg +
30 magnesium hidroksida 200 mg 29,826,700
Antifungi salep, kombinasi : asam benzoat 6%+ asam
31 salisilat 3% 212,400

Antihemoroid, kombinasi: bismut subgalat 150 mg +

heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng
32 oksida 120 mg + sup ad 2 g 234,781
33 Artemether inj 80 mg/ml 1,816
34 Asam asetilsalisilat (asetosal) tab 100 mg 4,089,367
35 Asam asetilsalisilat (asetosal) tab 80 mg 77,500,000
36 Asam askorbat (vitamin C) tab 250 mg 29,000,000
37 Asam askorbat (vitamin C) tab 50 mg 666,570,068
38 Asam ibandronat inj 1 mg/ml 390
39 Asam mefenamat kaps 250 mg 200,000,000
40 Asam mefenamat kaps 500 mg 300,000,000
41 Asam pipemidat kaps 400 mg 4,500,198,197
42 Asam traneksamat inj 100 mg/ml 206,717
43 Asam traneksamat inj 50 mg/ml 286,095
44 Asam ursodeoksikolat kaps 250 mg 108,975
45 Asiklovir tab 200 mg 676,161
46 Asiklovir tab 400 mg 696,184
47 Asparaginase serb inj 10.000 UI/vial 608
48 Atapulgit 600 mg 783,532
49 Atenolol tab 100 mg 22,792
50 Atrakurium inj 25 mg/2,5 ml 41,667
51 Azatioprin tab 50 mg 2,000
52 Azitromisin tab 250 mg 10,410
53 Azitromisin tab 500 mg 214,160
54 Beraprost sodium tab 20 mcg 90,184
55 Betahistin tab 6 mg 24,500,000
56 Bevasizumab inj 25 mg/ml 1,306
57 Bikalutamid tab sal 150 mg 436
58 Bikalutamid tab sal 50 mg 23,420
59 Bisakodil sup 10 mg 62,092
60 Bisakodil sup 5 mg 15,113
61 Bisoprolol tab 2,5 mg 9,000,000
62 Bisoprolol tab 5 mg 3,293,390
63 Bleomisin serb inj 15 mg/ml 1,909
64 Budesonid cairan ih 0,25mg/ml 24,333
65 Budesonid ih 200 mcg/dosis 107,968
Budesonid-formoterol (fixed combination)* ih 160/4,5
66 mcg 3,682
Budesonid-formoterol (fixed combination)* ih 80/4,5
67 mcg 1,946
68 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% 13,365
69 Dabigatran eteksilat kaps 110 mg 2,410
70 Dabigatran eteksilat kaps 75 mg 340
71 Dakarbazin serb inj 200 mg/vial 2,650
72 Deferipron lar oral 100 mg/ml 1,080
73 Deferipron tab sal 500 mg 298
74 Desoksimetason krim 0,25% 14,368
75 Desoksimetason salep 0,25% 4,321
76 Diazepam lar rektal 10 mg/2,5 ml 6,981
 77 Diazepam lar rektal 5 mg/2,5 ml 12,727
78 Diazepam tab 5 mg 785,128
79 Dietilkarbamazin tab 100 mg 3,514,894
80 Difenhidramin inj 10 mg/ml (i.v./i.m.) 162,034
81 Diflukortolon valerat salep berlemak 0,1% 2,000,032
82 Diltiazem hcl tab 30 mg 113,112
83 Diltiazem kaps SR 100 mg 209,771
84 Diltiazem kaps SR 200 mg 129,480
85 Diltiazem serb inj 50 mg/vial 3,559
86 Dinatrium klodronat inj 60 mg/ml 2,310
87 Doksisiklin kaps 100 mg 453,537
88 Doksisiklin kaps 50 mg 7,570
89 Doksorubisin serb inj 10 mg/vial (i.v.) 39,283
90 Doksorubisin serb inj 50 mg/vial 25,168
91 Domperidon susp 5 mg/5 ml 49,000
92 Domperidon tab 10 mg 3,641,187
93 Donepezil tab 5 mg 58,319
94 Donepezil tab eff 10 mg 84,000
95 Dosetaksel inj 20 mg/0,5 ml 11,957
96 Dosetaksel inj 40 mg/ml 3,691
DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg
97 pentetate calcium trisodium/ml 30
98 Dutasterid kaps 0,5 mg 150,000
99 Efavirens tab sal 600 mg 338,262
100 Enoksaparin sodium inj 20 mg/0,2 ml 3,296
101 Enoksaparin sodium inj 40 mg/0,4 ml 7,692
102 Enoksaparin sodium inj 60 mg/0,6 ml 24,938
103 Epirubisin serb inj 2 mg/ml 2,905
104 Epirubisin serb inj 50 mg 4,172
105 Eritromisin kaps 250 mg 972,035
106 Eritromisin sir 200 mg/5 ml 39,399
107 Eritropoetin-alfa inj 10.000 UI/ml 15
108 Eritropoetin-alfa inj 2.000 UI/ml 14,702
109 Eritropoetin-alfa inj 3.000 UI/ml 39,221
110 Eritropoetin-beta inj 2000 UI/0,3 ml 6,526
111 Estrogen terkonjugasi tab sal 0,625 mg 500
112 Etanol 70% cairan 70% 63,000
113 Etoposid inj 20 mg/ml 3,948
114 Eugenol 2,966
115 Everolimus tab 0,25 mg 0
116 Everolimus tab 0,5 mg 0
117 Faktor IX kompleks serb inj 500 UI/vial + pelarut 1,770

Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI,

faktor koagulasi IX 25 UI, faktor koagulasi X 14-35 serb
118 inj 500 UI/10 ml UI 75
119 Faktor VIII (konsentrat) serb inj 230 -340 UI 7,677
Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5
120 ml 7,230
121 Faktor VIII (konsentrat) serb inj 480 - 600 UI 8,668
Faktor VIII (konsentrat) serb inj 500 UI/vial + pelarut 5
122 ml 9,304
123 Faktor VIII serb inj 1000 mg/vial 3,760
124 Fenitoin Na inj 50 mg/ml 1,000,000
125 Fenofibrat kaps 100 mg 8,062
126 Fenofibrat kaps 300 mg 5,405
127 Fenoksimetil penisilin (penisilin V) tab 125 mg 1,300
128 Fenoterol hbr aerosol 100 mcg/puff 6,731
129 Fenoterol hbr cairan ih 0,1% 1,150
130 Fentanil inj 0,05 mg/ml (i.v.) 0
131 Fentanil patch 12,5 mcg/jam 2,504
132 Fentanil patch 25 mcg/jam 3,589
133 Fentanil patch 50 mcg/jam 796
134 Filgrastim inj 300 mcg/ml 2,188
135 Finasterid tab 5 mg 38,000,511
136 Fludarabin inj 50 mg/vial 15
137 Fludarabin tab sal 10 mg 400
138 Flufenazin inj 25 mg/ml (i.m.) 500,000
139 Flukonazol inj 2 mg/ml 5
140 Flukonazol kaps 150 mg 233,854
141 Fluorourasil inj 50 mg/ml (i.v.) 61,303
142 Flusinolon asetonid krim 0,025% 17,846
143 Flutikason furoat intranasal spray 40,000
144 Flutikason propionat cairan ih 0,5 mg/dosis 100,000
145 Fondaparinuks inj 2,5 mg/0,5 ml 50,000
146 Fraksi protein plasma lar inf 5% 86,428
147 Furosemid inj 10 mg/ml (i.v./i.m.) 824,455
148 Gabapentin kaps 100 mg 191,800
149 Gabapentin kaps 300 mg 6,000,000
150 Gadobutrol macrocyclic 30
151 Gansiklovir serb inj 500 mg/vial 270
152 Gefitinib tab 250 mg 7,600
153 Gemfibrozil kaps 600 mg 4,520
154 Gemsitabin inj 1000 mg/vial 6,598
155 Gemsitabin inj 200 mg/vial 10,446
156 Gentamisin inj 40 mg/ml 173,186
157 Gentamisin salep mata 0,3% 14,900
158 Gentamisin tts mata 0,3% 51,100
159 Gliklazid tab 80 mg 238,900
160 Glikuidon tab 30 mg 411,088
161 Glimepirid tab 2 mg 1,923,128
162 Glimepirid tab 3 mg 8,000,000
163 Glimepirid tab 4 mg 7,000,000
164 Gliseril trinitrat inj 50 mg/ml 500
165 Gliseril trinitrat kaps lepas lambat 2,5 mg 367,132
166 Gliseril trinitrat kaps lepas lambat 5 mg 69,310
167 Gliseril trinitrat tab 0,5 mg 50,670
168 Gliserin lar 50% 1,099
169 Glukosa Larutan Infus 10% steril 500 ml 188,200
170 Glukosa Larutan Infus 5% steril 100 ml 33,343
171 Glukosa Larutan Infus 5% steril 500 ml 727,000
172 Goserelin asetat inj 10,8 mg/vial 296
173 Goserelin asetat inj 3,6 mg/vial 490
174 Haloperidol inj 5 mg/ml (i.m.) 2,700,000
175 Haloperidol inj 50 mg/ml (decanoat) 598
176 Haloperidol tab 0,5 mg 1,018,426
177 Haloperidol tab 1,5 mg 3,827,950
178 Haloperidol tab 2 mg 3,100,000
179 Haloperidol tab 5 mg 37,000,000
180 Haloperidol tts 2 mg/ml 50,000
181 Halotan ih 265,712
182 Hepatitis B imunoglobulin (human) inj 0,5 ml 2,000
183 Hidroklorotiazid tab 25 mg 2,569,293
184 Hidrokortison krim 1% 6,666
185 Hidrokortison krim 2,5% 728,359
186 Hidroksi urea tab 500 mg 100,000
Human insulin : fast acting inj 100 UI/ml (kemasan
187 cartridge, penfill cartridge) 120,000

Human insulin : intermediate acting inj 100 UI/ml

188 (kemasan vial/ cartridge disposible, penfill cartridge) 120,000
189 Human tetanus imunoglobulin inj 250 UI (i.m.) 10,153
190 Ibuprofen tab 200 mg 4,300,000
191 Ibuprofen tab 400 mg 9,523,014
192 Imidapril tab 10 mg 53,911
193 Imidapril tab 5 mg 86,410
Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS
194 (Guillain Bare Syndrom) 195
195 Indakaterol serb ih 150 mcg 0
196 Indakaterol serb ih 300 mcg 0
197 Iopromid 240 -370 mg Iodium/ml 2,346
198 Iopromid 300-370 mg Iodium/ml 2,346
199 Ipratropium bromida ih 20mcg/puff 45
200 Ipratropium bromida nebulizer 0,025% 33,861
201 Irbesartan tab 150 mg 7,500,000
202 Irbesartan tab 300 mg 8,000,000
203 Irinotekan inj 20 mg/ml 1,145
204 Isoniazid tab 100 mg 2,180,778
205 Isoniazid tab 300 mg 2,184,045
206 Kalium aspartat tab 300 mg 2,500,000
207 Kalium klorida tab SR 600 mg 12,000,000
208 Kalsium laktat (kalk) tab 500 mg 750,000,000
209 Kalsium polistirena sulfonat ktg 5 g 17,349
210 Kandesartan tab 16 mg 475,501
211 Kandesartan tab 8 mg 330,173
212 Kapesitabin tab sal 500 mg 87,480
213 Kaptopril tab 50 mg 9,381,320
214 Karbamazepin Tab 200 mg 28,000,000
215 Karbogliserin tts telinga 10 % 31,706
216 Karboplatin inj 150 mg/15 ml 10,754
217 Karboplatin inj 450 mg/45 ml 7,398
218 Ketamin inj 50 mg/ml (i.v.) 2,891
219 Ketokonazol krim 2% 44,871
220 Ketokonazol scalp sol 2% 659,000
221 Ketokonazol tab 200 mg 1,100,000
222 Ketoprofen sup 100 mg 2,000,000
223 Klaritromisin tab 500 mg 35,114
224 Klindamisin kaps 300 mg 15,500,000
225 Klobazam tab 10 mg 565,501
226 Klomifen sitrat tab 50 mg 640
227 Klonazepam kaps 2 mg 6,000,000
228 Klonidin inj 150 mcg/ml 4,996
229 Klonidin tab 0,15 mg 227,080
230 Klopidogrel tab 75 mg 25,000,000
231 Kloramfenikol kaps 250 mg 3,990,097
232 Kloramfenikol kaps 500 mg 4,452
233 Kloramfenikol salep kulit 2% 347,248
234 Kloramfenikol salep mata 1% 291,544
235 Kloramfenikol serb inj 1.000 mg/ml 12,916
236 Kloramfenikol susp 125 mg/5 ml 88,306
237 Klorfeniramin tab 4 mg 29,000,000
238 Klorpromazin tab sal 100 mg 50,000,000
239 Klozapin tab 100 mg 7,500,000
240 Klozapin tab 25 mg 16,000,000
241 Kodein tab 10 mg 685,307
242 Kodein tab 15 mg 52,800
243 Kodein tab 20 mg 191,661
244 Koloid HES BM 130 000 lar inf 6% 593,933
Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin
245 320 mg tab sal selaput 4,500,000
 Kombinasi : levodopa 100 mg+Karbidopa 25 mg +
246 entekapon 200 mg 0
Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30
247 mcg 818
248 Kombinasi : zidovudin 300 mg +lamivudin 150 mg 89,133
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg
249 nebules 288,867
Kombinasi: natrium klorida 8,664 mg + kalium klorida
250 1,32 mg (tetes mata) 50,000
Kombinasi: salmeterol 25 mcg + flutikason propionat 50
251 mcg ih 50 mcg/puff 50,000
Kombinasi: salmeterol 50 mcg +flutikason propionat 100
252 mcg ih 50 mcg/puff 25,000
Kombinasi: salmeterol 50 mcg+ flutikason propionat 250
253 mcg ih 250 mcg/puff 5,000
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400
254 mg+ trimetoprim 80 mg 4,500,000
255 Kuinin tab 222 mg 76,942
256 Lamivudin (3TC) tab 150 mg 65,775
257 Lansoprazol inj 30 mg/ml 400,000
258 Lansoprazol kaps 30 mg 1,871,166
Larutan mengandung Asam Amino (Asam Amino 100 g,
259 Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq) 1,700
Larutan mengandung Asam Amino (Asam Amino 27 g,
260 Sorbitol 50 g, Cl-52 mEq) 7,100
Larutan mengandung Asam Amino (Asam Amino 30 g,
261 Glukosa 7,3 % dan elektrolit) 1000 ml 40,600
Larutan mengandung Asam Amino (Asam Amino 30 g,
262 Glukosa 7,3 % dan elektrolit) 500 ml 40,600

Larutan mengandung Asam Amino (Asam Amino 5%

dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L,
263 Sorbitol 50 gr/L, Xylitol 50 gr/L) 5,503

Larutan mengandung Asam Amino (Asam Amino 6%,

264 mengandung Taurine 0,24 gr/l) : Aminosteril Infant 6% 77,265

Larutan mengandung Asam Amino (Asam Amino 7%,

Komposisi: Asam Amino esensial: Asam Amino non
265 esensial = 60 : 40) 105,565

Larutan mengandung Asam Amino (Asam Amino 72.05

g, Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq,
266 Asetat 46 mEq) 28,300
Larutan mengandung Asam Amino (Asam Amino 79.9 g,
267 Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq) 4,800
Larutan mengandung Asam Amino (Asam amino 8%) :
268 Aminosteril N-Hepa 7,875
 Larutan mengandung Asam Amino (Kombinasi Asam
269 amino 50 g/L, vitamin dan elektrolit) 2,353

Larutan mengandung Asam Amino (Kombinasi Asam

Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan Elektrolit
270 (Kalori = 1000 kkal, Akses peripheral)) 57,060

Larutan mengandung Asam Amino (Kombinasi Asam

Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan Elektrolit
271 (Kalori = 1400 kkal, Akses peripheral)) 21,246
Larutan mengandung Asam Amino (Kombinasi Glukosa
272 dan elektrolit 80 gr + Asam Amino 40 gr) 1,069
273 Larutan mengandung Elektrolit (Kalium Klorida) 89,900
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109
274 mEq, Ca 3 mEq, Asetat 28 mEq) 703,900
Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa
275 18.75 gr) 96,100

Larutan mengandung Elektrolit (Sodium Lactate sol

(50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium
276 Chloride 0.2 gr/L, elektrolit) 419
Larutan mengandung Karbohidrat (Fructose 120 g,
277 glucose 66 g, Xylitol 60 g/ L + elektrolit) 494
Larutan mengandung Karbohidrat (Fructose 60 g,
278 glucose 33 g, Xylitol 30 g/ L) 5,992
279 Larutan mengandung Karbohidrat (Maltose 100 gr) 28,400

Larutan mengandung Karbohidrat + Elektrolit (25.00g

maltose, 3.00 g sodium chloride, 0.15 g potassium
chloride, 0.10 g calcium chloride dihydrate dan 1.55 g
280 sodium lactate) 118,991
Larutan mengandung Karbohidrat + Elektrolit (Acetate,
281 Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) 6,077

Larutan mengandung Karbohidrat + Elektrolit (Glukosa

55 g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml)
282 (D5-NS) 900
Larutan mengandung Karbohidrat + Elektrolit (Glukosa:
283 25,0 g; NaCl: 4,5 g) 379,400
Larutan mengandung Karbohidrat + Elektrolit (Glukosa:
284 55.0 g; NaCl: 2.25 g) 129,053
Larutan mengandung Karbohidrat + Elektrolit (Glukosa:
285 55.0 g; NaCl: 4.5 g) 24,176

Larutan mengandung Karbohidrat + Elektrolit (Larutan

nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca.
4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol
286 50g) 25,456
Larutan mengandung Karbohidrat + Elektrolit (Larutan
287 Ringer & Glukosa 5%) 8,690
 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75
288 g, KCL 1.5g, Glukosa 100 gr) 9,600

Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75

gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN
289 3B) 213,320

Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34

gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN
290 3A) 15,400
Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT
291 20% 100 ml) 10,393
Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT
292 20% 250 ml) 14,050

Larutan mengandung Lipid (Kombinasi Glukosa dan

elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr dgn
293 akses sentral) 50
294 Latanoprost tts mata 0,01% 50,000
295 Lenograstim inj 263 mcg/vial 34
296 Letrozol tab 2,5 mg 105,106
297 Leuprorelin asetat serb inj 1,88 mg 10,000
298 Leuprorelin asetat serb inj 11,25 mg 12,000
299 Leuprorelin asetat serb inj 3,75 mg 12,000
300 Levofloksasin inf 5 mg/ml 67,776
301 Levofloksasin tts mata 0,5% 2,200
302 Levotiroksin tab 100 mcg 1,500,000
303 Levotiroksin tab 50 mcg 1,000,000
304 Lidokain gel 2% 31,200
305 Lidokain inj 2% (hcl) 547,965
306 Lisinopril tab 10 mg 346,887
307 Lisinopril tab 5 mg 252,590
308 Loperamid tab 2 mg 984,068
309 Lorazepam tab 0,5 mg 24,400
310 Lorazepam tab 1 mg 5,116
311 Lorazepam tab sal 2 mg 32,746
312 Low molecule feri sucrose inj amp 100 mg/5 ml 829
313 Magnesium sulfat inj 20% 46,400
314 Magnesium sulfat inj 40% 64,600
315 Manitol lar infus 20% 18,959
316 Maprotilin hcl tab sal 50 mg 500,000
MDP (methylene diphosphonate) 1 mg methylene
317 diphosphonic acid/ml 30
318 Mebendazol tab 500 mg 2,033
319 Medroksi progesteron asetat inj 150 mg/ml 1,326,440
320 Meropenem serb inj 500 mg/vial 23,939
321 Metadon sir 50 mg/5 ml 1,314
322 Metformin tab 500 mg 130,000,000
323 Metformin tab 850 mg 18,000,000
324 Metildopa tab sal 250 mg 307,650
325 Metilfenidat tab SR 10 mg 1,000,000
326 Metilfenidat tab SR 20 mg 0
327 Metilprednisolon tab 16 mg 1,233,585
328 Metilprednisolon tab 8 mg 736,648
329 Metoklopramid sir 5 mg/5 ml 32,311
330 Metoklopramid tab 10 mg 1,114,276
331 Metoklopramid tab 5 mg 253,677
332 Metotreksat serb inj 25 mg/ml 8,861
333 Metronidazol ovula 500 mg 10,704
334 Metronidazol tab 250 mg 459,738
335 Metronidazol tab 500 mg 2,824,800
336 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial 30
337 Midazolam inj 1 mg/ml (i.v.) 18,172
338 Midazolam inj 5 mg/ml (i.v.) 29,356
339 Mikafungin Na serb inj 50 mg/vial 1,500
340 Mikonazol krim 2% 317,749
341 Moksifloksasin inf 1,6 mg/mL 360
342 Moksifloksasin tab 400 mg 21,500
343 Moksifloksasin tts mata 0,5% 7,600
344 Mometason furoat krim 0,1% 500,000
345 Morfin Hcl tab 10 mg 16,284
346 Morfin Hcl tab SR 15 mg 360
347 N-asetil sistein ih 100 mg/ml 200,000
348 N-asetil sistein kaps 200 mg 202,918
349 NaCl 0,9% Larutan 2,442,900
350 Natrium bikarbonat inj 8,4% (i.v.) 25,300
351 Natrium fosfat btl, 133 ml 5,828
352 Natrium fosfat lar oral 45 ml 1,197
353 Natrium fusidat krim 20 mg/g 19,476
354 Natrium fusidat salep 20 mg/g 576
355 Neostigmin inj 0,5 mg/ml 74,991
356 Nifedipin kaps 10 mg 2,781,755
357 Nifedipin tab SR 20 mg 89,958
358 Nifedipin tab SR 30 mg 638,918
359 Nikardipin inj 10 mg/vial 7,407
360 Nimodipin tab 30 mg 17,200
361 Noretisteron tab 5 mg 31,732
362 Obat Anti Tuberculosis FDC Kategori I 68,690
363 Obat Anti Tuberculosis FDC Kategori Sisipan 1,871
364 Ofloksasin tab 200 mg 45,971
365 Ofloksasin tab 400 mg 81,319
366 Ofloksasin tts telinga 3% 6,236
367 Oksaliplatin serb inj 100 mg/vial 7,180
368 Oksaliplatin serb inj 50 mg/vial 11,081
369 Olanzapin tab sal 10 mg 143,034
370 Olanzapin tab sal 5 mg 164,092
371 Olopatadin tts mata 0,1% 4,800
372 Omeprazol inj 40 mg/10 ml 339,932
373 Omeprazol kaps 20 mg 3,631,000
374 Ondansetron inj 2 mg/ml 894,811
375 Ondansetron tab 4 mg 385,913
376 Ondansetron tab 8 mg 189,910
377 Paklitaksel inj 100 mg/vial 15,234
378 Paklitaksel inj 30 mg/vial 56,704
379 Paklitaksel inj 300 mg/vial 2,423
380 Parasetamol sir 120 mg/5 ml 30,700,123
381 Parasetamol tab 500 mg 900,000,011
382 Parasetamol tts 60 mg/0,6 ml 183,295
383 Pegylated interferon alfa-2b serb inj 100 mcg/ml 90
384 Pegylated interferon alfa-2b serb inj 120 mcg/ml 35
385 Pegylated interferon alfa-2b serb inj 50 mcg/ml 35
386 Pegylated interferon alfa-2b serb inj 80 mcg/ml 35
387 Pioglitazon tab 15 mg 89,325
388 Pioglitazon tab 30 mg 56,889
389 Pirantel pamoat susp 125 mg/5 ml 18,004
390 Pirantel pamoat tab scored 125 mg 232,324
391 Pirazinamid tab 500 mg 5,430,258
392 Piridoksin (vitamin B6) tab 10 mg 669,272,374
393 Piridoksin (vitamin B6) tab 25 mg 100,000,000
394 Povidon iodin lar 100 mg/ml 210,015,926
395 Pramipeksol tab ER 0,375 mg 80,060
396 Pramipeksol tab ER 0,750 mg 68,195
397 Pravastatin tab 20 mg 13,330
398 Prednison tab 5 mg 32,160,762
399 Probenesid tab 500 mg 87,440
400 Prokaterol HCl cairan ih 30 mcg 1,256,792
401 Prokaterol HCl cairan ih 50 mcg 86,754
402 Prokaterol HCl serb ih 10 mcg 67,855
403 Propiltiourasil tab 100 mg 846,798
404 Propofol inj 1% (i.v. Bolus) 203,664
405 Propranolol tab 10 mg 3,261,172
406 Propranolol tab 40 mg 189,159
407 Quetiapin tab SR 200 mg 30,944
408 Quetiapin tab SR 300 mg 4,552
409 Quetiapin tab SR 400 mg 16,340
410 Ramipril tab 2,5 mg 159,518
411 Ramipril tab 5 mg 236,286
412 Ranitidin tab 150 mg 15,805,741
413 Retinol (vitamin A) kaps lunak 100.000 UI 2,134,354
414 Rifampisin kaps 300 mg 460,416
415 Rifampisin tab 450 mg 1,997,021
416 Ringer Laktat Larutan 3,778,600
417 Ringer Laktat Larutan 1000 ml 10
418 Risperidon tab 3 mg 98,350
419 Risperidon tab sal 1 mg 56,370
420 Risperidon tab sal 2 mg 35,000,000
421 Rituksimab inj 100 mg/ml 630
422 Rituksimab inj 500 mg/ml 750
423 Rivaroksaban tab sal 10 mg 4,600
424 Rivaroksaban tab sal 15 mg 220
425 Rivaroksaban tab sal 20 mg 100
426 Ropinirol tab lepas lambat 2 mg 67,200
427 Ropinirol tab lepas lambat 4 mg 67,200
428 Ropinirol tab lepas lambat 8 mg 67,200
429 Rosuvastatin tab 10 mg 30,258
430 Salbutamol cairan ih 0,1% 600,000

431 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler 640,000

432 Salbutamol sir 2 mg/5 ml 5,652
433 Salbutamol tab 4 mg 1,234,525
Salep 2-4, kombinasi : asam salisilat 2 %+ belerang
434 endap 4 % 327,571
435 Sefadroksil kaps/tab 500 mg 2,328,692
436 Sefadroksil sir kering 125 mg/5 ml 170,870
437 Sefadroksil sir kering 250 mg/5 ml 29,956
438 Sefaleksin kaps 500 mg 189,950
439 Sefazolin serb inj 1 g/vial 24,505
440 Sefepim serb inj 1000 mg/vial 8,000,000
441 Sefiksim sir 100 mg/5 ml 60,430
442 Sefiksim tab 100 mg 1,473,845
443 Sefoperazon serb inj 1.000 mg/vial 362,880
444 Sefotaksim inj 500 mg/vial 73,565
445 Sefotaksim serb inj 1.000 mg/vial 1,173,122
446 Seftazidim serb inj 1.000 mg/vial 69,770
447 Sefuroksim serb inj 750 mg/vial 2,160,390
448 Sefuroksim tab 250 mg 7,000
449 Sefuroksim tab sal 500 mg 7,000
450 Sertralin tab sal 50 mg 2,500,000
451 Setirizin sir 5 mg/5 ml. 83,160
452 Setirizin tab 10 mg 30,000,000
453 Setuksimab inj 5 mg/ml 150,000
454 Sianokobalamin (vitamin B12) inj 500 mcg/ml 31,330
455 Sianokobalamin (vitamin B12) tab 50 mcg 600,100,000
456 Siklosporin kaps 100 mg 0
457 Siklosporin kaps lunak 25 mg 0
458 Simvastatin tab sal 10 mg 75,000,000
459 Simvastatin tab sal 20 mg 1,175,882
460 Siprofloksasin inf 2 mg/ml 94,910
461 Siprofloksasin tab scored 500 mg 6,230,000
462 Sisplatin serb inj 10 mg 2,509
463 Sisplatin serb inj 50 mg 364
464 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) 500
465 Spironolakton tab 100 mg 476,373
466 Spironolakton tab 25 mg 1,799,314
467 Sufentanil inj 5 mcg/ml (i.v.) 210
468 Sukralfat susp 500 mg/5 ml 1,328,106
469 Sukralfat tab 500 mg 352,730
470 Takrolimus kaps 0,5 mg 60,000
471 Takrolimus kaps 1 mg 18,000
472 Tamsulosin tab 0,2 mg 513,310
473 Tamsulosin tab SR 0,4 mg 1,367,869
474 Telbivudin tab 600 mg 0
475 Telmisartan tab 40 mg 86,792
476 Telmisartan tab 80 mg 501,998
477 Temozolamid kaps 100 mg 700
478 Temozolamid kaps 20 mg 700
479 Tenofovir tab 300 mg 103,512
480 Teofilin tab 150 mg 248,474
481 Terazosin hcl tab 1 mg 104,461
482 Terazosin hcl tab 2 mg 69,664
483 Terbutalin cairan ih 2,5 mg/ml 16,448
484 Terbutalin serb ih 0,50 mg/dose 21,960
485 Terbutalin tab 2,5 mg 134,970
486 Testosteron kaps lunak 40 mg 220
487 Tetrakain tts mata 0,5% 1,000
488 Tetrasiklin kaps 250 mg 5,868,868
489 Tetrasiklin kaps 500 mg 101,780,000
490 Tiamazol tab 10 mg 2,500,000
491 Tiamazol tab 5 mg 4,500,000
492 Tiamin (vitamin B1) tab 50 mg 13,000,000
493 Tikagrelor tab 90 mg 0
494 Tiotropium serb ih 18 mcg + handihaller 15,223
495 Tiotropium serb ih 18 mcg, refill 28,784
496 Tramadol inj 50 mg/ml 3,000,000
497 Trastuzumab serb inj 440 mg/vial 950
498 Travoprost tts mata 0,004% 9,000
499 Triamsinolon asetonid nasal spray 55 mcg/puff 4,350
500 Triamsinolon inj 10 mg/ml 4,818
501 Trifluoperazin tab sal 5 mg 20,000,000
502 Triheksifenidil tab 2 mg 109,029,629
503 Tropikamid tts mata 1% 1,000
504 Vaksin BCG inj (i.k) 547,220
505 Vaksin campak inj (s.k.) 300,500
506 Vaksin jerap difteri tetanus (DT) 237,990
507 Vaksin jerap difteri tetanus (Td) 800,270
508 Vaksin kombinasi DPT-HB-Hib 985,350
509 Valsartan tab 160 mg 75,988
510 Valsartan tab 80 mg 341,090
511 Verapamil tab 80 mg 171,253
512 Vinkristin serb inj 1 mg (i.v.) 3,017
513 Vinkristin serb inj 1 mg/ml (i.v.) 2,320
514 Vinorelbin inj 10 mg/ml 990
515 Vitamin B kompleks 678,166,744
516 Zidovudin kaps 300 mg 89,133
517 Zinc sir 10 mg/ml 5,578,511
518 Zinc tab disp 20 mg 4,744,757
 0
280,500
14,750
853,900
464,500
0
120,400

5,208

1,095

816

83

197

5
102,600
279,000
139,600
0
2,458
2,638,140
169,497
1,343,485
12,896,900
15,879,000

10,957
21,915
0
0
10,976

20,510,000

55,212
12
 0
484,100
3,000
5,730,500
0
2,431,000
10,139,300
16,600
54,906
88,350
27,720
120,000
20,000
160
1,252,500
0
11,240
0
0
24,680
32,670
195,570
0
84
1,904
1,650
648
141,100
308,700
0
27,532
1,259

4,793

536
48
360
540
583
0
0
10,784
4,041
9,970
 20,100
0
0
0
240
31,900
1,980
1,500
0
0
0
0
6,651
4,106
207,203
2,506,600
13,449
11,424
362
243

0
18,540
0
9,664
4,786
8,152
120
120
0
0
0
1,092
0
0
0
9,630
1,325
1,408
0
0
139

35
 500

275,385
437

1,586
260
770
0
0
0
561
0
780
1,845
1,280
80
0
4,800
30
2,340
3,015
2,393
25,300
0
0
225
160
420
0
0
119,400
0
0
0
16,470
0
466
1,075
0
20
0
273,800
356,400
0
 0
0
30
431,300
40,900
112,710
0
47,589
0
156,750
39
239
1,260
290
174,001
164,101
18,800
248,100
20
9
97
2,186,200
0
378,854
51,000

0
6,919
4,502,800
0
8,980
0

25
0
0
0
0
0
0
61,800
45,690
 0
214,500
824,900
11,000
58,900
11,996,400
5,040
49,080
378,520
0
0
769,800
0
2,600
1,725
131
76,097
0
137,300
0
180
355,200
417,600
30
2,100
30
48,300
0
0
1,945,100
397,524
357,249
750
78,303
62,196,800
844,000
117,450
344,050
224,830
14,900
62,700
0

1,450
 0

1,490
0

13,700

8,760

51

115

900

11,693,700
240
5,020
0
0

787

954

26,201

5,671

10,850

1,883

0
 0

0
56,339

485,893

22,310

0
4,200

51,320

23,240

200

220
 2,340

87,872

8,600

0
0
173
7,200
0
0
0
0
20
27,100
1,000
14,900
0
52,400
69,950
71,500
5
2
0
925
27,150
55,086
0
10,350

0
5,140
14,640
4,105
0
202,000
 5,500
400,700
18,990
0
0
212,300
60
1,190,000
345,200
0
7,010
0
7,000
0
0
0
503
113,276
0
0
0
0
1,680
0
0
0
1,331,390
12,653
690
168
210
250
11,880
901,710
0
0
3,790
0
0
777
0
0
0
0
469
 418
123,452
144,704
170
0
5,117,010
85,340
0
0
5,951
6,187
57
2,375,773
37,271,500
0
0
0
0
0
15,450
4,500
0
9,500
154,900
8,725,700
0
35,494
1,830
1,200
250
0
16,900
1,064
8,758
1,290
0
0
147,000
0
84,123
22,043
37,393
143,200
316,800
11,881,300
 88,900
0
15,000
2,274,730
90
118,800
244,600
0
0
0
0
0
0
1,400
0
0
39,150
12,620

0
0
1,387,200

0
5,019,062
0
0
0
9,920
0
0
35,400
1,410
0
334,500
49,860
2,310
0
3,000
52,110
50
1,399,900
368
0
1,300,600
 0
0
616,540
545,650
18,133
8,035,500
0
0
0
0
0
100
135,026
155,901
1,500
4,200
75,584
171,540
0
42,740
66,920
0
0
0
0
36,200
30,300
1,100
0
14,000
0
110
358,000
4,931,300
38,500
32,300
30,385,300
4,424
310
22,890
43,030
0
0
2,493
627
 0
1,686,800
40
0
0
0
0
0
85,371
321,370
7,200
0
0
2,210
13,930,000
0
1,111
709,100
FORMAT DATA ISIAN ESTIMASI KEBUTUHAN OBAT
PERIODE APRIL - DESEMBER 2017

DIVRE PROVINSI KC
No KODE FASKES NAMA FASKES SWASTA

1 IV JAWA BARAT CIKARANG 0132R013 RS ANNISA (JST)

2 IV JAWA BARAT CIKARANG 0132R014 RS BHAKTI HUSADA (JST)

3 IV JAWA BARAT CIKARANG 0132R015 RS HOSANA MEDICA LIPPO (JST)

4 IV JAWA BARAT CIKARANG 0132R016 RS KARTIKA HUSADA TAMBUN
 5 IV JAWA BARAT CIKARANG 0132R017 RS KARYA MEDIKA (JST)
6 IV JAWA BARAT CIKARANG 0132R018 RS MITRA MEDIKA
7 IV JAWA BARAT CIKARANG 0132R020 RS Asri Medika
8 IV JAWA BARAT CIKARANG 0132R023 RS AMANDA (JST)
9 IV JAWA BARAT CIKARANG 0132R024 RS CIKARANG MEDIKA (JST)
10 IV JAWA BARAT CIKARANG 0132R025 RS CIBITUNG MEDIKA (JST)
11 IV JAWA BARAT CIKARANG 0132R026 RS TIARA BEKASI (JST)
12 IV JAWA BARAT CIKARANG 0132R027 RS HARAPAN MULIA (JST)
13 IV JAWA BARAT CIKARANG 0132R040 RS MEDIROSSA 2
14 IV JAWA BARAT CIKARANG 0132R044 RS HERMINA GRAND WISATA
15 IV JAWA BARAT CIKARANG 0132R045 Siloam Hospital Lippo Cikarang
16 IV JAWA BARAT CIKARANG 0132R051 kartika husada setu
17 IV JAWA BARAT CIKARANG 0132R055 RS Ridhoka Salma
18 IV JAWA BARAT CIKARANG 0132R058 RS OMNI CIKARANG
19 IV JAWA BARAT CIKARANG 0132R059 RS BUNDA MULIA
20 IV JAWA BARAT CIKARANG 0132R061 RS Amanda Cikarang
21 IV JAWA BARAT CIKARANG 0132R062 RS Hosana Cikarang Baru
22 IV JAWA BARAT CIKARANG 0132R063 RS Multazam Medika
23 IV JAWA BARAT CIKARANG 0132R064 RS KARYA MEDIKA 2
24 IV JAWA BARAT CIKARANG 1014R005 RS SENTRA MEDIKA (JST)
25 IV JAWA BARAT CIKARANG 1014R010 RSUD KAB BEKASI
26 IV JAWA BARAT CIKARANG 1014R012 RS MEDIROSA BEKASI
JENIS FASKES NAMA GENERIK SEDIAAN

FKRTL Obat A (contoh)

Obat B
FKRTL

FKRTL
FKRTL SUKRALFAT SUSPENSI
METILDOPA TABLET
MEDROXYPROGESTERON ASETAT TABLET
CEFTRIAXONE SERBUK INJEKSI
ISONIAZIDE 100 MG
ISONIAZIDE 300 MG
DEKSAMETASON INJEKSI
FUROSEMID INJEKSI (i.v./i.m.)
ONDANSENTRON TABLET
ONDANSENTRON INJEKSI
Mg(OH)2 & Al(OH)3 SUSPENSI
Mg(OH)2 & Al(OH)3 TABLET KUNYAH
PHENOBARBITAL TABLET
ACYCLOVIR TABLET
ACYCLOVIR TABLET
ACYCLOVIR KRIM
ALBENDAZOL TABLET
ALLOPURINOL TABLET
ALLOPURINOL TABLET
ALLYLESTRENOL TABLET
ALPRAZOLAM TABLET
AMBROXOL SIRUP
AMBROXOL SIRUP
AMBROXOL TABLET
AMLODIPIN TABLET
AMLODIPIN TABLET
AMOXICILLIN KAPSUL
AMOXICILLIN SIRUP KERING
AMOXICILLIN SIRUP KERING
ANTALGIN TABLET
ASAM FOLAT TABLET
ASAM MEFENAMAT TABLET
ASAM TRANEKSAMAT TABLET
ASAM TRANEKSAMAT INJEKSI
ASAM TRANEKSAMAT INJEKSI
AZITHROMYCIN TABLET
AZITHROMYCIN SIRUP KERING
BETAHISTIN TABLET
BISOPROLOL TABLET
CAPTOPRIL TABLET
CAPTOPRIL TABLET
CEFADROXIL CAPSUL
CEFADROXIL SIRUP KERING
CEFADROXIL SIRUP KERING
CEFEPIME INJEKSI
CEFIXIM KAPSUL
CEFIXIM KAPSUL
CEFIXIM SIRUP KERING
CEFOTAXIM SERBUK INJEKSI
CEFTAZIDIME INJEKSI
CETIRIZIN DROP
CETIRIZIN TABLET
CETIRIZIN SIRUP
AIR UNTUK INJEKSI LARUTAN
ALBUMIN SERUM NORMAL ( HUMAN ALBUMIN ) INJEKSI
AMIKASIN INJEKSI

ANALOG INSULIN : fast acting inj 100 UI/ml (kemasan INJEKSI

vial, cartridge disposible, penfil cartridge)
ASAM ASETIL SALISILAT ( ASETOSAL ) TABLET
ASAM ASKORBAT ( VITAMIN C ) TABLET
ASAM PIPEMIDAT KAPSUL
ASAM URSODEOKSIKOLAT KAPSUL
ATTAPULGIT TABLET
ATRAKURIUM INJEKSI
DESOKSIMETASON KRIM
DIAZEPAM REKTAL TUBE
DIAZEPAM REKTAL TUBE
DIAZEPAM TABLET
DIAZEPAM TABLET
DIAZEPAM INJEKSI
DIFENHIDRAMIN INJEKSI (i.v./i.m.)
DILTIAZEM TABLET
CIPROFLOXACIN TABLET
CIPROFLOXACIN INFUS
CITICOLIN TABLET
CITICOLIN INJEKSI
CITICOLIN INJEKSI
KLINDAMISIN KAPSUL
KLINDAMISIN KAPSUL
KLONIDIN TABLET
KLONIDIN INJEKSI
KLOPIDOGREL TABLET
CO AMOXICLAV TABLET
KOTRIMOKSAZOL KOMBINASI : SULFAMETOKSAZOL + SUSPENSI
TRIMETOPRIM
KOTRIMOKSAZOL (DEWASA) KOMBINASI : TABLET
SULFAMETOKSAZOL + TRIMETOPRIM
KLORFENIRAMIN TABLET
DEXAMETHASON TABLET
DEXAMETHASON INJEKSI
DIGOXIN TABLET
DOBUTAMIN INJEKSI
DOMPERIDON TABLET
DOMPERIDON SUSPENSI
DOXYCYCLIN KAPSUL
ENOKSAPARIN SODIUM INJEKSI
ENOKSAPARIN SODIUM INJEKSI
EPERISONE HCl TABLET
EPHINEPHRINE INJEKSI
EPHEDRIN INJEKSI
ERITROMISIN SIRUP
ERITROMISIN KAPSUL
FENOFIBRAT KAPSUL
FENTANIL INJEKSI (i.v.)
FLUKONAZOL KAPSUL
FLUKONAZOL INJEKSI
FLUSINOLON ASETONID krim 0,025% KRIM
FLUNARIZIN TABLET
GABAPENTIN KAPSUL
GEMFIBROZIL KAPSUL
GENTAMISIN INJEKSI
GENTAMISIN SALEP MATA
GENTAMISIN TETES MATA
GLIKUIDON TABLET
GLISERIL GUAIAKOLAT TABLET
GLIBENKLAMID TABLET
GLIMEPIRID TABLET
GLIMEPIRID TABLET
GLIMEPIRID TABLET
GLIMEPIRID TABLET
GLUKOSA INFUS STERIL
GLUKOSA INFUS STERIL
GLUKOSA INFUS STERIL
HALOPERIDOL INJEKSI (i.m.)
HALOPERIDOL TABLET
GLUKOSAMIN TABLET
GLUKOSAMIN TABLET
GRISEOFULVIN TABLET
HIDROKLOROTIAZID TABLET
HIDROKORTISON KRIM
HEPATITIS B IMUNOGLOBULIN (HUMAN) INJEKSI
IBUPROFEN TABLET
IBUPROFEN TABLET
IBUPROFEN SIRUP
IBUPROFEN SIRUP
IRBESARTAN TABLET
IRBESARTAN TABLET
KALIUM ASPARTAT TABLET
KALIUM KLORIDA SR TABLET
KALSIUM LAKTAT (KALK) TABLET
KARBAMAZEPIN TABLET
KARBOGLISERIN TETES TELINGA
KETAMIN INJEKSI (i.v.)
KALIUM DIKLOFENAK TABLET
KALIUM DIKLOFENAK TABLET
KETOKONAZOL TABLET
KETOKONAZOL KRIM
KETOKONAZOL SCALP SOLUTION
KETOPROFEN SUPPOSITORIA
KETOPROFEN TABLET
KETOPROFEN TABLET
KLOMIFEN SITRAT TABLET
KLORAMFENICOL KAPSUL
KLORAMFENICOL SALEP KULIT
KLORAMFENICOL SALEP MATA
KLORAMFENICOL SUSPENSI
KLORAMFENICOL SERBUK INJEKSI
KLORPROMAZIN TABLET SALUT
KODEIN TABLET
KODEIN TABLET
KODEIN TABLET
KOLOID HES LARUTAN INFUS
KOMBINASI : LEVONORGESTREL + ETINILESTRADIOL TABLET
KOMBINASI: IPRATROPIUM + SALBUTAMOL NEBULES
KOMBINASI: NATRIUM KLORIDA + KALIUM KLORIDA TETES MATA
KOMBINASI: SALMETEROL + FLUTIKASON PROPIONAT INHALASI
KETOROLAK INJEKSI
KETOROLAK TABLET
LANSOPRAZOL KAPSUL
LARUTAN MENGANDUNG ASAM AMINO LARUTAN INFUS
LARUTAN MENGANDUNG ASAM AMINO LARUTAN INFUS
LARUTAN MENGANDUNG ASAM AMINO (KOMBINASI LARUTAN INFUS
ASAM AMINO, VITAMIN DAN ELEKTROLIT)

LARUTAN MENGANDUNG ASAM AMINO (ASAM AMINO, LARUTAN INFUS

GLUKOSA DAN ELEKTROLIT
LARUTAN MENGANDUNG ASAM AMINO (ASAM AMINO, LARUTAN INFUS
GLUKOSA DAN ELEKTROLIT
LARUTAN MENGANDUNG ASAM AMINO (ASAM AMINO, LARUTAN INFUS
SORBITOL , Cl)
LARUTAN MENGANDUNG ELEKTROLIT (KALIUM KLORIDA) LARUTAN ELEKTROLIT
LARUTAN MENGANDUNG LIPID (INFUS LIPID EMULSI) LARUTAN INFUS
LEVOFLOKSASIN INFUS
LEVOFLOKSASIN TABLET
LEVOFLOKSASIN TETES MATA
LEVOTIROKSIN TABLET
LIDOKAIN (HCl) INJEKSI
LIDOKAIN (HCl) GEL
LINKOMISIN KAPSUL
LISINOPRIL TABLET
LISINOPRIL TABLET
LOPERAMID TABLET
MAGNESIUM SULFAT INJEKSI
MAGNESIUM SULFAT INJEKSI
LORATADIN TABLET
MEKOBALAMIN KAPSUL
MEKOBALAMIN INJEKSI
MANITOL LARUTAN INFUS
MEBENDAZOL TABLET
MEDROKSI PROGESTERON ASETAT TABLET
MEDROKSI PROGESTERON ASETAT TABLET
MELOKSIKAM TABLET
MELOKSIKAM TABLET
MEROPENEM SERBUK INJEKSI
MEROPENEM SERBUK INJEKSI
METFORMIN TABLET
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
FKRTL
KEKUATAN

500 MG/5 ML 100 ML

250 MG
100 MG
1000 MG/ML
TABLET
TABLET
5 MG/ML 1 ML
10 MG/ML 2 ML
4 MG
2 MG/ML 2 ML
200 MG/5 ML 60 ML
200 MG
30 MG
200 MG
400 MG
50 MG/GR 5 GR
400 MG
100 MG
300 MG
5 MG
0,5 MG
15 MG
30 MG
30 MG
5 MG
10 MG
500 MG
125 MG/5 ML 60 ML
250 MG/5 ML 60 ML
500 MG
400 MCG
500 MG
500 MG
250 MG
500 MG
500 MG
200 MG/5 ML 15 ML
6 MG
5 MG
12,5 MG
25 MG
500 MG
125 MG/5 ML 60 ML
250 MG/5 ML 60 ML
1 GR
200 MG
100 MG
100 MG/5 ML 30 ML
1000 MG/ML
1 GR
10 MG/ML 20 ML
10 MG
5 MG/5 ML 60 ML
25 ML
20% 50 ML
250 MG

100 UI/ML

80 MG
50 MG
400 MG
250 MG
600 MG
25 MG/2,5 ML
0,25% 15 GR
10 MG/2,5 ML
5 MG/2,5 ML
5 MG
2 MG
10 MG/2 ML
10 MG/ML
30 MG
500 MG
200 MG/100 ML
500 MG
250 MG
500 MG
300 MG
150 MG
0,150 MG
150 MCG/ML
75 MG
625 MG
TRIMETOPRIM 40 MG/SULFAMETOKSAZOL 200 MG PER 5 ML

SULFAMETOKSAZOL 400 MG, TRIMETOPRIM 80 MG

4 MG
0,5 MG
5 MG/ML
0,25 MG
250 MG
10 MG
5 MG/5 ML 60 ML
100 MG
40 MG/0,4 ML
60 MG/0,6 ML
50 MG
1 MG/ML
50 MG/ML
200 MG/5 ML
500 MG
300 MG
0,05 MG/ML 2 ML
150 MG
2 MG/ML 200 ML
0,025% 10 GR
5 MG
300 MG
300 MG
40 MG/ML 2 ML
0,3% 5 GR
0,3% 5 ML
30 MG
100 MG
5 MG
1 MG
2 MG
3 MG
4 MG
10% 500 ML
5% 500 ML
5% 100 ML
5 MG/ML
0,5 MG
500 MG
250 MG
500 MG
25 MG
2,5% 5 GR
0,5 ML
200 MG
400 MG
100 MG/5 ML
200 MG/5 ML
150 MG
300 MG
300 MG
600 MG
500 MG
200 MG
10%
50 MG/ML
50 MG
25 MG
200 MG
2% 10 GR
2% 60 ML
100 MG
100 MG
50 MG
50 MG
500 MG
2% 5 GR
1% 5 GR
125 MG/5 ML 60 ML
1000 MG/ML
100 MG
10 MG
15 MG
20 MG
BM 130 000 6% 500 ML
LEVONORGESTREL 150 MCG, ETINILESTRADIOL 30 MCG
IPRATROPIUM Br 0,5 MG, SALBUTAMOL 2,5 MG
NATRIUM KLORIDA 8,664 MG, KALIUM KLORIDA 1,32 MG
SALMETEROL 50 MCG, FLUTIKASON PROPIONAT 250 MCG 250 MCG/PUFF
30 MG
10 MG
30 MG
ASAM AMINO 30 G, GLUKOSA 7,3% DAN ELEKTROLIT 500 ML
ASAM AMINO 5% DENGAN BCAA 45%, L-ORNITHINE L ASPARTATE 8,03GR/L, SORBITOL 50 GR/L, XYLITOL 50 GR/L
ASAM AMINO 50 G/L, VITAMIN DAN ELEKTROLIT

ASAM AMINO 30 G, GLUKOSA 7,3% DAN ELEKTROLIT 1000 ML

ASAM AMINO 30 G, GLUKOSA 7,3% DAN ELEKTROLIT 500 ML

ASAM AMINO 27 G, SORBITOL 50 G, Cl-52 mEq

7,46% 25 ML
INFUS LIPID EMULSI MCT/LCT 20% 250 ML
5 MG/ML 100 ML
500 MG
0,5% 5 ML
100 MCG
2% 2 ML
2% 30 GR
500 MG
10 MG
5 MG
2 MG
20% 25 ML
40% 25 ML
10 MG
500 MG
500 MCG
20% 500 ML
500 MG
100 MG
10 MG
7,5 MG
15 MG
500 MG
1000 MG
500 MG
 *) Dalam satuan
JUMLAH PEMAKAIAN ESTIMASI KEBUTUHAN BULAN APRIL - terkecil
TAHUN 2016 *) DES 2017 (Sudah termasuk buffer)*) (tablet/vial/botol
sirup/dll)

2400 BOTOL 2000 BOTOL

4200 TABLET 3500 TABLET
6000 TABLET 5000 TABLET
19200 VIAL 16000 VIAL
2400 TABLET 2000 TABLET
8400 TABLET 7000 TABLET
6000 AMPUL 5000 AMPUL
1200 AMPUL 1000 AMPUL
6000 TABLET 5000 TABLET
4800 AMPUL 4000 AMPUL
600 BOTOL 500 BOTOL
4800 TABLET 4000 TABLET
1800 TABLET 1500 TABLET
24000 TABLET 20000 TABLET
6000 TABLET 5000 TABLET
900 TUBE 750 TUBE
120 TABLET 100 TABLET
2400 TABLET 2000 TABLET
1200 TABLET 1000 TABLET
24000 TABLET 20000 TABLET
2400 TABLET 2000 TABLET
1200 BOTOL 1000 BOTOL
840 BOTOL 700 BOTOL
10800 TABLET 9000 TABLET
18000 TABLET 15000 TABLET
6000 TABLET 5000 TABLET
6000 KAPSUL 5000 KAPSUL
300 BOTOL 250 BOTOL
300 BOTOL 250 BOTOL
1200 TABLET 1000 TABLET
12000 TABLET 10000 TABLET
42000 TABLET 35000 TABLET
6000 TABLET 5000 TABLET
600 AMPUL 500 AMPUL
600 AMPUL 500 AMPUL
2400 TABLET 2000 TABLET
750 BOTOL 600 BOTOL
4800 TABLET 4000 TABLET
2400 TABLET 2000 TABLET
8400 TABLET 7000 TABLET
6000 TABLET 5000 TABLET
84000 CAPSUL 70000 CAPSUL
240 BOTOL 200 BOTOL
240 BOTOL 200 BOTOL
120 VIAL 100 VIAL
18000 KAPSUL 15000 KAPSUL
24000 KAPSUL 20000 KAPSUL
840 BOTOL 700 BOTOL
7200 VIAL 6000 VIAL
180 VIAL 150 VIAL
96 BOTOL 80 BOTOL
9600 TABLET 8000 TABLET
600 BOTOL 500 BOTOL
7800 AMPUL 6500 AMPUL
36 BOTOL 30 BOTOL
60 VIAL 50 VIAL

180 AMPUL 150 AMPUL

7200 TABLET 6000 TABLET

7200 TABLET 6000 TABLET
720 KAPSUL 600 KAPSUL
3600 KAPSUL 3000 KAPSUL
13200 TABLET 11000 TABLET
60 AMPUL 50 AMPUL
300 TUBE 250 TUBE
300 SUPP 250 SUPP
240 SUPP 200 SUPP
3600 TABLET 3000 TABLET
3600 TABLET 3000 TABLET
480 AMPUL 400 AMPUL
120 VIAL 100 VIAL
6000 TABLET 5000 TABLET
42000 TABLET 35000 TABLET
36 BOTOL 30 BOTOL
2400 TABLET 2000 TABLET
420 AMPUL 350 AMPUL
300 AMPUL 250 AMPUL
3600 KAPSUL 3000 KAPSUL
600 KAPSUL 500 KAPSUL
3600 TABLET 3000 TABLET
120 AMPUL 100 AMPUL
2400 TABLET 2000 TABLET
1200 TABLET 1000 TABLET
180 BOTOL 150 BOTOL

1200 TABLET 1000 TABLET

3600 TABLET 3000 TABLET

3600 TABLET 3000 TABLET
6000 AMPUL 5000 AMPUL
6000 TABLET 5000 TABLET
60 VIAL 50 VIAL
12000 TABLET 10000 TABLET
360 BOTOL 300 BOTOL
3600 KAPSUL 3000 KAPSUL
48 AMPUL 40 AMPUL
48 AMPUL 40 AMPUL
6000 TABLET 5000 TABLET
300 AMPUL 250 AMPUL
1800 AMPUL 1500 AMPUL
120 BOTOL 100 BOTOL
1200 KAPSUL 1000 KAPSUL
1800 KAPSUL 1500 KAPSUL
300 AMPUL 250 AMPUL
120 KAPSUL 100 KAPSUL
36 BOTOL 30 BOTOL
60 TUBE 50 TUBE
2400 TABLET 2000 TABLET
1200 KAPSUL 1000 KAPSUL
600 KAPSUL 5000 KAPSUL
7200 AMPUL 6000 AMPUL
120 TUBE 100 TUBE
180 BOTOL 150 BOTOL
360 TABLET 300 TABLET
1200 TABLET 1000 TABLET
1200 TABLET 1000 TABLET
2400 TABLET 2000 TABLET
9600 TABLET 8000 TABLET
1200 TABLET 1000 TABLET
1200 TABLET 1000 TABLET
720 BOTOL 600 BOTOL
4800 BOTOL 4000 BOTOL
120 BOTOL 100 BOTOL
60 AMPUL 50 AMPUL
1200 TABLET 1000 TABLET
720 TABLET 600 TABLET
720 TABLET 600 TABLET
1200 TABLET 1000 TABLET
1200 TABLET 1000 TABLET
360 TUBE 300 TUBE
24 BOX 20 BOX
4800 TABLET 4000 TABLET
4800 TABLET 4000 TABLET
240 BOTOL 200 BOTOL
120 BOTOL 100 BOTOL
600 TABLET 500 TABLET
600 TABLET 500 TABLET
2400 TABLET 2000 TABLET
6000 TABLET 5000 TABLET
7200 TABLET 6000 TABLET
1200 TABLET 1000 TABLET
36 BOTOL 30 BOTOL
96 VIAL 80 VIAL
6000 TABLET 5000 TABLET
600 TABLET 500 TABLET
2400 TABLET 2000 TABLET
240 TUBE 200 TUBE
180 BOTOL 150 BOTOL
2400 SUPP 2000 SUPP
4800 TABLET 4000 TABLET
4800 TABLET 4000 TABLET
7200 TABLET 6000 TABLET
1200 KAPSUL 1000 KAPSUL
240 TUBE 200 TUBE
240 TUBE 200 TUBE
120 BOTOL 100 BOTOL
120 VIAL 100 VIAL
1200 TABLET 1000 TABLET
6000 TABLET 5000 TABLET
4800 TABLET 4000 TABLET
4800 TABLET 4000 TABLET
360 BOTOL 300 BOTOL
180 BOX 150 BOX
720 AMPUL 600 AMPUL
840 BOTOL 700 BOTOL
36 BOX 30 BOX
2400 AMPUL 2000 AMPUL
1200 TABLET 1000 TABLET
8400 KAPSUL 7000 KAPSUL
60 BOTOL 50 BOTOL
60 BOTOL 50 BOTOL
600 BOTOL 500 BOTOL

36 BOTOL 30 BOTOL

72 BOTOL 60 BOTOL

36 botol 30 BOTOL
420 AMPUL 350 AMPUL
36 BOTOL 30 BOTOL
240 BOTOL 200 BOTOL
12000 TABLET 10000 TABLET
36 BOTOL 30 BOTOL
600 TABLET 500 TABLET
1800 AMPUL 1500 AMPUL
60 TUBE 50 TUBE
3600 KAPSUL 3000 KAPSUL
720 TABLET 600 TABLET
720 TABLET 600 TABLET
6000 TABLET 5000 TABLET
120 AMPUL 100 AMPUL
600 AMPUL 500 AMPUL
3600 TABLET 3000 TABLET
9600 KAPSUL 8000 KAPSUL
360 AMPUL 300 AMPUL
60 BOTOL 50 BOTOL
120 TABLET 100 TABLET
7200 TABLET 6000 TABLET
720 TABLET 600 TABLET
6000 TABLET 5000 TABLET
4800 TABLET 4000 TABLET
300 VIAL 250 VIAL
240 VIAL 200 VIAL
18000 TABLET 15000 TABLET