Lampiran Usulan Obat Golongan Non Generik Fprmularium PDF
Lampiran Usulan Obat Golongan Non Generik Fprmularium PDF
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
1 T0004 ACITRAL TABLET TABLET 300 117 500 100 5 59.662,50 298
2 I2629 ACTABONE INJEKSI 300 MG/ 5 ML VIAL 53 12 29 1 29 109.087,50 3.163
3 IA000000003 ACTOPLATIN INJEKSI 150 MG/15 ML AMPUL 0 7 42 1 42 172.725,00 7.254
4 Z0320 ACUATIM KRIM 10 GRAM TUBE 0 3 20 1 20 86.130,00 1.722
5 T0008 ADALAT OROS TABLET 30 MG TABLET 9.060 1.920 3.990 30 133 95.460,68 12.696
6 I0004 ADONA (AC-17) INJEKSI 50 MG/10 ML AMPUL 0 2 10 10 1 208.000,00 208
7 T0011 AERIUS FC TABLET 5 MG TABLET 0 28 180 30 6 198.549,00 1.191
8 I0424 AERRANE INJEKSI 250 ML BOTOL 3 2 11 1 11 1.398.600,00 15.384
9 I0423 ALBAPURE INJEKSI 20 % 100 ML BOTOL 35 30 169 1 169 681.800,00 115.224
10 Z0002 ALBOTHYL LARUTAN 10 ML BOTOL 0 1 5 1 5 26.600,00 133
11 I0891 ALBUMINAR INJEKSI 25 % 100 ML BOTOL 0 39 265 1 265 1.332.000,00 352.980
12 I0006 ALINAMIN F INJEKSI 25 MG/10 ML AMPUL 455 125 395 5 79 47.639,90 3.763
13 Z0285 ALKOHOL 70% 100 ML BOTOL 345 67 111 1 111 2.272,72 252
14 I0900 AMINOFLUID INFUS 500 ML BAG 109 221 1.394 1 1.394 56.000,00 78.064
15 I0012 AMINOFUSIN PAED INFUS 250 ML BOTOL 85 14 10 1 10 41.818,00 418
16 I0014 AMINOLEBAN INFUS BAG 85 15 17 1 17 59.091,00 1.004
17 I0019 AMINOSTERIL INFANT 6% INFUS BOTOL 150 51 197 1 197 33.334,00 6.566
18 I0023 AMOXSAN INJEKSI 1 GRAM VIAL 0 1 10 10 1 202.050,00 202
19 T0034 ANALSIK TABLET TABLET 0 1.517 10.300 100 103 109.000,00 11.227
20 I2636 ANBACIM INJEKSI 1 GRAM VIAL 25 13 63 1 63 67.610,00 4.259
21 T0848 ANBACIM KAPLET KAPLET 0 20 140 20 7 371.200,00 2.598
22 T1465 ANEMOLAT TABLET 1 MG TABLET 3.300 8.583 55.100 100 551 14.840,00 8.176
23 I0028 ANTRAIN INJEKSI 500 MG/ML, AMP @ 2 ML AMPUL 420 219 1.070 5 214 28.595,00 6.119
24 S0224 APIALYS DROP 10 ML BOTOL 0 1 7 1 7 28.500,00 199
25 S0225 APIALYS SYRUP 100 ML BOTOL 0 4 27 1 27 23.750,00 641
26 TA000000023 ARIMIDEX TABLET TABLET 1.680 933 4.676 28 167 814.457,55 136.014
27 I0583 ARIXTRA INJEKSI 2,5MG/0,5ML VIAL 182 55 192 2 96 439.395,00 42.181
Halaman 1 dari 19
HARGA
P)
1
298.312,50
3.163.537,50
7.254.450,00
1.722.600,00
12.696.270,44
208.000,00
1.191.294,00
15.384.600,00
115.224.200,00
133.000,00
352.980.000,00
3.763.552,10
252.271,92
78.064.000,00
418.180,00
1.004.547,00
6.566.798,00
202.050,00
11.227.000,00
4.259.430,00
2.598.400,00
8.176.840,00
6.119.330,00
199.500,00
641.250,00
136.014.410,85
42.181.920,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 2
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
28 I0031 ASERING INFUS FLABOT 2.000 385 618 1 618 8.182,00 5.056
29 T0057 ASPAR K TABLET TABLET 0 42 300 100 3 204.360,00 613
30 T0945 ASPILET THROMBO TABLET TABLET 450 475 2.850 150 19 86.400,00 1.641
31 T0058 ASPILET TABLET TABLET 0 3.350 22.800 100 228 14.500,00 3.306
32 Z0022 ASTHENOF TETES MATA BOTOL 5 1 1 1 1 21.000,00 21
33 T0005 ASTHIN FORCE TABLET TABLET 1.998 737 3.006 18 167 114.075,00 19.050
34 Z0006 ATROVENT INH SOL 20 ML BOTOL 88 17 28 1 28 81.818,18 2.290
35 Z0188 AUGENTONIC TETES MATA 5 ML BOTOL 0 2 14 1 14 25.125,00 351
36 S0198 AVAMYS 120 SPRAY BOTOL 0 1 6 1 6 84.848,20 509
37 I0959 AVASTIN INJEKSI 100 MG VIAL 20 14 75 1 75 4.366.997,27 327.524
38 T0914 AVELOX TABLET 400 MG TABLET 0 2 10 5 2 254.678,00 509
39 T6289 AVODART KAPSUL KAPLET 660 233 930 30 31 193.636,36 6.002
40 Z0008 BACTODERM 5 G KRIM TUBE 0 11 75 1 75 41.000,00 3.075
41 Z0009 BACTROBAN 5 G KRIM TUBE 0 1 5 1 5 35.000,00 175
42 T0089 BD-GARD TABLET TABLET 900 570 2.970 30 99 250.000,00 24.750
43 Z0014 BEROTEC INHALATION SOL 50 ML BOTOL 20 9 41 1 41 106.818,18 4.379
44 Z0176 BEROTEC MDI 100 10 ML BOTOL 29 24 134 1 134 66.272,73 8.880
45 OA000000001 BETADINE OBAT KUMUR 175 ML BOTOL 0 21 143 1 143 16.000,00 2.288
46 I0039 BIOCEF INJEKSI VIAL 0 2 12 1 12 125.000,00 1.500
47 T1378 BIOCURKEM KAPLET TABLET 0 400 2.730 30 91 292.500,00 26.617
48 T1420 BIOCURLIV KAPLET KAPLET 120 85 450 30 15 190.125,00 2.851
49 Z0018 BIOPLACENTON JELLY 15 GRAM TUBE 6 4 21 1 21 12.000,00 252
50 S0015 BISOLVON ELIXIR 60 ML BOTOL 0 1 7 1 7 22.040,00 154
51 I0042 BISOLVON INJEKSI AMPUL 0 52 350 10 35 399.475,00 13.981
52 Z0071 BLECIDEX EYE / EAR DROP BOTOL 0 2 14 1 14 37.015,00 518
53 T0827 BLESIFEN TABLET TABLET 100 67 360 20 18 221.700,00 3.990
54 T1078 BLOPRESS TABLET 16 MG TABLET 0 6 28 14 2 199.760,00 399
Halaman 2 dari 19
HARGA
P)
1
5.056.476,00
613.080,00
1.641.600,00
3.306.000,00
21.000,00
19.050.525,00
2.290.909,04
351.750,00
509.089,20
327.524.795,25
509.356,00
6.002.727,16
3.075.000,00
175.000,00
24.750.000,00
4.379.545,38
8.880.545,82
2.288.000,00
1.500.000,00
26.617.500,00
2.851.875,00
252.000,00
154.280,00
13.981.625,00
518.210,00
3.990.600,00
399.520,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 3
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
303.560,00
8.519.659,95
246.000,00
1.580.000,00
88.000.000,00
356.700.000,00
1.435.336,00
255.565,20
1.672.727,28
227.795.000,00
146.363,00
794.880,00
1.282.500,00
297.500,00
113.525,00
589.000,00
22.906.476,60
475.052,00
906.628,00
1.868.125,00
425.000,00
2.280.000,00
1.265.118,00
3.277.692,00
5.090.909,11
46.000,00
9.010.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 4
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
82 I0069 CERNEVIT INJEKSI VIAL 573 133 331 1 331 144.000,00 47.664
83 I0070 CEROPID INJEKSI 1 GRAM VIAL 20 15 82 2 41 255.000,00 10.455
84 T2242 CESTER CAPSUL TABLET 0 10 60 30 2 71.250,00 142
85 IA000000058 CETROTIDE INJEKSI 0,25 MG VIAL 0 1 7 7 1 3.611.000,00 3.611
86 I0437 CHLORAMEX INJEKSI 1000 MG VIAL 0 3 16 1 16 28.000,00 448
87 Z0059 CHLORETHYL SPRAY 100 ML BOTOL 10 4 17 1 17 109.250,00 1.857
88 Z0235 CIDEX OPA 5 LITER BOTOL 0 2 14 1 14 665.500,00 9.317
89 T1369 CIPRALEX TABLET 10 MG TABLET 0 5 28 28 1 475.000,00 475
90 I0080 CLINIMIX N9G15E INFUS 1 LITER BAG 47 36 198 1 198 180.909,09 35.819
91 T6323 CODIPRONT CUM EXPECT TABLET 0 60 410 10 41 86.800,00 3.558
92 T1475 CODIPRONT KAPSUL KAPSUL 0 83 600 100 6 656.000,00 3.936
93 I0549 COMAFUSIN HEPAR INFUS 500 ML BOTOL 70 18 52 1 52 59.000,00 3.068
94 Z0516 COMBIVENT NEBULES AMPUL 40 42 240 20 12 108.909,09 1.306
95 T0151 COMTRO TABLET 250 MG TABLET 0 15 100 20 5 163.350,00 816
96 S0024 COMTUSI SIRUP BOTOL 0 1 7 1 7 32.455,00 227
97 T0153 CONCOR TABLET 2.5 MG TABLET 0 3.075 20.900 100 209 67.818,15 14.173
98 I0084 CORDARON INJEKSI AMPUL 108 43 186 6 31 68.073,00 2.110
99 I0905 CRAVIT INFUS 750 MG BOTOL 10 19 119 1 119 268.180,00 31.913
100 Z0063 CRAVIT TETES MATA BOTOL 0 1 7 1 7 110.000,00 770
101 I0580 CRAVOX INFUS BOTOL 0 5 30 1 30 190.000,00 5.700
102 I0089 CURACIL INJEKSI 500 MG VIAL 767 201 600 1 600 30.000,00 18.000
103 T0162 CURCUMA TABLET TABLET 2.200 3.333 20.500 100 205 66.000,00 13.530
104 T1514 CYCLO PROGYNOVA TABLET TABLET 0 18 84 21 4 107.800,00 431
105 IA000000034 CYCLOVID INJEKSI 1 GRAM VIAL 12 3 6 1 6 232.727,27 1.396
106 Z0186 CYGEST OVULA 400 MG OVULA 150 56 225 15 15 300.000,00 4.500
107 I0888 CYMEVENE INJEKSI 500 MG VIAL 15 3 5 1 5 363.181,82 1.815
108 T5678 CYTODROX TABLET 500 MG TABLET 0 492 3.300 100 33 568.167,60 18.749
Halaman 4 dari 19
HARGA
P)
1
47.664.000,00
10.455.000,00
142.500,00
3.611.000,00
448.000,00
1.857.250,00
9.317.000,00
475.000,00
35.819.999,82
3.558.800,00
3.936.000,00
3.068.000,00
1.306.909,08
816.750,00
227.185,00
14.173.993,35
2.110.263,00
31.913.420,00
770.000,00
5.700.000,00
18.000.000,00
13.530.000,00
431.200,00
1.396.363,62
4.500.000,00
1.815.909,10
18.749.530,80
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 5
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
75.467.127,36
4.720.235,00
5.500.000,00
20.826.375,00
3.024.000,00
268.380,96
3.554.726,00
495.455,00
7.483.623,00
1.018.182,00
106.903,50
69.600,00
177.600,00
2.821.500,00
64.137.268,89
2.304.545,49
165.000,00
436.356,00
14.138.208,00
75.000,00
8.105.536,00
673.920,00
53.000,00
3.951.525,00
25.036.380,00
44.394.300,00
54.801.600,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 6
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
17.763.300,00
76.250,00
358.340,00
10.000.000,00
90.388,80
13.262.671,08
13.230.000,00
877.500,00
5.232.772,34
268.772.727,42
3.285.000,00
57.944,00
7.280.000,00
5.795.454,75
96.727.271,50
39.000,00
67.500,00
199.990,00
2.640.000,00
55.000,00
68.998.800,00
919.800,00
5.381.976,60
291.668,00
1.131.363,17
15.570.324,00
1.643.978,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 7
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
722.250,00
315.000,00
560.000,00
3.264.000,00
1.400.000,25
87.750,00
6.120.000,00
3.685.500,00
3.744.000,00
3.022.500,00
7.527.325,00
3.797.683,20
25.650.000,00
558.600,00
3.599.933,64
1.141.812,00
161.000,00
320.000,00
26.231.310,00
7.199.999,84
929.724,84
5.796.000,00
14.597.700,00
7.241.850,00
885.816,00
29.789.184,00
712.087,20
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 8
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
1.782.000,00
2.481.873,35
3.000.000,00
9.000.818,10
20.805.000,00
356.509.709,00
0,00
1.311.500,00
5.760.000,00
25.980.600,00
6.036.365,00
1.877.850,00
132.481.927,86
26.818.182,00
9.715.950,00
10.193.181,86
3.800.725,00
19.533.602,00
46.960.233,00
781.508,00
572.000,00
7.400.250,00
349.125,00
8.778.000,00
38.181,82
1.391.038,26
764.750,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 9
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
217 T0820 INTUNAL FORTE TABLET TABLET 0 83 600 100 6 62.700,00 376
218 I0223 INVICLOT INJEKSI 5000 IU / ML VIAL 516 198 830 1 830 39.000,00 32.370
219 IA000000042 IOPAMIRO INJEKSI 300 MG 100 ML VIAL 10 8 44 1 44 318.182,00 14.000
220 I0191 IOPAMIRO INJEKSI 300 MG 50 ML VIAL 218 113 550 1 550 150.909,00 82.999
221 I2664 IOPAMIRO INJEKSI 370 MG 100 ML BOTOL 4 1 3 1 3 335.455,00 1.006
222 I2670 IOPAMIRO INJEKSI 370 MG 50 ML VIAL 2 1 5 1 5 180.909,09 904
223 TA000000019 IRESSA TABLET 250 MG TABLET 680 242 970 10 97 2.681.397,60 260.095
224 I0443 KABIVEN PERIPHERAL INJEKSI 1440 ML BAG 64 17 52 1 52 268.400,00 13.956
225 I0199 KAEN 3A FLABOT 0 8 54 1 54 9.091,00 490
226 S0048 KALITAKE SACCHET 40 60 360 20 18 140.005,35 2.520
227 T0328 KALNEX TABLET 500 MG TABLET 0 258 1.800 100 18 260.000,00 4.680
228 Z0114 KALTROFEN SUPPOSITORIA 100 MG SUPPOS 0 3 20 10 2 110.000,00 220
229 T0329 KALTROFEN TABLET 50 MG TABLET 0 15 90 30 3 75.000,00 225
230 T0333 KALXETIN TABLET 20 MG TABLET 0 33 210 30 7 156.000,00 1.092
231 S0177 KANDISTATIN SUSP. 100.000 IU/ML, BTL 12 ML BOTOL 31 25 139 1 139 28.000,00 3.892
232 Z0297 KENALOG IN ORABASE 5GR TUBE 0 4 27 1 27 44.600,00 1.204
233 I0058 KETESE INJEKSI AMPUL 35 277 1.850 5 370 235.000,00 86.950
234 T0823 KETESE TABLET TABLET 0 50 350 50 7 379.480,00 2.656
235 Z0194 KETOMED KRIM 15 GRAM TUBE 4 1 2 1 2 19.665,00 39
236 Z0240 KETOMED SHAMPOO 60 ML BOTOL 0 3 20 1 20 30.043,75 600
237 T0337 KETOSTERIL TABLET TABLET 600 458 2.500 100 25 552.000,00 13.800
238 I0214 KIDMIN 7.2% 200 ML BOTOL 874 314 1.261 1 1.261 41.818,00 52.732
239 Z0146 KLODERMA KRIM 10 GRAM TUBE 0 4 27 1 27 23.750,00 641
240 Z0119 KLODERMA KRIM 5 GRAM TUBE 6 2 8 1 8 15.960,00 127
241 Z0224 KLODERMA OINT 10 GRAM TUBE 0 4 27 1 27 23.750,00 641
242 I0805 KOATE INJEKSI 480 IU - 600 IU BOTOL 346 118 456 1 456 1.954.467,65 891.237
243 T0323 KSR TABLET TABLET 2.300 1.300 6.500 100 65 143.636,37 9.336
Halaman 9 dari 19
HARGA
P)
1
376.200,00
32.370.000,00
14.000.008,00
82.999.950,00
1.006.365,00
904.545,45
260.095.567,20
13.956.800,00
490.914,00
2.520.096,30
4.680.000,00
220.000,00
225.000,00
1.092.000,00
3.892.000,00
1.204.200,00
86.950.000,00
2.656.360,00
39.330,00
600.875,00
13.800.000,00
52.732.498,00
641.250,00
127.680,00
641.250,00
891.237.248,40
9.336.364,05
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 10
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
981.750,00
2.082.512,00
1.920.000,00
6.615.000,00
27.818.181,36
980.000,00
3.726.000,00
266.750,00
671.363,00
4.054.500,00
204.546,00
1.976.000,00
1.090.908,00
768.500,00
5.827.500,00
244.553.129,06
0,00
4.365.000,00
2.307.272,76
208.690,00
3.855.390,00
93.600,00
862.125,00
125.685,00
17.600.000,00
16.920.000,00
520.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:21 Halaman 11
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
291.558,00
2.044.184,00
439.608,00
11.463.636,54
1.079.200,00
6.468.000,00
731.500,00
409.687,50
10.224.000,00
6.270.000,00
82.000,00
1.481.873,40
1.418.184,00
945.000,00
675.750,00
114.750,00
1.336.500,00
5.334.669,00
3.420.000,00
25.627.500,00
3.272.720,00
73.799.880,00
246.050,00
1.090.908,00
5.617.920,00
1.209.084,80
11.226.600,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 12
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
399.000,00
800.000,00
4.725.000,00
3.270.285,00
418.000,00
289.500,00
624.000,00
1.386.000,00
41.961.310,00
134.805,00
1.824.000,00
966.000,00
54.290.800,00
560.000,00
591.500,00
403.767,96
8.725.096,00
1.440.000,00
1.795.200,00
62.636.362,10
1.121.250,00
2.640.000,00
25.843.350,00
35.017.500,00
18.630.000,00
12.000.000,00
87.500.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 13
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
325 T1359 OSCAL KAPSUL 0,25 MCG KAPSUL 0 75 510 30 17 157.700,00 2.680
326 T0498 OSSORAL 200 TABLET TABLET 0 65 420 60 7 60.000,00 420
327 T0499 OSSORAL 800 TABLET TABLET 0 185 1.260 60 21 234.000,00 4.914
328 T1083 OSTEOCAL TABLET KAPLET 4.104 678 504 72 7 36.591,36 256
329 I0474 OVIDREL INJEKSI 250 MCG VIAL 0 4 27 1 27 579.000,00 15.633
330 Z0145 OXOFERIN SOL BOTOL 0 2 14 1 14 58.500,00 819
331 IA000000048 PACLITAXEL INJEKSI 30 MG/5ML VIAL 0 218 1.482 1 1.482 245.491,17 363.817
332 T1330 PANTOGAR KAPSUL KAPSUL 0 11 45 45 1 219.450,00 219
333 I0954 PANTOPRAZOLE INJEKSI VIAL 0 62 422 1 422 40.000,00 16.880
334 T0508 PANTOZOL TABLET 20MG TABLET 0 25 168 7 24 93.600,00 2.246
335 T0509 PANTOZOL TABLET 40MG TABLET 0 6 42 7 6 118.800,00 712
336 T0505 PARIET TABLET 10 MG TABLET 0 2 14 14 1 205.193,00 205
337 IA000000033 PEGASYS PREFILLED SYRINGE 135 MCG BUAH 33 6 8 1 8 979.831,82 7.838
338 I2655 PEGASYS PREFILLED SYRINGE 180 MCG VIAL 0 5 34 1 34 1.134.745,45 38.581
339 I0291 PEHACAIN INJEKSI 2 % AMPUL 200 105 520 20 26 56.601,00 1.471
340 I0857 PEHAMOXIL INJEKSI 1000 MG VIAL 0 24 163 1 163 10.609,20 1.729
341 I0830 PELASTIN INJEKSI BOTOL 531 125 319 1 319 230.872,20 73.648
342 I0738 PERDIPINE INJEKSI 10 MG AMPUL 80 45 230 10 23 1.118.262,04 25.720
343 T1306 PETRAZOLE KAPSUL TABLET 0 7 48 12 4 176.700,00 706
344 I0971 PHINEV INJEKSI 0.1 % 1 ML VIAL 190 38 70 10 7 70.359,10 492
345 I0485 PICYN INJEKSI 1500 MG VIAL 152 81 399 1 399 121.250,00 48.378
346 I0297 PIRALEN INJEKSI AMPUL 1.590 590 2.420 5 484 18.750,00 9.075
347 Z0526 PIROTOP KRIM 10 GRAM TUBE 0 1 7 1 7 50.326,25 352
348 I0834 PITOGIN INJEKSI AMPUL 80 74 420 10 42 56.250,00 2.362
349 I0299 PLASBUMIN INJEKSI 20% 100 ML BOTOL 0 1 6 1 6 818.182,00 4.909
350 I0487 PLASBUMIN INJEKSI 20% 50 ML BOTOL 0 7 48 1 48 376.363,64 18.065
351 I0298 PLASBUMIN INJEKSI 25% 50 ML BOTOL 77 17 39 1 39 666.115,00 25.978
alaman 13 dari 19
HARGA
P)
1
2.680.900,00
420.000,00
4.914.000,00
256.139,52
15.633.000,00
819.000,00
363.817.913,94
219.450,00
16.880.000,00
2.246.400,00
712.800,00
205.193,00
7.838.654,56
38.581.345,30
1.471.626,00
1.729.299,60
73.648.231,80
25.720.026,92
706.800,00
492.513,70
48.378.750,00
9.075.000,00
352.283,75
2.362.500,00
4.909.092,00
18.065.454,72
25.978.485,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 14
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
4.909.090,92
3.534.544,00
612.000,00
366.600,00
1.319.580,00
715.500,00
810.000,00
2.314.350,25
4.252.780,00
6.762.000,00
357.000,00
600.000,00
23.760.000,00
113.050,00
15.064.337,86
2.265.452,00
507.273,00
10.213.276,50
2.269.006,50
6.087.272,72
333.000,00
1.108.800,00
1.075.000,00
896.000,00
191.668,00
9.900.000,00
1.848.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 15
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
3.150.000,00
8.544.960,00
4.718.700,00
2.208.000,00
1.845.000,00
2.000.000,00
1.620.000,00
17.180,00
11.727.270,00
28.909.115,00
2.682.000,00
3.010.500,00
312.900,00
1.134.000,00
5.130.000,00
8.880.000,00
1.232.000,00
4.995.000,00
4.308.302,00
12.466.630,00
633.000,00
2.203.308,96
17.550.000,00
72.520.000,00
1.440.000,00
6.480.000,12
9.664.200,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 16
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
406 T0925 SIRDALUD TABLET 2 MG TABLET 200 125 700 100 7 764.446,00 5.351
407 I0230 SNMC INJEKSI AMPUL 0 47 320 1 320 78.210,00 25.027
408 I0691 SOJOURN 250 ML BOTOL 13 4 14 1 14 1.199.900,00 16.798
409 I0916 SOMATOSTATIN INJEKSI VIAL 0 4 27 1 27 668.800,00 18.057
410 T0927 SPASMOMEN TABLET TABLET 0 30 210 30 7 186.000,00 1.302
411 YA000000003 SPIRIVA 18 MCG COMBO + HANDIHALER BOX 95 53 265 1 265 138.675,45 36.748
412 TA000000030 STALEVO TABLET TABLET 0 188 1.290 30 43 242.727,00 10.437
413 T0675 STELAZINE TABLET 5 MG TABLET 0 450 3.100 100 31 94.833,75 2.939
414 Z0295 STERIMAR NASAL HYGIENE BOTOL 23 9 38 1 38 94.050,00 3.573
415 N0017 STESOLID INJEKSI 10 MG / 2ML AMPUL 0 79 535 5 107 52.000,00 5.564
416 N0018 STESOLID RECTAL 5 MG/2,5 ML TUBE 80 14 15 5 3 52.390,80 157
417 T1500 STOBLED TABLET TABLET 0 89 608 16 38 102.600,00 3.898
418 T0626 STOMACAIN TABLET TABLET 0 17 100 100 1 99.000,00 99
419 I0343 STREPTASE INJEKSI 1.500.000 IU / VIAL VIAL 14 3 6 1 6 2.990.909,08 17.945
420 I0967 SULBACEF INJEKSI 500 MG VIAL 0 1 5 1 5 169.750,00 848
421 T0934 SULCOLON TABLET TABLET 0 117 800 100 8 679.000,00 5.432
422 IA000000008 SUPRANE 240 ML VIAL 4 1 3 1 3 2.517.500,00 7.552
423 I*000000001 SURVANTA INJEKSI AMPUL 1 1 6 1 6 2.881.101,00 17.286
424 YA000000010 SYMBICORT 160/4,5 DOSE BOTOL 164 31 47 1 47 106.909,00 5.024
425 T6355 TALION TABLET 10 MG TABLET 0 3 30 30 1 72.150,00 72
426 I2675 TAMOLIV INFUS BOTOL 0 97 660 1 660 38.000,00 25.080
427 T0965 TANAPRES TABLET 10 MG TABLET 8.670 1.935 4.500 30 150 106.581,82 15.987
428 T0940 TANAPRESS TABLET 5 MG TABLET 4.920 843 810 30 27 57.818,18 1.561
429 Z0162 TANTUM VERDE SOL BOTOL 0 2 14 1 14 21.000,00 294
430 I2603 TAPROS INJEKSI 1,88 MG VIAL 3 1 4 1 4 636.344,10 2.545
431 I0946 TAPROS INJEKSI 11,25 MG (3M) VIAL 5 2 9 1 9 2.454.255,17 22.088
432 I0506 TAPROS INJEKSI 3,75 MG VIAL 6 5 28 1 28 454.406,70 12.723
alaman 16 dari 19
HARGA
P)
1
5.351.122,00
25.027.200,00
16.798.600,00
18.057.600,00
1.302.000,00
36.748.994,25
10.437.261,00
2.939.846,25
3.573.900,00
5.564.000,00
157.172,40
3.898.800,00
99.000,00
17.945.454,48
848.750,00
5.432.000,00
7.552.500,00
17.286.606,00
5.024.723,00
72.150,00
25.080.000,00
15.987.273,00
1.561.090,86
294.000,00
2.545.376,40
22.088.296,53
12.723.387,60
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 17
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
3.042.279,00
581.700.000,00
2.181.774,24
5.751.000,00
698.225,78
47.600.921,06
322.000,00
772.727,35
1.436.400,00
1.496.880,00
2.889.096,00
1.289.250,00
580.000,00
2.058.000,00
324.000,00
1.800.000,00
1.500.000,00
408.172,00
1.176.000,00
125.000,00
133.000,00
3.068.181,72
128.000,00
23.100.000,00
2.090.000,00
8.327.085,00
3.360.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 18
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
853.050,00
4.655.000,00
859.800,00
20.454.000,00
1.653.000,00
1.186.912,00
480.000,00
3.105.200,00
1.666.000,00
238.000,00
8.932.000,00
3.969.000,00
1.160.000,00
12.228.505,00
1.080.000,00
992.726,00
1.155.165,00
6.583.500,00
358.675,00
194.610,00
262.500,00
2.880.000,00
213.000.000,00
6.022.250,00
266.388,00
1.290.797,80
345.000,00
Dicetak Oleh : WENI Hari :Kamis Tanggal : 27/Aug/2015 Jam : 08:17:22 Halaman 19
No. KODE NAMA OBAT SATUAN STOK RERATA USULAN INDEKS USULAN HARGA BOX JUMLAH HARGA
GUDANG 30/04/2015 (BOX) (RP) (RP)
1 2 3 4 5 6 7 8 9 10 11
HARGA
P)
1
1.487.700,00
190.654,52
20.615.748,75
36.818.182,35
1.900.000,00
676.280.568,01
867.628.056,80
543.908.624,81
676.280.568,01
867.628.056,80
558.570.833,21