1.

SATUAN KERJA ADALAH NAMA APOTEK, KLINIK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
KALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
3. RENCANA KEBUTUHAN TAHUN 2018 ADALAH RENCANA KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2016
4. RENCANA PENGADAAN TAHUN 2018 ADALAH RENCANA OBAT DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2018
5. SURAT PENGANTAR DAN LAMPIRAN HARUS DI TANDATANGANI OLEH KEPALA SATUAN KERJA DAN DIBERI STEMPEL
6. MOHON UNTUK TIDAK MELAKUKAN PENAMBAHAN MAUPUN PENGURANGAN BARIS/KOLOM PADA FORMAT

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2018

SATUAN KERJA : RSUD MUNYANG KUTE REDELONG

NO NAMA OBAT SATUAN SISA STOK PER 31 PEMAKAIAN JUMLAH RENCANA RENCANA REALISASI
DESEMBER 2016 RATA-RATA PER KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN
BULAN SELAMA TAHUN 2018 TAHUN 2018 TAHUN 2018 TAHUN 2016
2016

(a) (b) (c) = (b) x 18 (d) = (c) - (a) (e)

1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44 Tab 0 0 0
mg Ca/Na EDTMP, 5-46 ?g samarium, dan 1850 ± 185 mbq samarium 153
per ml

2 Adefovir dipivoksil tab 10 mg Tab 0 0 0

3 Afatinib tab sal selaput 40 mg Tablet 0 0 0
4 Air untuk injeksi amp 20 ml Ampul 0 0 0
5 Air untuk injeksi amp 25 ml Ampul 3240 900 16200 12960 12960 8000
6 Air untuk irigasi lar inf 1000 ml Botol 0 0 0
7 Akarbose tab 100 mg Tab 0 0 0
8 Akarbose tab 50 mg Tab 0 0 0
9 Albendazol susp 200 mg/5 ml Botol 0 0 0
10 Albendazol tab 400 mg Tab 0 0 0
11 Albumin serum normal (human albumin) inj 20% 100 ml Botol 0 0 0
12 Albumin serum normal (human albumin) inj 20% 50 ml Botol 0 0 0
13 Albumin serum normal (human albumin) inj 25% 100 ml Botol 0 0 0
14 Albumin serum normal (human albumin) inj 25% 20 ml Botol 0 0 0
15 Albumin serum normal (human albumin) inj 25% 50 ml Botol 3 10 180 177 177 85
16 Albumin serum normal (human albumin) inj 5% 250 ml Botol 0 0 0
17 Albumin serum normal (human albumin) inj 5% 50 ml Botol 0 0 0
18 Alopurinol tab 100 mg Tab 0 500 9000 9000 9000 2000
19 Alopurinol tab 300 mg Tab 0 0 0
20 Alprazolam tab 0,25 mg Tab 0 0 0
21 Alprazolam tab 0,5 mg Tab 0 0 0
22 Alprazolam tab 1 mg Tab 4500 2000 36000 31500 31500 10000
23 Alteplase serb inj 50 mg/vial Vial 0 0 0
24 Amfoterisin B inj 50 mg/10 ml (i.v.) Ampul 0 0 0
25 Amfoterisin B salep mata 1% Tube 0 0 0
26 Amfoterisin B salep mata 3% Tube 0 0 0
27 Amikasin inj 250 mg/ml Vial 0 0 0
28 Amilorid tab 2,5 mg Tab 0 0 0
29 Amilorid tab 5 mg Tab 0 0 0
30 Aminofilin inj 24 mg/ml Ampul 930 4 72 -858 0 0
31 Aminofilin tab 150 mg Tab 0 0 0
32 Aminofilin Tab 200 mg Tab 3110 3100 55800 52690 52690 0
33 Amiodaron inj 150 mg/3 ml Ampul 0 0 0
34 Amiodaron tab 200 mg Tab 0 0 0
35 Amitriptilin tab sal 25 mg Tab sal 2800 1200 21600 18800 18800 10000
36 Amlodipin tab 10 mg Tab 1170 1200 21600 20430 20430 4980
37 Amlodipin tab 5 mg Tab 0 1800 32400 32400 32400 0
38 Amoksisilin drops 100 mg/ml Botol 0 0 0
39 Amoksisilin sir forte 250 mg/5 ml Botol 0 0 0
40 Amoksisilin sir kering 125 mg/5 ml Botol 125 50 900 775 775 320
41 Amoksisilin tab 250 mg Tab 0 0 0
42 Amoksisilin tab 500 mg Tab 4900 1000 18000 13100 13100 11400
43 Ampisilin serb inj 1000 mg/vial Vial 0 10 180 180 180 540
44 Ampisilin serb inj 250 mg/vial Vial 0 0 0
45 Analog insulin : fast acting inj 100 UI/ml (kemasan vial, cartridge Vial/Cartridge 0 0 0
disposible, penfil cartridge)
46 Analog insulin : intermediate acting inj 100 UI/ml (kemasan vial, cartridge vial/cartridge 0 0 0
disposible, penfill cartridge)
47 Analog insulin : long acting (inj 100 UI/ml ) Vial/Cartridge 0 0 0
48 Analog insulin : long acting (inj 100 UI/ml) Penfill 0 0 0
49 Analog insulin : mix insulin (inj 100 UI/ml) Penfill 0 0 0
50 Analog insulin : mix insulin (inj 100 UI/ml) Vial/Cartr 0 150 2700 2700 2700 650
51 Anastrozol tab 1 mg Tab 0 0 0
52 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 Vial 0 0 0
ml
53 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Tab 0 0 0
hidroksida 200 mg
54 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Botol 0 0 0
hidroksida 200 mg
55 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps 0 0 0
56 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin B 10.000 UI/g Tube 0 0 0

57 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Tube 0 0 0

58 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Botol 0 0 0
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g

59 Antimalaria kombinasi : sulfadoksin 500 mg + primetamin 25 mg Kaps 0 0 0

60 Aripiperazol oral solution 1 mg/ml Botol 0 0 0
61 Aripiperazol tab discmelt 10 mg Tab 0 0 0
62 Aripiperazol tab discmelt 15 mg Tab 0 0 0
63 Artemether inj 80 mg/ml Ampul 0 0 0
64 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 0 0 0
65 Articulating paper kertas warna penanda oklusi Kertas warna penanda oklusi 0 0 0
66 Asam asetilsalisilat (asetosal) tab 100 mg Tab 0 0 0
67 Asam asetilsalisilat (asetosal) tab 80 mg Tab 3100 2500 45000 41900 41900 20000
68 Asam askorbat (vitamin C) tab 250 mg Tab 0 0 0
 69 Asam askorbat (vitamin C) tab 50 mg Tab 1000 700 12600 11600 11600 3000
70 Asam folat tab 0,4 mg Tab 0 0 0
71 Asam folat tab 1 mg Tab 7000 1500 27000 20000 20000 20000
72 Asam folat tab 5 mg Tab 0 0 0
73 Asam fusidat tts mata 1% Botol 0 0 0
74 Asam ibandronat inj 1 mg/ml Vial 0 0 0
75 Asam mefenamat kaps 250 mg Kaps 0 0 0
76 Asam mefenamat kaps 500 mg Kaps 0 2500 45000 45000 45000 16300
77 Asam pipemidat kaps 400 mg Kaps 0 0 0
78 Asam retinoat krim 0,1% Tube 0 0 0
79 Asam salisilat lar 0,1% Botol 0 0 0
80 Asam salisilat salep 10% Tube 0 0 0
81 Asam salisilat salep 2% Tube 0 0 0
82 Asam salisilat salep 5% Tube 0 0 0
83 Asam traneksamat inj 100 mg/ml Ampul 2550 800 14400 11850 11850 5800
84 Asam traneksamat inj 50 mg/ml Ampul 0 0 0
85 Asam traneksamat tab 500 mg Tab 12800 600 10800 -2000 0 16000
86 Asam ursodeoksikolat kaps 250 mg Kaps 420 90 1620 1200 1200 510
87 Asam zoledronat inf 4 mg/100 ml Vial 0 0 0
88 Asetazolamid tab 250 mg Tab 0 0 0
89 Asiklovir salep mata 3% Tube 0 0 0
90 Asiklovir tab 200 mg Tab 0 50 900 900 900 0
91 Asiklovir tab 400 mg Tab 0 50 900 900 900 750
92 Asparaginase serb inj 10.000 UI/vial Vial 0 0 0
93 Atapulgit 600 mg Tab 0 0 0
94 Atapulgit tab 630 mg Tablet 0 0 0
95 Atapulgit tablet 650 mg Tab 0 0 0
96 Atapulgit tablet 750 mg Tab 0 0 0
97 Atenolol tab 100 mg Tab 0 0 0
98 Atenolol tab 50 mg Tab 0 0 0
99 Atorvastatin tab 10 mg Tab 0 0 0
100 Atorvastatin tab 20 mg Tab 0 120 2160 2160 2160 0
101 Atrakurium inj 10 mg/ml (i.v) Vial 230 15 270 40 40 345
102 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 150 2700 2700 2700
103 Atropin inj 1 mg/ml (i.m./i.v./s.k) Ampul 0 0 0
104 Atropin tab 0,5 mg Tab 0 0 0
105 Atropin tts mata 0,5% Botol 0 0 0
106 Atropin tts mata 1% Botol 0 0 0
107 Azatioprin tab 50 mg Tab 0 0 0
108 Azitromisin serb inj 500 mg Vial 200 10 180 -20 0 350
109 Azitromisin sir kering 200 mg/5 ml Botol 25 10 180 155 155 0
110 Azitromisin tab 250 mg Tab 0 0 0
111 Azitromisin tab 500 mg Tab 200 500 9000 8800 8800 2470
112 Bahan tumpatan sementara lar, serb Botol 0 0 0
113 Barium sulfat serb 92 g/100 ml Botol 0 0 0
114 Barium sulfat susp 2,2% Botol 0 0 0
115 Barium sulfat susp 55% Botol 0 0 0
116 Barium sulfat susp 65% Botol 0 0 0
117 Bedak salisil serb 2% Botol 80 15 270 190 190 50
118 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial 0 0 0
119 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial 0 0 0
120 Beractant susp 25 mg/ml (intratekal) Botol 0 0 0
121 Beraprost sodium tab 20 mcg Tab 0 0 0
122 Betahistin tab 24 mg Tab 0 0 0
123 Betahistin tab 6 mg Tab 2520 2000 36000 33480 33480 17130
124 Betaksolol tts mata 0,5% Botol 0 0 0
125 Betametason krim 0,1% Tube 0 10 180 180 180 0
126 Betametason krim 0,5 mg/g Tube 0 0 0
127 Betametason salep 0,1% Tube 0 0 0
128 Betametason tts mata 1 mg/ml Botol 0 0 0
129 Bevasizumab inj 25 mg/ml Vial 0 0 0
130 Bikalutamid tab sal 150 mg Tab 0 0 0
131 Bikalutamid tab sal 50 mg Tab 0 0 0
132 Bisakodil sup 10 mg Botol 0 0 0
133 Bisakodil sup 5 mg Botol 0 0 0
134 Bisakodil tab sal 5 mg Tab sal 0 0 0
135 Bisoprolol tab 1,25 mg Tab 0 0 0
136 Bisoprolol tab 10 mg Tab 0 0 0
137 Bisoprolol tab 2,5 mg Tab 0 0 0
138 Bisoprolol tab 5 mg Tab 1700 1000 18000 16300 16300 7900
139 Bleomisin serb inj 15 mg/ml Vial 0 0 0
140 Brinzolamid tetes mata Botol 0 0 0
141 Bromokriptin tab 2,5 mg Tab 0 0 0
142 Budesonid cairan ih 0,25mg/ml Botol 0 0 0
143 Budesonid ih 200 mcg/dosis Botol 0 0 0
144 Budesonid serb ih 100 mcg/dosis Botol 0 0 0
145 Budesonid-formoterol (fixed combination)* ih 160/4,5 mcg Botol 0 0 0
146 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol 0 0 0
147 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% Ampul 0 0 0
148 Bupivakain inj 5 mg/ml (p.v.) Ampul 0 0 0
149 Busulfan tab salut 2 mg Tab 0 0 0
150 Coal tar lar 5 % Botol 0 0 0
151 Copper T set/buah 0 0 0
152 Dabigatran eteksilat kaps 110 mg Kaps 0 0 0
153 Dabigatran eteksilat kaps 75 mg Kaps 0 0 0
154 Dakarbazin serb inj 100 mg/vial Vial 0 0 0
155 Dakarbazin serb inj 200 mg/vial Vial 0 0 0
156 Daktinomisin inj 0,5 mg/vial (i.v.) Vial 0 0 0
157 Dapson tab scored 100 mg Tab 0 0 0
158 Daunorubisin serb inj 20 mg/vial Vial 0 0 0
159 Deferasiroks tab disp 250 mg Tab 0 0 0
160 Deferasiroks tab disp 500 mg Tab 0 0 0
161 Deferipron lar oral 100 mg/ml Botol 0 0 0
162 Deferipron tab sal 500 mg Botol 0 0 0
163 Deferoksamin mesilat serb inj 500 mg/vial Vial 0 0 0
164 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1225 200 3600 2375 2375 2500
165 Deksametason tab 0,5 mg Tab 0 50 900 900 900 0
166 Deksametason tab 4 mg Tab 0 0 0
167 Deksmedetomidin Inj 100 mcg/ml Ampul 0 0 0
168 Desmopresin nasal spray 10 mcg/puf Botol 0 0 0
169 Desmopresin tab 0,1 mg Tab 0 0 0
170 Desmopresin tab 0,2 mg Tab 0 0 0
171 Desogestrel tab 75 mcg Tab 0 0 0
172 Desoksimetason gel 0,05% Tube 0 0 0
173 Desoksimetason krim 0,25% Tube 0 0 0
174 Desoksimetason salep 0,25% Tube 0 0 0
175 Dialisa peritoneal lar intraperitonial Botol 0 0 0
176 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 0 0 0
177 Diazepam lar rektal 10 mg/2,5 ml Botol 90 50 900 810 810 500
178 Diazepam lar rektal 5 mg/2,5 ml Botol 0 0 0
179 Diazepam tab 2 mg Tab 100 1800 1800 1800 1000
180 Diazepam tab 5 mg Tab 4500 1200 21600 17100 17100 12000
181 Dienogest tab 2 mg Tablet 0 0 0
182 Dietilkarbamazin tab 100 mg Tab 0 0 0
183 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 0 0 0
184 Diflukortolon valerat salep berlemak 0,1% Tube 0 0 0
185 Digoksin inj 0,25 mg/ml Vial 0 0 0
186 Digoksin tab 0,25 mg Tab 10200 10 180 -10020 0 0
187 Diltiazem hcl inj 5 mg/5 ml Ampul 0 0 0
188 Diltiazem hcl tab 30 mg Tab 7100 100 1800 -5300 0 0
189 Diltiazem inj 25 mg/5 ml Ampul 0 0 0
190 Diltiazem kaps SR 100 mg Kaps 2370 200 3600 1230 1230 5010
191 Diltiazem kaps SR 200 mg Kaps 0 0 0
192 Diltiazem serb inj 10 mg/10 ml Ampul 0 0 0
193 Diltiazem serb inj 50 mg/vial Vial 20 2 36 16 16 50
194 Diltiazem tab 30 mg Tab 0 0 0
195 Dimenhidrinat tab 50 mg Tab 0 0 0
196 Dinatrium edetat tts mata 0,35% Botol 0 0 0
197 Dinatrium klodronat inj 60 mg/ml Botol 0 0 0
198 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic Vial 0 0 0
acid/vial
199 Dobutamin inj 12,5 mg/ml Vial 0 0 0
200 Dobutamin inj 25 mg/ml Vial 40 10 180 140 140 130
201 Dobutamin inj 50 mg/ml Vial 0 0 0
202 Doksazosin mesilat tab 1 mg Tab 0 0 0
203 Doksazosin mesilat tab 2 mg Tab 0 0 0
204 Doksazosin tab 1 mg Tab 0 0 0
205 Doksazosin tab 2 mg Tab 0 0 0
206 Doksisiklin kaps 100 mg Kaps 0 50 900 900 900 0
207 Doksisiklin kaps 50 mg Kaps 0 0 0
208 Doksorubisin serb inj 10 mg/vial (i.v.) Vial 0 0 0
209 Doksorubisin serb inj 50 mg/vial Vial 0 0 0
210 Domperidon susp 5 mg/5 ml Botol 0 60 1080 1080 1080 0
211 Domperidon tab 10 mg Tab 3150 2000 36000 32850 32850 22000
212 Domperidon tts 5 mg/ml Botol 0 0 0
213 Donepezil tab 5 mg Tab 0 0 0
214 Donepezil tab ef 10 mg Tab ef 0 0 0
215 Dopamin inj 40 mg/ml Vial 0 10 180 180 180 40
216 Dosetaksel inj 40 mg/ml Ampul 0 0 0
217 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial 0 0 0
calcium trisodium/ml
218 Dutasterid kaps 0,5 mg Kaps 0 0 0
219 Efavirens tab sal 600 mg Tab sal 0 0 0
220 Efavirenz tab 200 mg Tablet 0 0 0
221 Efedrin inj 50 mg/ml Ampul 0 0 0
222 Eksemestan tab 25 mg Tab 0 0 0
223 Enoksaparin sodium inj 20 mg/0,2 ml Ampul 0 0 0
224 Enoksaparin sodium inj 40 mg/0,4 ml Ampul 0 0 0
225 Enoksaparin sodium inj 60 mg/0,6 ml Ampul 0 0 0
226 Entekavir tab sal selaput 0,5 mg Tablet 0 0 0
227 Entekavir tab sal selaput 1 mg Tablet 0 0 0
228 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 0 0 0
229 Epinefrin (adrenalin) inj 1 mg/ml Ampul 200 30 540 340 340 0
230 Epirubisin serb inj 2 mg/ml Vial 0 0 0
231 Epirubisin serb inj 50 mg Vial 0 0 0
232 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps 0 0 0
233 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol 0 0 0
234 Ergotamin tab 1 mg Tab 0 0 0
235 Eritromisin kaps 250 mg Kaps 0 0 0
236 Eritromisin sir 200 mg/5 ml Botol 0 0 0
237 Eritromisin tab 500 mg Tab 0 0 0
238 Eritropoetin-alfa inj 10.000 UI/ml Vial 0 0 0
239 Eritropoetin-alfa inj 2.000 UI/ml Vial 0 0 0
240 Eritropoetin-alfa inj 3.000 UI/ml Vial 0 0 0
241 Eritropoetin-beta inj 2000 UI/0,3 ml Vial 0 0 0
242 Erlotinib tab sal selaput 100 mg Tab 0 0 0
243 Erlotinib tab sal selaput 150 mg Tab 0 0 0
244 Esomeprazole inj 40 mg/vial Vial 0 30 540 540 540 60
245 Estrogen terkonjugasi tab sal 0,3 mg Tab sal 0 0 0
246 Estrogen terkonjugasi tab sal 0,625 mg Tab sal 0 0 0
247 Etambutol tab 250 mg Tab 0 0 0
248 Etambutol tab 400 mg Tab 0 0 0
249 Etambutol tab 500 mg Tab 0 0 0
250 Etanol 70% cairan 70% Botol 0 0 0
251 Etil klorida semprot 100 ml Botol 10 3 54 44 44 20
252 Etinilestradiol tab 0,05 mg Tab 0 0 0
253 Etinilestradiol tab 0,5 mg Tab 0 0 0
254 Etonogestrel implan 68 mg Set 0 0 0
255 Etoposid inj 20 mg/ml Vial 0 0 0
256 Etoposid kaps 100 mg Kaps 0 0 0
257 Eugenol Botol 0 0 0
258 Everolimus tab 0,25 mg Tab 0 0 0
259 Everolimus tab 0,5 mg Tab 0 0 0
260 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial 0 0 0
261 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial 0 0 0
262 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi Vial 0 0 0
IX 25 UI, faktor koagulasi X 14-35 serb inj 250 IU/10 ml
263 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi Vial 0 0 0
IX 25 UI, faktor koagulasi X 14-35 serb inj 500 UI/10 ml UI

264 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi Vial 0 0 0

265 Faktor VIII (konsentrat) serb inj 230 -340 UI Vial 0 0 0

266 Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5 ml Vial 0 0 0
267 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial 0 0 0
268 Faktor VIII (konsentrat) serb inj 500 UI/vial + pelarut 5 ml Vial 0 0 0
269 Faktor VIII serb inj 1000 mg/vial Vial 0 0 0
270 Faktor VIII serb inj 2000 mg/vial Vial 0 0 0
271 Fenitoin Na inj 100 mg/2 ml Ampul 0 0 0
272 Fenitoin Na inj 50 mg/ml Ampul 0 0 0
273 Fenitoin Na kaps 100 mg Kaps 3600 2500 45000 41400 41400 19700
274 Fenitoin Na kaps 30 mg Kaps 0 0 0
275 Fenobarbital inj 50 mg/ml Ampul 565 15 270 -295 0 0
276 Fenobarbital tab 100 mg Tab 0 0 0
277 Fenobarbital tab 30 mg Tab 13600 200 3600 -10000 0 0
278 Fenofibrat kaps 100 mg Kaps 0 0 0
279 Fenofibrat kaps 300 mg Kaps 0 0 0
280 Fenoksimetil penisilin (penisilin V) tab 125 mg Tab 0 0 0
281 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 0 0 0
282 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 0 0 0
283 Fenoterol hbr aerosol 100 mcg/puf Botol 0 0 0
284 Fenoterol hbr cairan ih 0,1% Botol 0 0 0
285 Fentanil inj 0,05 mg/ml (i.v.) Vial 150 225 4050 3900 3900 2930
286 Fentanil patch 12,5 mcg/jam Pack 0 0 0
287 Fentanil patch 25 mcg/jam Pack 0 2 36 36 36 25
288 Fentanil patch 50 mcg/jam Pack 0 0 0
289 Ferrakrilum cairan 1% Botol 0 0 0
290 Ferro fumarat kaps lunak 300 mg Kaps lunak 0 0 0
291 Ferro sulfat sir. 15 mg/5 ml Botol 0 0 0
292 Ferro sulfat tab salut 300 mg Tab sal 0 0 0
293 Filgrastim inj 300 mcg/ml Vial 0 0 0
294 Finasterid tab 5 mg Tab 0 0 0
295 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 450 90 1620 1170 1170 1200
296 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 0 0
297 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul 180 90 1620 1440 1440 1200
298 Fludarabin inj 50 mg/vial Vial 0 0 0
299 Fludarabin tab sal 10 mg Tab 0 0 0
300 Flufenazin inj 25 mg/ml (i.m.) Vial 0 0 0
301 Flukonazol inj 2 mg/ml Ampul 0 0 0
302 Flukonazol kaps 150 mg Kaps 0 0 0
303 Flukonazol kaps 50 mg Kaps 0 0 0
304 Fluoksetin kaps 10 mg Kaps 0 0 0
305 Fluoksetin kaps 20 mg Kaps 0 0 0
306 Fluor kapl 1 mg Kaplet 0 0 0
307 Fluor sediaan topikal Tube 0 0 0
308 Fluor tab 0,5 mg Tab 0 0 0
309 Fluoresein injeksi 10% Ampul 0 0 0
310 Fluoresein tts mata 2,5 mg/ml Botol 0 0 0
311 Fluoro deoxy glucose (FDG) Vial 0 0 0
312 Fluorometolon tts mata 0,1% Botol 0 0 0
313 Fluorourasil Inj 25 mg/ml Vial 0 0 0
314 Fluorourasil inj 250 mg/ml Ampul 0 0 0
315 Fluorourasil inj 50 mg/ml (i.v.) Ampul 0 0 0
316 Fluorourasil serb inj 250 mg Ampul 0 0 0
317 Flusinolon asetonid krim 0,025% Tube 0 0 0
318 Flusinolon asetonid salep 0,025% Tube 0 0 0
319 Flutikason furoat intranasal spray Botol 0 0 0
320 Flutikason propionat cairan ih 0,5 mg/dosis Botol 0 0 0
321 Fondaparinuks inj 2,5 mg/0,5 ml Vial 0 0 0
322 Formokresol Botol 0 0 0
323 Fraksi protein plasma lar inf 5% Botol 0 0 0
324 Framisetin Sulfat Tulle 1% Patch 0 0 0
325 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 530 250 4500 3970 3970 1500
326 Furosemid tab 40 mg Tab 900 800 14400 13500 13500 4600
327 Gabapentin kaps 100 mg Kaps 3450 900 16200 12750 12750 10000
328 Gabapentin kaps 300 mg Kaps 1900 300 5400 3500 3500 4650
329 Gadobutrol macrocyclic Macrocyclic 0 0 0
330 Gadodiamid inj 287 mg/10 ml Vial 0 0 0
331 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial 0 0 0
332 Gadopentetat dimenglumin inj 469 mg/ml Vial 0 0 0
333 Galactose microparticle 200-400 mg micropart/ml Vial 0 0 0
334 Gansiklovir serb inj 500 mg/vial Vial 0 0 0
335 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + Sachet 0 0 0
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
336 Gefitinib tab 250 mg Tab 0 0 0
337 Gemfibrozil kaps 300 mg Kaps 6500 600 10800 4300 4300 5000
338 Gemfibrozil kaps 600 mg Kaps 0 0 0
339 Gemsitabin inj 1000 mg/vial Vial 0 0 0
340 Gemsitabin inj 200 mg/vial Vial 0 0 0
341 Gentamisin inj 10 mg/ml Ampul 0 0 0
342 Gentamisin inj 40 mg/ml Ampul 30 100 1800 1770 1770 800
343 Gentamisin inj 80 mg/ml Ampul 0 0 0
344 Gentamisin salep mata 0,3% Tube 0 0 0
345 Gentamisin tts mata 0,3% Botol 0 0 0
346 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g Sachet 0 0 0

347 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol 0 0 0

348 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial 0 0 0
349 Glibenklamid tab 2,5 mg Tab 0 0 0
350 Glibenklamid tab 5 mg Tab 1400 50 900 -500 0 0
351 Gliklazid tab 80 mg Tab 0 0 0
352 Gliklazid tab MR 30 mg Tab 0 0 0
353 Gliklazid tab SR 60 mg Tab 0 0 0
354 Glikuidon tab 30 mg Tab 0 0 0
355 Glimepirid tab 1 mg Tab 0 0 0
356 Glimepirid tab 2 mg Tab 0 400 7200 7200 7200 0
357 Glimepirid tab 3 mg Tab 0 0 0
358 Glimepirid tab 4 mg Tab 0 100 1800 1800 1800 1000
359 Glipizid tab 10 mg Tab 0 0 0
360 Glipizid tab 5 mg Tab 0 0 0
361 Gliseril trinitrat inj 10 mg/ml Ampul 0 0 0
362 Gliseril trinitrat inj 5 mg/ml Ampul 0 0 0
363 Gliseril trinitrat kaps lepas lambat 2,5 mg Kaps 0 0 0
364 Gliseril trinitrat kaps lepas lambat 5 mg Kaps 0 0 0
365 Gliseril trinitrat tab 0,5 mg Tab sub 0 0 0
366 Gliserin lar 50% Botol 0 0 0
367 Gliserin tts 10 mg/ml Botol 0 0 0
368 Gliserin tts 100 mg/ml Botol 0 0 0
369 Glukosa Larutan Infus 10% steril 100 ml Botol 0 0 0
370 Glukosa Larutan Infus 10% steril 250 ml Botol 0 0 0
371 Glukosa Larutan Infus 10% steril 500 ml Botol 840 60 1080 240 240 1000
372 Glukosa Larutan Infus 5% steril 100 ml Botol 0 0 0
373 Glukosa Larutan Infus 5% steril 250 ml Botol 0 0 0
374 Glukosa Larutan Infus 5% steril 500 ml Botol 460 260 4680 4220 4220 2360
375 Goserelin asetat inj 10,8 mg/vial Vial 0 0 0
376 Goserelin asetat inj 3,6 mg/vial Vial 0 0 0
377 Griseofulvin (micronized) tab 125 mg Tab 0 0 0
378 Griseofulvin (micronized) tab 500 mg Tab 0 0 0
379 Griseofulvin (micronized) tab scored 250 mg Tab 0 0 0
380 Gutta percha dan paper points 15 - 40 mm Roll 0 0 0
381 Gutta percha dan paper points 45 - 80 mm Roll 0 0 0
382 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0 0
383 Haloperidol inj 50 mg/ml (decanoat) Vial 0 0 0
384 Haloperidol tab 0,5 mg Tab 0 0 0
385 Haloperidol tab 1,5 mg Tab 0 0 0
386 Haloperidol tab 2 mg Tab 0 0 0
387 Haloperidol tab 5 mg Tab 0 0 0
388 Haloperidol tts 2 mg/ml Botol 0 0 0
389 Halotan ih Botol 0 0 0
390 Hemodialisa lar konsentrat basis asetat Botol 0 0 0
391 Hemodialisa lar konsentrat basis natrium bikarbonat Botol 0 0 0
392 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial 0 0 0
393 Hepatitis B imunoglobulin (human) inj 0,5 ml Ampul 0 0 0
394 Hepatitis B imunoglobulin (human) Inj 220 IU/ml Vial 0 0 0
395 Hidrogen peroksida cairan 3% Botol 0 0 0
396 Hidrogen peroksida lar. Konsentrat 3% Botol 0 0 0
397 Hidroklorotiazid tab 12,5 mg Tab 0 0 0
398 Hidroklorotiazid tab 25 mg Tab 0 0 0
399 Hidrokortison inj 100 mg/vial Vial 0 0 0
400 Hidrokortison krim 1% Tube 188 3 54 -134 0 0
401 Hidrokortison krim 2,5% Tube 1056 5 90 -966 0 0
402 Hidrokortison serb inj 100 mg/vial Vial 0 0 0
403 Hidrokortison tab 10 mg Tab 0 0 0
404 Hidroksi Klorokuin Inj 50 mg/ml Ampul 0 0 0
405 Hidroksi klorokuin tab 200 mg Tab 0 0 0
406 Hidroksi klorokuin tab 400 mg Tab 0 0 0
407 Hidroksi progesteron inj 125 mg/ml Vial 0 0 0
408 Hidroksi urea tab 500 mg Tab 0 0 0
409 Hidroxyl ethyl starch lar inf 6% Botol 0 0 0
410 Hiosina butilbromida inj 20 mg/ml Ampul 0 0 0
411 Hiosina butilbromida tab 10 mg Tab 0 0 0
412 Homatropin tts mata 2% Botol 0 0 0
413 Human insulin : fast acting inj 100 UI/ml (kemasan cartridge, penfill Cartridge, Penfill Cartridge 0 0 0
cartridge)
414 Human insulin : intermediate acting inj 100 UI/ml (kemasan vial/ Vial 0 0 0
cartridge disposible, penfill cartridge)
415 Human insulin : mix insulin inj 100 UI/ml (kemasan vial, cartridge Vial 0 0 0
disposible, penfill cartridge)
416 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul 0 0 0
417 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul 0 0 0
418 Hydromorphone HCl tab oros 16 mg Tab 0 0 0
419 Hydromorphone HCl tab oros 8 mg Tab 0 0 0
420 Ibuprofen sir 100 mg/5 ml Botol 0 10 180 180 180 0
421 Ibuprofen sir 200 mg/5 ml Botol 0 0 0
422 Ibuprofen tab 200 mg Tab 200 200 3600 3400 3400 2000
423 Ibuprofen tab 400 mg Tab 0 200 3600 3600 3600 1000
424 Idarubisin serb inj 20 mg Vial 0 0 0
425 Ifosfamid serb inj 1000 mg/vial Vial 0 0 0
426 Ifosfamid serb inj 2000 mg/vial Vial 0 0 0
427 Ifosfamid serb inj 500 mg/vial Vial 0 0 0
428 Imatinib mesilat tab 100 mg Tab 0 0 0
429 Imatinib Mesilat tab 400 mg Tab 0 0 0
430 Imidapril tab 10 mg Tab 0 200 3600 3600 3600 2200
431 Imidapril tab 5 mg Tab 0 200 3600 3600 3600 2000
432 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS (Guillain Bare Vial 0 0 0
Syndrom)
433 Imunoglobullin Intravena inj 250 mg/50 ml Botol 0 0 0
434 Indakaterol serb ih 150 mcg Vial 0 0 0
435 Indakaterol serb ih 300 mcg Vial 0 0 0
436 Interferon alfa inj 18 miu Set 0 0 0
437 Iodiksanol vial 320 mg Iodium/50 ml Vial 0 0 0
438 Iodium 131 Botol 0 0 0
439 Iodohippurate sodium I 132 37-74 mbq/ multiple-dose Vial 0 0 0
440 Ioheksol 180-300 mg Iodium/ml Vial 0 0 0
441 Ioheksol 240-350 mg Iodium/ml Vial 0 0 0
442 Ioheksol inj 140-350 mg Iodium/ml Vial 0 0 0
443 Iopamidol 200-300 mg Iodium/ml Vial 0 0 0
444 Iopamidol 300-370 mg Iodium/ml Vial 0 0 0
445 Iopamidol inj 200-370 mg Iodium/ml Vial 0 0 0
446 Iopromid 240 -370 mg Iodium/ml Vial 0 0 0
447 Iopromid 300-370 mg Iodium/ml Vial 0 0 0
448 Ipratropium bromida ih 20mcg/puf Botol 0 0 0
449 Ipratropium bromida ih padat 20 mcg Puf 0 0 0
450 Ipratropium bromida nebulizer 0,025% Botol 0 0 0
451 Irbesartan tab 150 mg Tab 0 0 0
452 Irbesartan tab 300 mg Tab 630 150 2700 2070 2070 990
453 Irinotekan inf 20 mg/ml Ampul 0 0 0
454 Irinotekan inj 20 mg/ml Ampul 0 0 0
455 Isofluran inhalasi 100 ml Botol 0 0 0
456 Isofluran inhalasi 250 ml Botol 6 0.5 9 3 3 0
457 Isoniazid tab 100 mg Tab 0 0 0
458 Isoniazid tab 300 mg Tab 0 0 0
459 Isosorbid dinitrat inj 1 mg/ml (i.v) Ampul 0 0 0
460 Isosorbid dinitrat tab 10 mg Tab 0 0 0
461 Isosorbid dinitrat tab 5 mg Tab 0 50 900 900 900 0
462 IUD Cu T 380 A Set 0 0 0
463 IUD Levonorgestrel Set 0 0 0
464 Ivabradin tab 5 mg Tab 0 0 0
465 k.y jelly Tube gel 0 0 0
466 Kalamin Tube 0 0 0
467 Kalium aspartat tab 300 mg Tab 0 0 0
468 Kalium klorida tab siap larut 300 mg Tab 0 0 0
469 Kalium klorida tab SR 600 mg Tab 0 0 0
470 Kalsitriol kaps lunak 0,25 mcg Kapsul 0 0 0
471 Kalsitriol kaps lunak 0,5 mcg Kapsul 0 0 0
472 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml Ampul 0 0 0
473 Kalsium folinat (leukovorin, Ca) inj 3 mg/ml Vial 0 0 0
474 Kalsium folinat (leukovorin, Ca) inj 5 mg/ml Vial 0 0 0
475 Kalsium folinat (leukovorin, Ca) tab 15 mg Tab 0 0 0
476 Kalsium glukonat inj 100 mg/ml Ampul 0 0 0
477 Kalsium hidroksida bubuk, pasta Tube 0 0 0
478 Kalsium hipoklorit Sachet 0 0 0
479 Kalsium karbonat tab 500 mg Tab 0 0 0
480 Kalsium laktat (kalk) tab 500 mg Tab 1000 50 900 -100 0 0
481 Kalsium polistirena sulfonat ktg 5 g Sachet 0 0 0
482 Kanamisin inj 1.000 mg/ vial Vial 0 0 0
483 Kandesartan tab 16 mg Tab 0 800 14400 14400 14400 3060
484 Kandesartan tab 8 mg Tab 0 500 9000 9000 9000 4590
485 Kapesitabin tab sal 500 mg Tab sal 0 0 0
486 Kaptopril tab 12,5 mg Tab 0 50 900 900 900 500
487 Kaptopril tab 25 mg Tab 900 150 2700 1800 1800 2400
488 Kaptopril tab 50 mg Tab 0 0 0
489 Karbamazepin sir 100 mg/5 ml Botol 0 0 0
490 Karbamazepin tab 100 mg Tab 0 0 0
491 Karbamazepin Tab 200 mg Tablet 2400 250 4500 2100 2100 4100
492 Karbimazol tab 5 mg Tab 0 0 0
493 Karbo adsorben tab 0,5 g Tab 0 0 0
494 Karbogliserin tts telinga 10 % Botol 0 0 0
495 Karboksimetilselulosa tts mata Botol 0 0 0
496 Karbon aktif tab 0,5 mg Tablet 0 0 0
497 Karboplatin inj 10 mg/ml Vial 0 0 0
498 Karvedilol tab 25 mg Tablet 0 0 0
499 Karvediol kaps 6,25 mg Kaps 0 0 0
500 Ketamin inj 100 mg/ml (i.v.) Ampul 12 1 18 6 6 20
501 Ketamin inj 50 mg/ml (i.v.) Ampul 22 8 144 122 122 85
502 Ketokonazol krim 2% Tube 0 0 0
503 Ketokonazol scalp sol 2% Tube 0 0 0
504 Ketokonazol tab 200 mg Tab 100 10 180 80 80 0
505 Ketoprofen sup 100 mg Botol 0 0 0
506 Ketorolak inj 30 mg/ml Ampul 415 1500 27000 26585 26585 10270
507 Klaritromisin sir kering 125 mg/5 ml Botol 0 0 0
508 Klaritromisin sir kering 250 mg/5 ml Botol 0 0 0
509 Klaritromisin tab 500 mg Tab 0 0 0
510 Klindamisin kaps 150 mg Kaps 4900 100 1800 -3100 0 5750
511 Klindamisin kaps 300 mg Kaps 900 200 3600 2700 2700 5000
512 Klobazam tab 10 mg Tab 2200 500 9000 6800 6800 0
513 Klofazimin, micronized kaps 50 mg Kapsul 0 0 0
514 Klofazimin, micronizedkaps 100 mg kapsul 0 0 0
515 Klomifen sitrat tab 50 mg Tab 0 0 0
516 Klomipramin tab 25 Tab 0 0 0
517 Klonazepam kaps 2 mg Botol 0 0 0
518 Klonidin inj 150 mcg/ml Vial 0 0 0
519 Klonidin tab 0,15 mg Tab 0 0 0
520 Klopidogrel tab 75 mg Tab 3270 1800 32400 29130 29130 22230
521 Klopidogrel tab sal selaput 300 mg Tab 0 0 0
522 Kloral hidrat lar Botol 0 0 0
523 Klorambusil tab 2 mg Tab 0 0 0
524 Klorambusil tab sal selaput 5 mg Tab 0 0 0
525 Kloramfenikol kaps 250 mg Kaps 600 100 1800 1200 1200 0
526 Kloramfenikol kaps 500 mg Kaps 0 0 0
527 Kloramfenikol salep kulit 2% Tube 0 0 0
528 Kloramfenikol salep mata 1% Tube 0 0 0
529 Kloramfenikol serb inj 1.000 mg/ml Vial 0 0 0
530 Kloramfenikol susp 125 mg/5 ml Botol 0 0 0
531 Kloramfenikol tetes telinga 3% Botol 0 0 0
532 Kloramfenikol tts mata 0,5% Botol 0 0 0
533 Kloramfenikol tts mata 1% Botol 0 5 90 90 90 0
534 Klorfeniramin tab 4 mg Tab 8000 500 9000 1000 1000 0
535 Klorfenol kamfer mentol (CHKM) Botol 0 0 0
536 Klorheksidin lar 0,2% Botol 0 0 0
537 Klorheksidin lar 15% Botol 0 0 0
538 Klorokuin tab 250 mg Tablet 0 0 0
539 Klorpromazin inj 25 mg/ml (i.m.) Ampul 0 0 0
540 Klorpromazin inj 5 mg/ml (i.m.) Ampul 0 0 0
541 Klorpromazin tab sal 100 mg Tab sal 0 0 0
542 Klorpromazin tab sal 25 mg Tab sal 0 0 0
543 Klortalidon tab 50 mg Tab 0 0 0
544 Klotrimazol tab vagina 100 mg Tab 0 0 0
545 Klozapin tab 100 mg Tab 0 0 0
546 Klozapin tab 25 mg Tab 0 0 0
547 Kodein tab 10 mg Tab 0 0 0
548 Kodein tab 15 mg Tab 0 0 0
549 Kodein tab 20 mg Tab 4800 300 5400 600 600 0
550 Kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg Kaps lunak 0 0 0
551 Kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg Kaps lunak 0 0 0
552 Kolestiramin serb, 4 g Ampul 0 0 0
553 Kolkisin tab 500 mcg Tab 0 0 0
554 Koloid HES BM 130 000 lar inf 6% Botol 0 0 0
555 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab sal Tablet 0 0 0
selaput
556 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 mg Vial 0 0 0

557 Kombinasi : (Difenhidramin 2%, Kalamin 5%, Zinc 10%, Gliserin 5%) lotion Botol 0 0 0

558 Kombinasi : (Sefoperazon 500 mg + Sulbaktam 500 mg) serb inj 1000 mg Vial 0 0 0

559 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + Nevirapin 50 mg) Ped Tablet 0 0 0

Triple FDC
560 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg Vial 0 0 0
561 Kombinasi : artemether 20 mg + lumefantrin 120 mg Kaps 0 0 0
562 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab 0 0 0
563 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab 0 0 0
564 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 0 500 9000 9000 9000 1000
565 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut Tablet 0 0 0
566 Kombinasi : ferro sulfat 200 mg+ as. Folat 0,25 mg Tab sal 0 0 0
567 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg Tab 0 0 0

568 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab 0 0 0

569 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25 Vial 0 0 0
mg + 5 mg
570 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial 0 0 0

571 Kombinasi : Spironolakton 25 mg + Tiabutazid 2,5 mg Tablet 0 0 0

572 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube 0 0 0
573 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab 0 0 0
574 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Botol 0 0 0
575 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 0 0
576 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab 0 0 0
577 Kombinasi: natrium klorida 8,664 mg + kalium klorida 1,32 mg (tetes Botol 0 0 0
mata)
578 Kombinasi: parafin + gliserin + fenolftalein Botol 0 0 0
579 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 Botol 0 0 0
mcg/puf
580 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 mcg ih 50 Botol 0 0 0
mcg/puf
581 Kombinasi: salmeterol 50 mcg +flutikason propionat 100 mcg ih 50 Botol 0 0 0
mcg/puf
582 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol 0 0 0
mcg/puf
583 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg Tab 0 0 0
584 Komposit resin Set 0 0 0
585 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab 700 100 1800 1100 1100 2000
trimetoprim 80 mg
586 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ Tab 0 0 0
trimetoprim 160 mg
587 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : sulfametoksazol Botol 0 5 90 90 90 0
200 mg + trimetoprim 40 mg
588 Kuinin inj 25% (i.v.) Vial 0 0 0
589 Kuinin tab 200 mg Tab 0 0 0
590 Kuinin tab 222 mg Tab 0 0 0
591 Kuinin tab 250 mg Tab 0 0 0
592 Laktulosa sir 3,335 g/5 ml Botol 0 0 0
593 Lamivudin (3TC) tab 150 mg Tab 0 0 0
594 Lamivudin tab 100 mg Tab 0 0 0
595 Lamotrigin tab 50 mg Tablet 0 0 0
596 Lamotrigin tab dispersible 25 mg Tablet 0 0 0
597 Lansoprazol inj 30 mg/ml Vial 1730 100 1800 70 70 3500
598 Lansoprazol kaps 30 mg Kaps 21390 8000 144000 122610 122610 26990
599 Lapatinib tab 250 mg Tab 0 0 0
600 Larutan mengandung Asam Amino (Asam Amino 10%) Botol 0 0 0
601 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Botol 0 0 0
Na+ 2 mEq, Asetat 120 mEq)
602 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl- Botol 0 0 0
52 mEq)
603 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol 0 0 0
elektrolit) 1000 ml
604 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol 0 0 0
elektrolit) 500 ml
605 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, Botol 0 0 0
L-Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)

606 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol 0 0 0
Taurine 0,24 gr/l) : Aminosteril Infant 6%
607 Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Botol 0 0 0
Amino esensial: Asam Amino non esensial = 60 : 40)
608 Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N 11.53 g, Botol 0 0 0
AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)
609 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Botol 0 0 0
Na+ 14 mEq, Cl 94 mEq)
610 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N- Botol 0 0 0
Hepa
611 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 Botol 0 0 0
g/L)
612 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Botol 0 0 0
Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)

613 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, Botol 0 0 0
vitamin dan elektrolit)
614 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 34gr, Botol 0 0 0
Glukosa: 97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal, Akses
peripheral))
615 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 45gr, Botol 0 0 0
Glukosa: 130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400 kkal, Akses
peripheral))

616 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 Botol 0 0 0
gr + Asam Amino 48 gr dgn akses sentral)
617 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 Botol 0 0 0
gr + Asam Amino 40 gr)
618 Larutan mengandung Elektrolit (Kalium Klorida) Botol 0 0 0
619 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Botol 0 0 0
Asetat 28 mEq)
620 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) Botol 0 0 0
621 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol 0 0 0
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

622 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Botol 0 0 0

Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5 mmol/l,
Magnesium 1.0 mmol/l, Chloride 118 mmol/l, Acetate 24 mmol/l, Malate
5.0 mmol/l)

623 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol Botol 0 0 0

60 g/ L + elektrolit)
624 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol 0 0 0
g/ L)
625 Larutan mengandung Karbohidrat (Maltose 100 gr) Botol 0 0 0
626 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g Botol 0 0 0
sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)

627 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol 0 0 0
Sorbitol 50 gr/L)
628 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol 0 0 0
Glukosa 100 gr/L, elektrolit)
629 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol 0 0 0
Glukosa 75 gr/L, elektrolit)
630 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 g, glucose 33 Botol 0 0 0
g, Xylitol 30 g/ L)
631 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, Botol 0 0 0
KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
632 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol 0 0 0
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
633 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol 0 0 0
g)
634 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 Botol 0 0 0
g)
635 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol 0 0 0
g)
636 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi Botol 0 0 0
infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ,
Asetat 38mEQ, Sorbitol 50g)

637 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol 0 0 0
5%)
638 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol 0 0 0
Glukosa 100 gr)
639 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol 0 0 0
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
640 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat Botol 0 0 0
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
641 Larutan mengandung Lipid (Emulsi lemak 20%) Botol 0 0 0
642 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol 0 0 0

643 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml) Botol 0 0 0

644 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Botol 0 0 0
Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
645 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Botol 0 0 0
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
646 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Botol 0 0 0
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
647 Latanoprost tts mata 0,005% Botol 0 0 0
648 Latanoprost tts mata 0,01% Botol 0 0 0
649 Leflunomid tab sal selaput 20 mg Tablet 0 0 0
650 Lenograstim inj 263 mcg/vial Vial 0 0 0
651 Letrozol tab 2,5 mg Tab 0 0 0
652 Leuprorelin asetat serb inj 1,88 mg Vial 0 0 0
653 Leuprorelin asetat serb inj 11,25 mg Vial 0 0 0
654 Leuprorelin asetat serb inj 3,75 mg Vial 0 0 0
655 Levetirasetam tab 250 mg Tablet 0 0 0
656 levetirasetam tab 500 mg Tablet 0 0 0
657 Levofloksasin inf 5 mg/ml Botol 50 20 360 310 310 130
658 Levofloksasin tab 500 mg Tab 10000 450 8100 -1900 0 0
659 Levofloksasin tts mata 0,5% Botol 0 0 0
660 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) Set 0 0 0
661 Levotiroksin tab 100 mcg Tab 0 0 0
662 Levotiroksin tab 50 mcg Tab 0 0 0
663 Lidokain gel 2% Tube 0 0 0
664 Lidokain inj 1 % (infltr) Vial 0 0 0
665 Lidokain inj 100 mg, vial (i.v.) Vial 0 0 0
666 Lidokain inj 2% (infiltr/p.v.) Ampul 400 160 2880 2480 2480 5400
667 Lidokain inj 5% + glukosa (dekstrosa) 5 % Ampul 0 0 0
668 Lidokain spray oral 10% Botol 0 0 0
669 Linestrenol tab 0,5 mg Tab 0 0 0
670 Linestrenol tablet 5 mg Tab 0 0 0
671 Lisinopril tab 10 mg Tab 0 50 900 900 900 0
672 Lisinopril tab 20 mg Tab 0 0 0
673 Lisinopril tab 5 mg Tab 1680 20 360 -1320 0 0
674 Litium karbonat tab 200 mg Tab 0 0 0
675 Litium karbonat tab 400 mg Tab 0 0 0
676 Loperamid tab 2 mg Tab 0 100 1800 1800 1800 0
677 Loratadin tab 10 mg Tab 5400 1100 19800 14400 14400 12700
678 Lorazepam tab 0,5 mg Tab 0 0 0
679 Lorazepam tab 1 mg Tab 0 0 0
680 Lorazepam tab sal 2 mg Tab sal 0 0 0
681 Low molecular weight iron dextran inj 100mg/2 ml Ampul 0 0 0
682 Low molecule feri sucrose inj amp 100 mg/5 ml Ampul 0 0 0
683 Lugol Botol 0 0 0
684 MAA (macro agregate albumin) 0,11-2,5 mg albumin Vial 0 0 0
aggregated/reaction vial
685 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial 0 0 0
686 Magnesium sulfat inj 20% Vial 68 10 180 112 112 0
687 Magnesium sulfat inj 40% Vial 600 10 180 -420 0 0
688 Magnesium sulfat serb, ktg 30 g Sachet 0 0 0
689 Manitol lar infus 20% Botol 0 0 0
690 Maprotilin hcl tab sal 25 mg Tab sal 0 0 0
691 Maprotilin hcl tab sal 50 mg Tab sal 0 0 0
692 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml Vial 0 0 0

693 Mebendazol sir 50 mg/ml Botol 0 0 0

694 Mebendazol tab 100 mg Tan 0 0 0
695 Mebendazol tab 500 mg Tab 0 0 0
696 Medroksi progesteron asetat inj 150 mg/ml Vial 0 0 0
697 Medroksi progesteron asetat inj 200 mg/ml Vial 0 0 0
698 Medroksi Progesteron Asetat Inj 50 mg/ml Vial 0 0 0
699 Medroksi progesteron asetat tab 10 mg Tab 0 0 0
700 Medroksi progesteron asetat tab 100 mg Tab 0 0 0
701 Medroksi progesteron asetat tab 250 mg Tab 0 0 0
702 Medroksi progesteron asetat tab 5 mg Tab 0 0 0
703 Medroksi progesteron asetat tab 500 mg Tab 0 0 0
704 Melfalan tab 2 mg Tab 0 0 0
705 Merkaptopurin tab 50 mg Tab 0 0 0
706 Meropenem serb inj 1000 mg/vial Vial 390 20 360 -30 0 860
707 Meropenem serb inj 500 mg/vial Vial 45 5 90 45 45 80
708 Mesalazin tab sal 250 mg Tab 0 0 0
709 Mesna inj 100 mg/ml Vial 0 0 0
710 Metadon sir 50 mg/5 ml Botol 1000 ml 0 0 0
711 Metamizol Inj 500 mg/ml Ampul 400 120 2160 1760 1760 345
712 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut 0 0 0

713 Metformin tab 500 mg Tab 6900 1200 21600 14700 14700 4000
714 Metformin tab 850 mg Tab 0 0 0
715 Metildopa tab sal 250 mg Tab 0 0 0
716 Metilergometrin inj 0,2 mg/ml Ampul 223 25 450 227 227 0
717 Metilergometrin tab salut 0,125 mg Tab sal 0 850 15300 15300 15300 10000
718 Metilfenidat tab SR 10 mg Tab 0 0 0
719 Metilfenidat tab SR 20 mg Tab 0 0 0
720 Metilprednisolon inj 125 mg/2 ml Vial 250 130 2340 2090 2090 1150
721 Metilprednisolon inj 500 mg/8 ml Vial 0 0 0
722 Metilprednisolon tab 16 mg Tab 0 0 0
723 Metilprednisolon tab 4 mg Tab 18800 4500 81000 62200 62200 30000
724 Metoklopramid drop botol 10 ml Botol 0 0 0
725 Metoklopramid inj 5 mg/ml Vial 5200 700 12600 7400 7400 9960
726 Metoklopramid sir 5 mg/5 ml Botol 0 0 0
727 Metoklopramid tab 10 mg Tab 100 80 1440 1340 1340 800
728 Metoklopramid tab 5 mg Tab 0 0 0
729 Metoprolol tartat inj 1 mg/ml Ampul 0 0 0
730 Metotreksat Inj 10 mg/ml Vial 0 0 0
731 Metotreksat inj 2,5 mg/ml Vial 0 0 0
732 Metotreksat serb inj 25 mg/ml Vial 0 0 0
733 Metotreksat serb inj 5 mg/vial Vial 0 0 0
734 Metotreksat tab 2,5 mg Tab 0 0 0
735 Metronidazol lar inf 5 mg/ml Botol 350 200 3600 3250 3250 2000
736 Metronidazol ovula 500 mg Supp 0 0 0
737 Metronidazol sir 125 mg/5 Ml Botol 0 0 0
738 Metronidazol sup 500 mg Botol 0 0 0
739 Metronidazol tab 250 mg Tab 0 0 0
740 Metronidazol tab 500 mg Tab 2700 600 10800 8100 8100 6500
741 MIBG (meta-iodobenzylguanidine) Vial 0 0 0
742 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial 0 0 0
743 Midazolam inj 1 mg/ml (i.v.) Vial 0 50 900 900 900 420
744 Midazolam inj 5 mg/ml (i.v.) Vial 0 0 0
745 Mikafungin Na serb inj 50 mg/vial Vial 0 0 0
746 Mikofenolat mofetil tab 500 mg Tab 0 0 0
747 Mikofenolat Sodium Tab Sal 180 mg Tablet 0 0 0
748 Mikofenolat Sodium Tab Sal 360 mg Tablet 0 0 0
749 Mikonazol krim 2% Tube 0 6 108 108 108 72
750 Mikonazol serb 2% Tube 0 0 0
751 Mitomisin serb inj 10 mg Vial 0 0 0
752 Mitomisin serb inj 2 mg Vial 0 0 0
753 Modified fluid gelatine BM 30 000 lar inf 4% Botol 0 0 0
754 Moksifloksasin inf 1,6 mg/mL Botol 0 0 0
755 Moksifloksasin tab 400 mg Tab 0 0 0
756 Moksifloksasin tts mata 0,5% Botol 0 0 0
757 Mometason furoat krim 0,1% Tube 0 0 0
758 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial 100 5 90 -10 0 100
759 Morfin Hcl tab 10 mg Tab 0 0 0
760 Morfin Hcl tab SR 10 mg Tab 0 0 0
761 Morfin Hcl tab SR 15 mg Tab 0 0 0
762 Morfin Hcl tab SR 30 mg Tab 0 0 0
763 N-asetil sistein granula 200 mg Kaps 0 0 0
764 N-asetil sistein ih 100 mg/ml Botol 0 0 0
765 N-asetil sistein kaps 200 mg Kaps 0 0 0
766 NaCl 0,9% Larutan Botol 2470 850 15300 12830 12830 9600
767 Nadroparin inj 10 mg/ml Vial 0 0 0
768 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml Vial 0 0 0
769 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml Vial 0 0 0
770 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml Vial 0 0 0
771 Nalokson inj 0,4 mg/ml Ampul 0 0 0
772 Natamisin tts mata 5% Botol 0 0 0
773 Natamisin tts mata 50 mg/ml Botol 0 0 0
774 Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul 0 0 0
775 Natrium bikarbonat High alert medicine. Vial 0 0 0
776 Natrium bikarbonat inj 8,4% (i.v.) Vial 0 0 0
777 Natrium bikarbonat tab 500 mg Tab 0 0 0
778 Natrium diklofenak tab 25 mg Tab 18850 1100 19800 950 950 25700
779 Natrium diklofenak tab 50 mg Tab 4950 2087.5 37575 32625 32625 23250
780 Natrium Diklofenak Tetes Mata 1 mg/ml Botol 0 0 0
781 Natrium fluoresein tts mata 2% Botol 0 0 0
782 Natrium fosfat btl, 133 ml Botol 0 0 0
783 Natrium fosfat lar oral 45 ml Botol 0 0 0
784 Natrium fusidat krim 20 mg/g Tube 0 0 0
785 Natrium fusidat salep 20 mg/g Tube 0 0 0
786 Natrium hialuronat gel Tube 0 0 0
787 Natrium hipoklorit cairan konsentrat 5% Botol 0 0 0
788 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0 0
789 Neostigmin inj 0,5 mg/ml Vial 0 0 0
790 Nevirapin tab 200 g Tab 0 0 0
791 Nifedipin kaps 10 mg Kaps 2200 200 3600 1400 1400 0
792 Nifedipin tab SR 20 mg Tab 0 0 0
793 Nifedipin tab SR 30 mg Tab 0 0 0
794 Nikardipin inj 10 mg/vial Vial 0 0 0
795 Nikotinamid tab 100 mg Tab 0 0 0
796 Nikotinamid tab 20 mg Tab 0 0 0
797 Nikotinamid tab 5 mg Tab 0 0 0
798 Nilotinib kaps 150 mg Kaps 0 0 0
799 Nilotinib tab 200 mg Tab 0 0 0
800 Nimodipin inf 0,2 mg/ml Botol 0 0 0
801 Nimodipin tab 30 mg Tab 0 0 0
802 Nistatin susp 100.000 UI/ml Botol 415 60 1080 665 665 725
803 Nistatin tab salut 500.000 UI Tab 0 0 0
804 Nistatin tab vaginal 100.000 UI Tab 100 0 0 -100 0 0
805 Nitrofurantoin tab 50 mg Tab 0 0 0
806 Nitrogen oksida ih, gas dlm tabung Botol 0 0 0
807 Nomegestrol asetat Kaps/tab 5 mg Tablet 0 0 0
808 Norepinefrin inj 1 mg/ml Ampul 0 0 0
809 Noretisteron tab 5 mg Tab 0 0 0
810 Obat Anti Tuberculosis FDC Kategori Anak Paket 0 0 0
811 Obat Anti Tuberculosis FDC Kategori I Paket 0 0 0
812 Obat Anti Tuberculosis FDC Kategori II Paket 0 0 0
813 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 0 0 0
814 Obat Anti Tuberculosis Kombipak Anak Paket 0 0 0
815 Obat Anti Tuberculosis Kombipak Dewasa Paket 0 0 0
816 Octreotide acetate 0,05 - 6 mg/ml Botol 0 0 0
817 Ofloksasin tab 200 mg Tab 0 0 0
818 Ofloksasin tab 400 mg Tab 0 0 0
819 Ofloksasin tts telinga 3% Botol 128 30 540 412 412 350
820 Oksaliplatin serb inj 100 mg/vial Vial 0 0 0
821 Oksaliplatin serb inj 50 mg/vial Vial 0 0 0
822 Oksigen ih, gas dlm tabung Botol 0 0 0
823 Oksimetazolin tts hidung 0,025% Botol 0 0 0
824 Oksimetazolin tts hidung 0,050% Botol 0 0 0
825 Oksitetrasiklin hcl inj 250 mg/3 ml (i.m.) Vial 0 0 0
826 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial 0 0 0
827 Oksitetrasiklin hcl inj 500 mg/ml Vial 0 0 0
828 Oksitosin inj 10 UI/ml Ampul 0 320 5760 5760 5760 3030
829 Oktreotid asetat 0,05 - 6 mg/ml Vial 0 0 0
830 Oktreotid inj 0,1 mg/ml Ampul 0 0 0
831 Oktreotid serb inj 20 mg Ampul 0 0 0
832 Oktreotid serb inj 30 mg vial 0 0 0
833 Olanzapin inj 10 mg/2 ml Ampul 0 0 0
834 Olanzapin tab sal 10 mg Tab sal 0 0 0
835 Olanzapin tab sal 5 mg Tab 0 0 0
836 Olopatadin tts mata 0,1% Botol 0 0 0
837 Omeprazol inj 40 mg/10 ml Vial 256 430 7740 7484 7484 4900
838 Omeprazol kaps 20 mg Kaps 11160 1200 21600 10440 10440 14520
839 Ondansetron inj 2 mg/ml Vial 1450 500 9000 7550 7550 4860
840 Ondansetron tab 4 mg Tab 0 150 2700 2700 2700 710
841 Ondansetron tab 8 mg Tab 5100 400 7200 2100 2100 6540
842 Paklitaksel inj 100 mg/vial Vial 0 0 0
843 Paklitaksel inj 30 mg/vial Vial 0 0 0
844 Paklitaksel inj 300 mg/vial Vial 0 0 0
845 Paklitaksel Inj 6 mg/ml Ampul 0 0 0
846 Pankuronium inj 2 mg/ml Ampul 0 0 0
847 Paraformaldehid lar bufer 10% Botol 0 0 0
848 Paraformaldehid tab 1 g Tab 0 0 0
849 Parasetamol drips (infus) 1000 mg/100 ml Botol 0 450 8100 8100 8100 4313
850 Parasetamol sir 120 mg/5 ml Botol 552 165 2970 2418 2418 1684
851 Parasetamol tab 500 mg Tab 22600 9000 162000 139400 139400 90400
852 Parasetamol tts 60 mg/0,6 ml Botol 0 0 0
853 Pasta devitalisasi (non arsen) Tube 0 0 0
854 Pasta pengisi saluran akar (pasta) Tube 0 0 0
855 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Vial 0 0 0
856 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Vial 0 0 0
857 Pegylated interferon alfa-2b serb inj 100 mcg/ml Vial 0 0 0
858 Pegylated interferon alfa-2b serb inj 120 mcg/ml Vial 0 0 0
859 Pegylated interferon alfa-2b serb inj 50 mcg/ml Vial 0 0 0
860 Pegylated interferon alfa-2b serb inj 80 mcg/ml Vial 0 0 0
861 Pemetreksed serb inj 500 mg Vial 0 0 0
862 Pengganti plasma kombinasi : poligelin (ekivalen dengan 0,63 g nitrogen Botol 0 0 0
17,5 g ; natrium klorida 0,19 g ; kalsium klorida 0,19 g ; kalsium (terikat
pada polipeptida) 0,125 g

863 Perak nitrat lar 20% Botol 0 0 0

864 Perak sulfadiazin krim 1% Tube 0 0 0
865 Perak sulfadiazin krim 2 % Tube 0 0 0
866 Perindoprilarginin tab 5 mg Tab 0 0 0
867 Permetrin krim 5 % Tube 0 0 0
868 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial 240 60 1080 840 840 600
869 Pilokarpin tts mata 2% Botol 0 0 0
870 Pioglitazon tab 15 mg Tab 0 0 0
871 Pioglitazon tab 30 mg Tab 0 0 0
872 Pirantel pamoat susp 125 mg/5 ml Botol 0 0 0
873 Pirantel pamoat tab 500 mg Tab 0 0 0
874 Pirantel pamoat tab scored 125 mg Tab 0 0 0
875 Pirantel pamoat tab scored 250 mg Tab 0 0 0
876 Pirazinamid tab 500 mg Tab 0 0 0
877 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 0 0
878 Piridoksin (vitamin B6) tab 10 mg Tab 0 0 0
879 Piridoksin (vitamin B6) tab 25 mg Tab 0 0 0
880 Piridostigmin tab sal 60 mg Tab sal 0 0 0
881 Pirimetamin tab 25 mg Tablet 0 0 0
882 Podofilin tingtur 25 % Botol 0 0 0
883 Polietilen glikol Botol 0 0 0
884 Polikresulen Botol 0 0 0
885 Povidon iodin lar 100 mg/ml Botol 30 ml 0 0 0
886 Povidon iodin lar 100 mg/ml Botol 60 m 159 25 450 291 291 200
887 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0 0
888 Povidon iodin lar 100 mg/ml Botol 1000 30 20 360 330 330 237
889 Pramipeksol tab 0,125 mg Tablet 0 0 0
890 Pramipeksol tab ER 0,375 mg Tab 0 0 0
891 Pramipeksol tab ER 0,750 mg Tab 0 0 0
892 Pravastatin tab 10 mg Tab 0 0 0
893 Pravastatin tab 20 mg Tab 0 0 0
894 Prazikuantel tab scored 300 mg Tab 0 0 0
895 Prazikuantel tab scored 600 mg Tab 0 0 0
896 Prednisolon tts mata 10 mg/ml Botol 0 0 0
897 Prednison tab 5 mg Tab 3700 250 4500 800 800 0
898 Primakuin tab 15 mg Tab 0 0 0
899 Probenesid tab 500 mg Tab 0 0 0
900 Prokain benzilpenisilin serb inj 1 juta UI/vial (i.m.) Tab 0 0 0
901 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial 0 0 0
902 Prokaterol HCl cairan ih 30 mcg Botol 0 0 0
903 Prokaterol HCl cairan ih 50 mcg Botol 0 0 0
904 Prokaterol HCl serb ih 10 mcg Botol 0 0 0
905 Propiltiourasil tab 100 mg Tab 1500 250 4500 3000 3000 0
906 Propofol inj 1% (i.v. Bolus) Ampul 0 15 270 270 270 100
907 Propranolol inj 1 mg/ml (i.v.) Ampul 0 0 0
908 Propranolol tab 10 mg Tab 200 200 3600 3400 3400 1000
909 Propranolol tab 40 mg Tab 600 250 4500 3900 3900 2000
910 Prostaglandin (PGE 1) Inj 500 mcg/ml Vial 0 0 0
911 Protamin sulfat inj 10 mg/ml (i.m.) Ampul 0 0 0
912 Quetiapin tab SR 200 mg Tab 0 0 0
913 Quetiapin tab SR 300 mg Tab 0 0 0
914 Quetiapin tab SR 400 mg Tab 0 0 0
915 Ramipril tab 10 mg Tab 1080 180 3240 2160 2160 0
916 Ramipril tab 2,5 mg Tab 0 0 0
917 Ramipril tab 5 mg Tab 0 0 0
918 Ranibizumab inj 10 mg/ml Vial 0 0 0
919 Ranitidin inj 25 mg/ml Ampul 0 0 0
920 Ranitidin tab 150 mg Tab 7200 1500 27000 19800 19800 16000
921 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 0 0 0
922 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 0 0 0
923 Ribavirin tab 200 mg Tab 0 0 0
924 Rifampisin kaps 300 mg Kaps 0 0 0
925 Rifampisin tab 450 mg Tab 0 0 0
926 Rifampisin tab 600 mg Tab 0 0 0
927 Ringer Laktat Larutan Botol 4000 3000 54000 50000 50000 24500
928 Ringer Laktat Larutan 1000 ml Botol 0 0 0
929 Risedronat tab sal selaput 35 mg Tab 0 0 0
930 Risperidon tab 3 mg Tab 0 0 0
931 Risperidon tab sal 1 mg Tab sal 0 0 0
932 Risperidon tab sal 2 mg Tab sal 0 0 0
933 Rituksimab Inj 10 mg/ml Vial 0 0 0
934 Rituksimab inj 100 mg/ml Ampul 0 0 0
935 Rituksimab inj 500 mg/ml Ampul 0 0 0
936 Rivaroksaban tab sal 10 mg Tab sal 0 0 0
937 Rivaroksaban tab sal 15 mg Tab sal 0 0 0
938 Rivaroksaban tab sal 20 mg Tab sal 0 0 0
939 Rokuronium inj 50 mg/5 ml (i.v.) Vial 0 0 0
940 Ropinirol tab lepas lambat 2 mg Tab 0 0 0
941 Ropinirol tab lepas lambat 4 mg Tab 0 0 0
942 Ropinirol tab lepas lambat 8 mg Tab 0 0 0
943 Ropivakain Inj 7,5 mg/ml Ampul 0 0 0
944 Rosuvastatin tab 10 mg Tab 0 0 0
945 Salbutamol aerosol 100 mcg Botol 0 0 0
946 Salbutamol cairan ih 0,1% Botol 0 0 0
947 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol 0 0 0
948 Salbutamol inj 50 mcg/ml Botol 0 0 0
949 Salbutamol lar ih 0,5 % Botol 0 0 0
950 Salbutamol nebules vial 2,5 mg Vial 1400 250 4500 3100 3100 0
951 Salbutamol sir 2 mg/5 ml Botol 0 0 0
952 Salbutamol tab 2 mg Tab 6300 800 14400 8100 8100 20000
953 Salbutamol tab 4 mg Tab 0 0 0
954 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube 0 0 0
955 Sefadroksil kaps 250 mg Vial 0 0 0
956 Sefadroksil kaps/tab 500 mg Tab 8700 3500 63000 54300 54300 10000
957 Sefadroksil sir kering 125 mg/5 ml Botol 0 6 108 108 108 0
958 Sefadroksil sir kering 250 mg/5 ml Botol 0 0 0
959 Sefaleksin kaps 250 mg Kaps 0 0 0
960 Sefaleksin kaps 500 mg Kaps 0 0 0
961 Sefazolin serb inj 1 g/vial Vial 0 0 0
962 Sefepim serb inj 1000 mg/vial Vial 0 0 0
963 Sefiksim sir 100 mg/5 ml Botol 65 40 720 655 655 250
964 Sefiksim tab 100 mg Tab 11700 3000 54000 42300 42300 45000
965 Sefiksim Tab 200 mg Tablet 5520 1500 27000 21480 21480 16500
966 Sefoperazon serb inj 1.000 mg/vial Vial 1925 600 10800 8875 8875
967 Sefotaksim inj 500 mg/vial Vial 0 0 0
968 Sefotaksim serb inj 1.000 mg/vial Vial 580 450 8100 7520 7520 1800
969 Sefpirom serb inj 1000 mg Vial 0 100 1800 1800 1800 900
 970 Sefpodoksim proksetil tab sal 100 mg Tab 0 0 0
971 Seftazidim serb inj 1.000 mg/vial Vial 0 0 0
972 Seftriakson serb inj 1.000 mg/vial Vial 4240 600 10800 6560 6560 5248
973 Sefuroksim serb inj 750 mg/vial Vial 0 0 0
974 Sefuroksim tab 250 mg Tab 0 0 0
975 Sefuroksim tab sal 500 mg Tab 0 0 0
976 Sertralin tab sal 50 mg Tab sal 0 0 0
977 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj (i.m./i.v.) Papua Vial 1 3 54 53 53 10

978 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial 0 0 0

979 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial 0 0 0
980 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 20.000 UI/ Vial 0 0 0
981 Serum antirabies inj 100 UI/ml Vial 0 0 0
982 Serum antirabies inj 200 UI/ml Vial 0 0 0
983 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial 0 0 0
984 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 180 40 720 540 540 400
985 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial 0 0 0
986 Setirizin sir 5 mg/5 ml. Botol 0 20 360 360 360 277
987 Setirizin tab 10 mg Tab 5200 650 11700 6500 6500 10000
988 Setuksimab inj 5 mg/ml Vial 0 0 0
989 Sevofluran cairan ih 250 ml Botol 4 2 36 32 32 19
990 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 170 5 90 -80 0 0
991 Sianokobalamin (vitamin B12) tab 50 mcg Tab 5000 200 3600 -1400 0 0
992 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial 0 0 0
993 Siklofosfamid serb inj 200 mg/vial (i.v.) Vial 0 0 0
994 Siklofosfamid serb inj 500 mg/vial (i.v.) Vial 0 0 0
995 Siklofosfamid tab sal 50 mg Tab 0 0 0
996 Siklosporin inj 100 mg/ml Ampul 0 0 0
997 Siklosporin inj 50 mg/ml Ampul 0 0 0
998 Siklosporin kaps 100 mg Kaps 0 0 0
999 Siklosporin kaps lunak 25 mg Kaps 0 0 0
1000 Siklosporin Kaps lunak 50 mg Kapsul 0 0 0
1001 Silostazol tab 100 mg Tab 0 100 1800 1800 1800 0
1002 Simeprevir tab 150 mg Tablet 0 0 0
1003 Simvastatin tab sal 10 mg Tab sal 17430 2300 41400 23970 23970 0
1004 Simvastatin tab sal 20 mg Tab sal 900 1200 21600 20700 20700 4500
1005 Siprofloksasin inf 2 mg/ml Botol 0 60 1080 1080 1080 555
1006 Siprofloksasin tab scored 500 mg Tab 3600 1300 23400 19800 19800 16000
1007 Siprofloksasin tetes mata 3 mg/ml Botol 0 0 0
1008 Sisplatin serb inj 10 mg Vial 0 0 0
1009 Sisplatin serb inj 50 mg Vial 0 0 0
1010 Sitarabin inj 50 mg Vial 0 0 0
1011 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial 0 0 0
1012 Sofosbuvir tab sal selaput 400 mg Tablet 0 0 0
1013 Spiramisin tab 250 mg Tab 0 0 0
1014 Spiramisin tab 500 mg Tab 0 0 0
1015 Spironolakton tab 100 mg Tab 0 0 0
1016 Spironolakton tab 25 mg Tab 0 0 0
1017 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial 0 0 0
1018 Stavudin tab 30 mg Tab 0 0 0
1019 Streptokinase serb inj 1,5 juta UI/vial Vial 0 0 0
1020 Streptomisin serb inj 1.000 mg/vial Vial 0 0 0
1021 Sufentanil inj 5 mcg/ml (i.v.) Ampul 0 0 0
1022 Sugammadeks inj 100 mg/ml Vial 0 0 0
1023 Sukralfat susp 500 mg/5 ml Botol 2400 500 9000 6600 6600 4678
1024 Sukralfat tab 500 mg Tab 4500 600 10800 6300 6300 0
1025 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial 0 0 0
1026 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial 0 0 0
1027 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial 0 0 0
1028 Sulfadiazin tab 500 mg Tablet 0 0 0
1029 Sulfasalazin kapl sal enterik 500 mg Kaps salut 0 0 0
1030 Sulfur colloid 4,5 mg gelatin/reaction vial Vial 0 0 0
1031 Surfaktan susp 25 mg/ml (intratrakeal) Botol 0 0 0
1032 Surgical ginggival pack Tube 0 0 0
1033 Takrolimus kaps 0,5 mg Kaps 0 0 0
1034 Takrolimus kaps 1 mg Kaps 0 0 0
1035 Takrolimus kaps lepas lambat 0,5 mg Kaps 0 0 0
1036 Takrolimus kaps lepas lambat 1 mg Kaps 0 0 0
1037 Tamoksifen tab 10 mg Tablet 0 0 0
1038 Tamoksifen tab 20 mg Tab 0 0 0
1039 Tamsulosin tab 0,2 mg Tab 0 0 0
1040 Tamsulosin tab SR 0,4 mg Tab 0 0 0
1041 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set 0 0 0
1042 Telbivudin tab 600 mg Tab 0 0 0
1043 Telmisartan tab 40 mg Tab 0 0 0
1044 Telmisartan tab 80 mg Tab 0 0 0
1045 Temozolamid kaps 100 mg Kaps 0 0 0
1046 Temozolamid kaps 20 mg Kaps 0 0 0
1047 Tenofovir tab 300 mg Tab 0 0 0
1048 Teofilin tab 100 mg Tab 1000 300 5400 4400 4400 3000
1049 Teofilin tab 150 mg Tab 0 0 0
1050 Teofilin tab SR 300 mg Tab 0 0 0
1051 Terazosin hcl tab 1 mg Tab 0 0 0
1052 Terazosin hcl tab 2 mg Tab 0 0 0
1053 Terbinafrin tab 250 mg Tablet 0 0 0
1054 Terbutalin cairan ih 2,5 mg/ml Botol 0 0 0
1055 Terbutalin inj 0,5 mg/ml Vial 0 0 0
1056 Terbutalin serb ih 0,50 mg/dose Vial 0 0 0
1057 Terbutalin sir 1,5 mg/5 ml Botol 0 0 0
1058 Terbutalin tab 2,5 mg Tab 0 0 0
1059 Testosteron inj 250 mg/ml Tab 0 0 0
1060 Testosteron kaps lunak 40 mg Kaps 0 0 0
1061 Testoteron kombinasi : benserazin 25 mg +levodopa 100 mg Kaps 0 0 0
1062 Tetanus toxoid inj Ampul 0 0 0
1063 Tetrakain tts mata 0,5% Botol 0 0 0
1064 Tetrasiklin kaps 250 mg Kaps 0 0 0
1065 Tetrasiklin kaps 500 mg Kaps 0 0 0
1066 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set 0 0 0
1067 Tiamazol tab 10 mg Tab 700 50 900 200 200 1000
1068 Tiamazol tab 5 mg Tab 0 0 0
1069 Tiamin (vitamin B1) tab 50 mg Tab 0 0 0
1070 Tikagrelor tab 90 mg Tab 0 0 0
1071 Timolol tts mata 0,25% Botol 0 0 0
1072 Timolol tts mata 0,5% Botol 0 0 0
1073 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul 0 0 0
1074 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul 130 10 180 50 50 0
1075 Tiotropium serb ih 18 mcg + handihaller Botol 0 0 0
1076 Tiotropium serb ih 18 mcg, refill Botol 0 0 0
1077 Tobramisin tetes mata 0,3% Botol 0 0 0
1078 Topiramat tab 100 mg Tab 0 0 0
1079 Topiramat tab 25 mg Tab 0 0 0
1080 Topiramat tab 50 mg Tab 0 0 0
1081 Tramadol inj 50 mg/ml Ampul 0 125 2250 2250 2250 500
1082 Trastuzumab serb inj 440 mg/vial Vial 0 0 0
1083 Travoprost tts mata 0,004% Botol 0 0 0
1084 Triamsinolon asetonid nasal spray 55 mcg/puf Botol 0 0 0
1085 Triamsinolon inj 10 mg/ml Ampul 0 0 0
1086 Trifluoperazin tab sal 5 mg Tab sal 0 0 0
1087 Triheksifenidil tab 2 mg Tab 0 0 0
1088 Tropikamid tts mata 0,5% Botol 0 0 0
1089 Tropikamid tts mata 1% Botol 0 0 0
1090 Tuberkulin protein purified derivative 1:10 (i.k) Ampul 0 0 0
1091 Urea krim 10 % Tube 0 0 0
1092 Vaksin BCG inj (i.k) Vial 0 0 0
1093 Vaksin campak inj (s.k.) Vial 0 0 0
1094 Vaksin jerap difteri tetanus (DT) Vial 0 0 0
1095 Vaksin jerap difteri tetanus (Td) Vial 0 0 0
1096 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial 0 0 0
1097 Vaksin jerap tetanus (tetanus adsorbed toxoid) inj (i.m.) Vial 0 0 0
1098 Vaksin kombinasi DPT-HB-Hib Vial 0 0 0
1099 Vaksin polio IPV inj 0,5 ml Vial 0 0 0
1100 Vaksin polio t-OPV drops 10 dosis Vial 0 0 0
1101 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial 0 0 0
1102 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 0 0
1103 Valasiklovir tab 500 mg Tab 0 0 0
1104 Valgansiklovir tab sal 450 mg Tab sal 0 0 0
1105 Valproat sir 250 mg/5 ml Botol 0 0 0
1106 Valproat tab sal 250 mg Tab sal 0 0 0
1107 Valproat tab sal 500 mg Tab sal 0 0 0
1108 Valproat tab sal enterik 200 mg Tab 0 0 0
1109 Valproat tab SR 250 mg Tab 0 0 0
1110 Valproat tab SR 500 mg Tab 0 0 0
1111 Valsartan tab 160 mg Tab 0 0 0
1112 Valsartan tab 80 mg Tab 0 0 0
1113 Vankomisin serb inj 500 mg/vial Vial 0 0 0
1114 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial 0 0 0
1115 Verapamil inj 2,5 mg/ml Vial 0 0 0
1116 Verapamil tab 240 mg Tab 0 0 0
1117 Verapamil tab 80 mg Tab 0 0 0
1118 Vinblastin inj 1 mg/ml Ampul 0 0 0
1119 Vinkristin serb inj 1 mg/ml (i.v.) Vial 0 0 0
1120 Vinorelbin inj 10 mg/ml Vial 0 0 0
1121 Vitamin B kompleks Tab 16800 2500 45000 28200 28200 16000
1122 Warfarin tab 1 mg Tab 0 0 0
1123 Warfarin tab 2 mg Tab 0 0 0
1124 Zidovudin kaps 300 mg Kaps 0 0 0
1125 Zinc drops 10 mg/ml Botol 0 10 180 180 180 50
1126 Zinc serb 10 mg Sachet 0 0 0
1127 Zinc sir 10 mg/ml Botol 0 30 540 540 540 300
1128 Zinc sir 20 mg/5 ml Botol 0 0 0
1129 Zinc tab disp 20 mg Tab 600 300 5400 4800 4800 2000
AN DIADAKAN TAHUN 2018 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2018

KETERANGAN

(f)
0

0
0

0
0
NO NAMA OBAT SATUAN SISA STOK PER PEMAKAIAN JUMLAH
31 DESEMBER RATA-RATA KEBUTUHAN
2016 PER BULAN TAHUN 2018
SELAMA 2016

1 (a) (b) (c) = (b) x 18

1 Air untuk injeksi amp 25 ml Ampul 3240 900 16200
2 Albumin serum normal (human albumin) inj 25% 50 ml Botol 3 10 180
3 Alopurinol tab 100 mg Tab 0 500 9000
4 Alprazolam tab 1 mg Tab 4500 2000 36000
5 Aminofilin inj 24 mg/ml Ampul 930 4 72
6 Aminofilin Tab 200 mg Tab 3110 3100 55800
7 Amitriptilin tab sal 25 mg Tab sal 2800 1200 21600
8 Amlodipin tab 10 mg Tab 1170 1200 21600
9 Amlodipin tab 5 mg Tab 0 1800 32400
10 Amoksisilin sir kering 125 mg/5 ml Botol 125 50 900
11 Amoksisilin tab 250 mg Tab 0
12 Amoksisilin tab 500 mg Tab 4900 1000 18000
13 Ampisilin serb inj 1000 mg/vial Vial 0 10 180
14 Analog insulin : mix insulin (inj 100 UI/ml) Vial/Cartri 0 150 2700
15 Asam asetilsalisilat (asetosal) tab 80 mg Tab 3100 2500 45000
16 Asam askorbat (vitamin C) tab 50 mg Tab 1000 700 12600
17 Asam folat tab 1 mg Tab 7000 1500 27000
18 Asam mefenamat kaps 500 mg Kaps 0 2500 45000
19 Asam traneksamat inj 100 mg/ml Ampul 2550 800 14400
20 Asam traneksamat tab 500 mg Tab 12800 600 10800
21 Asam ursodeoksikolat kaps 250 mg Kaps 420 90 1620
22 Asiklovir tab 200 mg Tab 0 50 900
23 Asiklovir tab 400 mg Tab 0 50 900
24 Atorvastatin tab 20 mg Tab 0 120 2160
25 Atrakurium inj 10 mg/ml (i.v) Vial 230 15 270
26 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 150 2700
27 Azitromisin serb inj 500 mg Vial 200 10 180
28 Azitromisin sir kering 200 mg/5 ml Botol 25 10 180
29 Azitromisin tab 500 mg Tab 200 500 9000
30 Bedak salisil serb 2% Botol 80 15 270
31 Betahistin tab 6 mg Tab 2520 2000 36000
32 Betametason krim 0,1% Tube 0 10 180
33 Bisoprolol tab 5 mg Tab 1700 1000 18000
34 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1225 200 3600
35 Deksametason tab 0,5 mg Tab 0 50 900
36 Diazepam lar rektal 10 mg/2,5 ml Botol 90 50 900
37 Diazepam lar rektal 5 mg/2,5 ml Botol 0
38 Diazepam tab 2 mg Tab 100 1800
39 Diazepam tab 5 mg Tab 4500 1200 21600
40 Digoksin tab 0,25 mg Tab 10200 10 180
41 Diltiazem hcl tab 30 mg Tab 7100 100 1800
42 Diltiazem kaps SR 100 mg Kaps 2370 200 3600
43 Diltiazem serb inj 50 mg/vial Vial 20 2 36
44 Dobutamin inj 25 mg/ml Vial 40 10 180
45 Doksisiklin kaps 100 mg Kaps 0 50 900
46 Domperidon susp 5 mg/5 ml Botol 0 60 1080
47 Domperidon tab 10 mg Tab 3150 2000 36000
48 Dopamin inj 40 mg/ml Vial 0 10 180
49 Epinefrin (adrenalin) inj 1 mg/ml Ampul 200 30 540
50 Esomeprazole inj 40 mg/vial Vial 0 30 540
51 Etil klorida semprot 100 ml Botol 10 3 54
52 Fenitoin Na kaps 100 mg Kaps 3600 2500 45000
53 Fenobarbital inj 50 mg/ml Ampul 565 15 270
54 Fenobarbital tab 30 mg Tab 13600 200 3600
55 Fentanil inj 0,05 mg/ml (i.v.) Vial 150 225 4050
56 Fentanil patch 25 mcg/jam Pack 0 2 36
57 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 450 90 1620
58 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul 180 90 1620
59 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 530 250 4500
60 Furosemid tab 40 mg Tab 900 800 14400
61 Gabapentin kaps 100 mg Kaps 3450 900 16200
62 Gabapentin kaps 300 mg Kaps 1900 300 5400
63 Gemfibrozil kaps 300 mg Kaps 6500 600 10800
64 Gentamisin inj 40 mg/ml Ampul 30 100 1800
65 Glibenklamid tab 5 mg Tab 1400 50 900
66 Glimepirid tab 2 mg Tab 0 400 7200
67 Glimepirid tab 4 mg Tab 0 100 1800
68 Glukosa Larutan Infus 10% steril 500 ml Botol 840 60 1080
69 Glukosa Larutan Infus 5% steril 500 ml Botol 460 260 4680
70 Hidrokortison krim 1% Tube 188 3 54
71 Hidrokortison krim 2,5% Tube 1056 5 90
72 Ibuprofen sir 100 mg/5 ml Botol 0 10 180
73 Ibuprofen tab 200 mg Tab 200 200 3600
74 Ibuprofen tab 400 mg Tab 0 200 3600
75 Imidapril tab 10 mg Tab 0 200 3600
76 Imidapril tab 5 mg Tab 0 200 3600
77 Irbesartan tab 300 mg Tab 630 150 2700
78 Isofluran inhalasi 250 ml Botol 6 0.5 9
79 Isosorbid dinitrat tab 5 mg Tab 0 50 900
80 Kalsium laktat (kalk) tab 500 mg Tab 1000 50 900
81 Kandesartan tab 16 mg Tab 0 800 14400
82 Kandesartan tab 8 mg Tab 0 500 9000
83 Kaptopril tab 12,5 mg Tab 0 50 900
84 Kaptopril tab 25 mg Tab 900 150 2700
85 Karbamazepin Tab 200 mg Tablet 2400 250 4500
86 Ketamin inj 100 mg/ml (i.v.) Ampul 12 1 18
87 Ketamin inj 50 mg/ml (i.v.) Ampul 22 8 144
88 Ketokonazol tab 200 mg Tab 100 10 180
89 Ketorolak inj 30 mg/ml Ampul 415 1500 27000
90 Klindamisin kaps 150 mg Kaps 4900 100 1800
91 Klindamisin kaps 300 mg Kaps 900 200 3600
92 Klobazam tab 10 mg Tab 2200 500 9000
93 Klopidogrel tab 75 mg Tab 3270 1800 32400
94 Kloramfenikol kaps 250 mg Kaps 600 100 1800
95 Kloramfenikol tts mata 1% Botol 0 5 90
96 Klorfeniramin tab 4 mg Tab 8000 500 9000
 97 Kodein tab 20 mg Tab 4800 300 5400
98 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 0 500 9000
99 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 Tab 700 100 1800
mg+ trimetoprim 80 mg
100 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : Botol 0 5 90
sulfametoksazol 200 mg + trimetoprim 40 mg
101 Lansoprazol inj 30 mg/ml Vial 1730 100 1800
102 Lansoprazol kaps 30 mg Kaps 21390 8000 144000
103 Levofloksasin inf 5 mg/ml Botol 50 20 360
104 Levofloksasin tab 500 mg Tab 10000 450 8100
105 Lidokain inj 2% (infiltr/p.v.) Ampul 400 160 2880
106 Lisinopril tab 10 mg Tab 0 50 900
107 Lisinopril tab 5 mg Tab 1680 20 360
108 Loperamid tab 2 mg Tab 0 100 1800
109 Loratadin tab 10 mg Tab 5400 1100 19800
110 Magnesium sulfat inj 20% Vial 68 10 180
111 Magnesium sulfat inj 40% Vial 600 10 180
112 Meropenem serb inj 1000 mg/vial Vial 390 20 360
113 Meropenem serb inj 500 mg/vial Vial 45 5 90
114 Mesalazin tab sal 250 mg Tab 0
115 Mesna inj 100 mg/ml Vial 0
116 Metadon sir 50 mg/5 ml Botol 1000 ml 0
117 Metamizol Inj 500 mg/ml Ampul 400 120 2160
118 Metenamin mandelat (heksamin mandelat) tab salut Tab salut 0
enterik 500 mg
119 Metformin tab 500 mg Tab 6900 1200 21600
120 Metilergometrin inj 0,2 mg/ml Ampul 223 25 450
121 Metilergometrin tab salut 0,125 mg Tab sal 0 850 15300
122 Metilprednisolon inj 125 mg/2 ml Vial 250 130 2340
123 Metilprednisolon tab 4 mg Tab 18800 4500 81000
124 Metoklopramid inj 5 mg/ml Vial 5200 700 12600
125 Metoklopramid tab 10 mg Tab 100 80 1440
126 Metronidazol lar inf 5 mg/ml Botol 350 200 3600
127 Metronidazol tab 500 mg Tab 2700 600 10800
128 Midazolam inj 1 mg/ml (i.v.) Vial 0 50 900
129 Mikonazol krim 2% Tube 0 6 108
130 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial 100 5 90
131 NaCl 0,9% Larutan Botol 2470 850 15300
132 Natrium diklofenak tab 25 mg Tab 18850 1100 19800
133 Natrium diklofenak tab 50 mg Tab 4950 2087.5 37575
134 Nifedipin kaps 10 mg Kaps 2200 200 3600
135 Nistatin susp 100.000 UI/ml Botol 415 60 1080
136 Nistatin tab vaginal 100.000 UI Tab 100 0 0
137 Ofloksasin tts telinga 3% Botol 128 30 540
138 Oksitosin inj 10 UI/ml Ampul 0 320 5760
139 Omeprazol inj 40 mg/10 ml Vial 256 430 7740
140 Omeprazol kaps 20 mg Kaps 11160 1200 21600
141 Ondansetron inj 2 mg/ml Vial 1450 500 9000
142 Ondansetron tab 4 mg Tab 0 150 2700
143 Ondansetron tab 8 mg Tab 5100 400 7200
144 Parasetamol drips (infus) 1000 mg/100 ml Botol 0 450 8100
145 Parasetamol sir 120 mg/5 ml Botol 552 165 2970
146 Parasetamol tab 500 mg Tab 22600 9000 162000
147 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial 240 60 1080
148 Povidon iodin lar 100 mg/ml Botol 60 m 159 25 450
149 Povidon iodin lar 100 mg/ml Botol 300 ml 0
150 Povidon iodin lar 100 mg/ml Botol 1000 30 20 360
151 Prednison tab 5 mg Tab 3700 250 4500
152 Propiltiourasil tab 100 mg Tab 1500 250 4500
153 Propofol inj 1% (i.v. Bolus) Ampul 0 15 270
154 Propranolol tab 10 mg Tab 200 200 3600
155 Propranolol tab 40 mg Tab 600 250 4500
156 Ramipril tab 10 mg Tab 1080 180 3240
157 Ranitidin tab 150 mg Tab 7200 1500 27000
158 Ringer Laktat Larutan Botol 4000 3000 54000
159 Salbutamol nebules vial 2,5 mg Vial 1400 250 4500
160 Salbutamol tab 2 mg Tab 6300 800 14400
161 Sefadroksil kaps/tab 500 mg Tab 8700 3500 63000
162 Sefadroksil sir kering 125 mg/5 ml Botol 0 6 108
163 Sefiksim sir 100 mg/5 ml Botol 65 40 720
164 Sefiksim tab 100 mg Tab 11700 3000 54000
165 Sefiksim Tab 200 mg Tablet 5520 1500 27000
166 Sefoperazon serb inj 1.000 mg/vial Vial 1925 600 10800
167 Sefotaksim serb inj 1.000 mg/vial Vial 580 450 8100
168 Sefpirom serb inj 1000 mg Vial 0 100 1800
169 Seftriakson serb inj 1.000 mg/vial Vial 4240 600 10800
170 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj Vial 1 3 54
(i.m./i.v.) Papua
171 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 180 40 720
172 Setirizin sir 5 mg/5 ml. Botol 0 20 360
173 Setirizin tab 10 mg Tab 5200 650 11700
174 Sevofluran cairan ih 250 ml Botol 4 2 36
175 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 170 5 90
176 Sianokobalamin (vitamin B12) tab 50 mcg Tab 5000 200 3600
177 Silostazol tab 100 mg Tab 0 100 1800
178 Simvastatin tab sal 10 mg Tab sal 17430 2300 41400
179 Siprofloksasin inf 2 mg/ml Botol 0 60 1080
180 Siprofloksasin tab scored 500 mg Tab 3600 1300 23400
181 Sukralfat susp 500 mg/5 ml Botol 2400 500 9000
182 Sukralfat tab 500 mg Tab 4500 600 10800
183 Teofilin tab 100 mg Tab 1000 300 5400
184 Tiamazol tab 10 mg Tab 700 50 900
185 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul 130 10 180
186 Tramadol inj 50 mg/ml Ampul 0 125 2250
187 Vitamin B kompleks Tab 16800 2500 45000
188 Zinc drops 10 mg/ml Botol 0 10 180
189 Zinc sir 10 mg/ml Botol 0 30 540
190 Zinc tab disp 20 mg Tab 600 300 5400
 RENCANA RENCANA REALISASI KETERANGAN
KEBUTUHAN PENGADAAN PENGADAAN
TAHUN 2018 TAHUN 2018 TAHUN 2016

(d) = (c) - (a) (e) (f)

12960 12960 8000
177 177 85 0
9000 9000 2000
31500 31500 10000
-858 0 0
52690 52690 0
18800 18800 10000
20430 20430 4980
32400 32400 0
775 775 320 0
0 0
13100 13100 11400
180 180 540
2700 2700 650 0
41900 41900 20000 0
11600 11600 3000
20000 20000 20000
45000 45000 16300
11850 11850 5800
-2000 0 16000
1200 1200 510
900 900 0
900 900 750
2160 2160 0
40 40 345 0
2700 2700
-20 0 350
155 155 0
 8800 8800 2470
190 190 50
33480 33480 17130
180 180 0
16300 16300 7900
2375 2375 2500
900 900 0
810 810 500
0 0
1800 1800 1000
17100 17100 12000
-10020 0 0
-5300 0 0
1230 1230 5010
16 16 50
140 140 130
900 900 0
1080 1080 0
32850 32850 22000
180 180 40
340 340 0
540 540 60
44 44 20
41400 41400 19700
-295 0 0
-10000 0 0
3900 3900 2930
36 36 25
1170 1170 1200
1440 1440 1200
3970 3970 1500
13500 13500 4600
12750 12750 10000
3500 3500 4650
 4300 4300 5000
1770 1770 800
-500 0 0
7200 7200 0
1800 1800 1000
240 240 1000
4220 4220 2360
-134 0 0
-966 0 0
180 180 0
3400 3400 2000
3600 3600 1000
3600 3600 2200
3600 3600 2000
2070 2070 990
3 3 0
900 900 0
-100 0 0
14400 14400 3060
9000 9000 4590
900 900 500
1800 1800 2400
2100 2100 4100
6 6 20
122 122 85
80 80 0
26585 26585 10270
-3100 0 5750
2700 2700 5000
6800 6800 0
29130 29130 22230
1200 1200 0
90 90 0
1000 1000 0
 600 600 0
9000 9000 1000
1100 1100 2000
90 90 0
70 70 3500
122610 122610 26990
310 310 130
-1900 0 0
2480 2480 5400
900 900 0
-1320 0 0
1800 1800 0
14400 14400 12700
112 112 0
-420 0 0
-30 0 860
45 45 80
0 0
0 0
0 0
1760 1760 345
0 0
14700 14700 4000
227 227 0
15300 15300 10000
2090 2090 1150
62200 62200 30000
7400 7400 9960
1340 1340 800
3250 3250 2000
8100 8100 6500
900 900 420
108 108 72
-10 0 100
 12830 12830 9600
950 950 25700
32625 32625
1400 1400 0
665 665 725
-100 0 0
412 412 350
5760 5760 3030
7484 7484 4900
10440 10440 14520
7550 7550 4860
2700 2700 710
2100 2100 6540
8100 8100 4313
2418 2418 1684
139400 139400 90400
840 840 600
291 291 200
0 0
330 330 237
800 800 0
3000 3000 0
270 270 100
3400 3400 1000
3900 3900 2000
2160 2160 0
19800 19800 16000
50000 50000 24500
3100 3100 0
8100 8100 20000
54300 54300 10000
108 108 0
655 655 250
42300 42300 45000
21480 21480 16500
8875 8875
7520 7520 1800
1800 1800 900
6560 6560 5248
53 53 10
540 540 400
360 360 277
6500 6500 10000
32 32 19
-80 0 0
-1400 0 0
1800 1800 0
23970 23970 0
1080 1080 555
19800 19800 16000
6600 6600 4678
6300 6300 0
4400 4400 3000
200 200 1000
50 50 0
2250 2250 500
28200 28200 16000
180 180 50
540 540 300
4800 4800 2000