No Nama Obat Satuan Jumlah Ket

1 2 3 4 5
1 Alat Suntik Sekali Pakai 0.5 ml Pcs
2 Alat Suntik Sekali Pakai 1 ml Pcs
3 Alat Suntik Sekali Pakai 2,5 ml Pcs
4 Alat Suntik Sekali Pakai 3 ml Pcs 100
5 Alat Suntik Sekali Pakai 5 ml Pcs
6 Alat Suntik Sekali Pakai 10 ml Buah
7 Albendazol 400 mg Tablet
8 Alkohol Swab CHG + 0,5 % Pcs
9 Alopurinol tablet 100 mg Tablet
10 Alopurinol tablet 300 mg Tablet
11 Ambroxol Sirup Botol 10
12 Ambroxol Tablet 30 mg Tablet
13 Ampisilin Kaplet 500 mg Kaplet
14 Aminofilin Inj 24 mg/ml-10 ml Ampul
15 Aminofilin Tablet 200 mg Tablet
16 Aminofluid Botol
17 Amitriptilina HCl tablet salut 25 mg Tablet
18 Amlodipin tablet 5 mg Tablet
19 Amlodipin tablet 10 mg Tablet
20 Amoksilin Kapsul 250 mg Kapsul 200
21 Amoksilin sirup kering 125 mg/5ml Botol 30
22 Amoksilin sirup kering forte 250 mg/5ml Botol
23 Amoksilin 500 mg Kaplet 1,500
24 Amoksisilin + Asam klavulanat 625 mg (Co.Amoksiklav) Tablet
25 Ampisilin Kaplet 500 mg Kaplet
26 Ampisilin 1 gr inj Ampul
27 Antalgin(Metampiron) Tablet 500 mg Tablet 300
28 Antasida DOEN I tablet kombinasi Tablet 1,500
29 Antasida DOEN II suspensi kombinasi Botol
30 Anti hemoroid suppositorida Supp
31 Antifungi DOEN kombinasi : Pot
32 Antimigren DOEN/Ergotamin kafein Tablet
33 Antiseptik Hand Rub 5 lt Galon
34 Antiseptik Hand Rub 500 ml Botol
35 Antiseptik Surgical Hand Scrub 5 lt Galon
36 Antiseptik Surgical Hand Scrub 500 ml Botol
37 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul
38 Aquadest steril -500 ml Botol
39 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet
40 Asam folat tablet 0,4 mg Tablet
41 Asam Mefenamat 500 mg Tablet 300
42 Asetosal tablet 80 mg Tablet
43 Asering Botol
44 Asiklovir cr Tube
45 Asiklovir tab 200 mg Tablet
46 Asiklovir tab 400 mg Tablet
47 Atapulgit Tablet
48 Atorvastatin 10 mg Tablet
49 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul
50 Azitromisin 500 mg Kaplet
51 Bedak Salisil serbuk 2 % Buah 15
52 Benzatin benzil penisilin 1,2 juta IU/Vial Vial
53 Betametason Krim 0.1 % Tube
54 Bioplacenton Tulle Pcs
55 Bisturi no 10 Buah
56 Bloodseet Buah
57 Camabion Tablet
58 Catgut/Benang Bedah No.2/0-3/0 dg jarum bedah Roll
59 Catgut Chromic 2/0 100 m Roll
60 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Roll
61 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll
62 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll
63 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll
64 Carpul (Articain & Adrenalin) Ampul
65 Cefiksim 100 mg Kapsul
66 Cetirizine Kapsul
67 Citoject Pcs
68 Clorofenol (CHKM) Ples
69 Deksametason inj 5 mg/ml-1 ml Ampul
70 Deksametason Tablet 0,5 mg Tablet 600
71 Devitalisasi Pasta (Non arsen) Botol
72 Difenhidramin inj 10 mg/ml Ampul
73 Digoksin tablet 0,25 mg Tablet
74 Dimenhidrinat tablet 50 mg Tablet
75 Doksisiklin 100 mg Kapsul
76 Domperidon tablet 10 mg Tablet 200
77 Domperidon Syrup Botol
78 Ekstrak Belladona tablet 10 mg Tablet
79 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul
80 Eritromisin 250 mg Tablet
81 Eritromisin 500 mg Tablet
82 Eritromisin sirup kering 200 mg/5 ml Botol
83 Etambutol Hcl tablet 250 mg Tablet
84 Etambutol Hcl Tablet 500 mg Tablet
85 Etanol 70 %- 100 ml Botol
86 Etanol 70% - 1 L Botol
87 Etil Klorida semprot-100 ml Botol
 88 Eugenol Cairan Botol
89 Female Catheter no 16 Pcs
90 Female Catheter no 18 Pcs
91 Fenitoin Kapsul100 mg Kapsul
92 Fenoksimetil Penisilin tablet 250 mg Tablet
93 Fenoksimetil Penisilin tablet 500 mg Tablet
94 Fenol Gliserol Tetes telinga 10 % Botol
95 Film IV Dressing 6x7 P Pcs
96 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 30
97 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul
98 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet
99 Furosemid tablet 40 mg Tablet
100 Fluconazol 150 mg kapsul
101 Folley Cathether 2 way no 20 Pcs
102 Folley Cathether no 16 Pcs
103 Folley Cathether no 18 Pcs
104 Garam Oralit 200 ml air Sachet 300
105 Gentamisin Inj 40 mg/ml Vial
106 Gentamycin Salep Kulit Tube
107 Gentamycin Salep Mata Tube
108 Gentamycin Tetes Mata Tube
109 Gentian violet larutan 1 %-10 ml Botol
110 Glas Lonomer Cement Set
111 Glibenklamid tablet 5 mg Tablet
112 Glimepiride tablet 1 mg Tablet
113 Gliseril Gyayakolat tablet 100 mg Tablet 400
114 Glukosa Larutan infus 5% steril-500 ml Botol
115 Glukosa Larutan infus 10% steril-500 ml Botol
116 Griseofulvin tablet 125 mg micronized Tablet
117 Haloperidol tablet 0,5 mg Tablet
118 Haloperidol tablet 1,5 mg Tablet
119 Haloperidol tablet 2 mg Tablet
120 Haloperidol tablet 5 mg Tablet
121 Haloperidol Injeksi (Lodomer) Ampul
122 Hansaplast 2,5 cm x 4,5 m Roll
123 Hansaplast 7,5 cm x 4,5 m Roll
124 Hidrogen Peroksida 3% (H2O2) Botol
125 Hidroklortiazid (HCT) tablet 25 mg Tablet
126 Hidrokortison krim 2,5 % Tube 10
127 Ibuprofen tablet 200 mg Tablet 400
128 Ibuprofen tablet 400 mg Tablet
129 Ibuprofen sirup 100 mg/5 ml Botol 10
130 Infusion set anak Set
131 Infusion set dewasa Set
132 Isoniazida ( INH ) tablet 300 mg Tablet
133 Isosorbit 5 mg Tablet
134 IV Cateter no 26 wings & port Buah
135 IV Cateter with injection port 26 G Buah
136 IV Cateter 24 Buah
137 IV Cateter 22 Buah
138 IV Cateter 20 Buah
139 IV Cateter 18 Buah
140 Jarum Citojek No 16 Pcs
141 Jarum Jahit kulit No.12 Pcs
142 Jarum Jahit Otot No.12 Pcs
143 Kalium Permanganat Pot
144 Kalsium Glukonat injeksi i.v 10 % Ampul
145 Kalsium Hidroksida Pasta Set
146 Kalsium laktat (Kalk) tablet 500 mg Tablet 800
147 Kapas pembalut/absorben 250 mg Buah
148 Kaptropil 12,5 mg Tablet
149 Kaptropil 25 mg Tablet 300
150 Karbamazepin tablet 200 mg Tablet
151 Karbogliserin Tetes Telinga Botol
152 Kasa kompres 16x16 steril Buah
153 Kasa hidrofil 36 m x 80 cm Roll
154 Kasa pembalut hidrofil 4 m x 10 cm Roll
155 Ketokonazol 200 mg Tablet
156 Ketokonazol Krim 2% Tube
157 Klindamisin 300 mg Tablet
158 Kloramfenikol kapsul 250 mg Kapsul
159 Kloramfenikol salep mata 1 % Tube 10
160 Kloramfenikol salep kulit 2 % Tube
161 Kloramfenikol susp 125 ml Botol
162 Kloramfenikol tetes telinga 3 % Ples
163 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 1,000
164 Klorpromazin injeksi 5 mg/ml-2ml Ampul
165 Klorpromazin 25 mg Tablet
166 Klorpromazin 100 MG Tablet
167 Klorine Botol
168 Kotrimoksazol anak Tablet
169 Kotrimoksazol Susp Botol 10
170 Kotrimoksazol Tablet 480 mg Tablet
171 Leucoplast 2,50 cm x 4,5 m Roll
172 Leucoplast 7,50 cm x 4,5 m Roll
173 Lidocain compositum inj kombinasi Ampul
174 Lidocain Injeksi 2% Ampul
175 Lidocain Jeli 2% Syringe
176 Lisol Botol
177 Loratadine 10 mg Tablet
178 Magnesium Sulfat Inj 20% Vial
179 Masker Tali Buah
180 Masker Karet Buah
181 Metildopa 250 mg / Dopamet Tablet
182 Metilergometrin Maleat tab Tablet
183 Metilergometrin Maleat Inj Ampul
184 Metronidazol tablet 250 mg Tablet
185 Metronidazol tablet 500 mg Tablet
186 Metformin Tablet
187 Metoklopramide Inj Ampul
188 Mikonazol krim 2% Tube
189 Mummying Pasta Botol
190 Natrium Bikarbonat tablet 500 mg Tablet 500
191 Natrium Diklofenak Tablet
192 Natrium Klorida Lar.infus 0,9 % steril Botol
193 Natrium Tiroksin Tablet
194 Nasal Oxygen, O2 cannula size S Pcs
195 Nasal Oxygen, O2 cannula size XS Pcs
196 Nasal Oxygen, O2 cannula size L Pcs
197 Nifedipin 10 mg Tablet
198 Nistatin tablet vaginal 100.000 IU/g Tablet
199 Nistatin tablet vaginal 500.000 IU/g Tablet
200 Norit Tablet
201 Obat antituberkulosis anak/FDC Anak Paket
202 Obat antituberkulosis kategori 1/FDC 1 Paket
203 Obat antituberkulosis kategori 2/FDC 2 Paket
204 Obat antituberkolosis Kombipak Kat.I Dewasa Paket
205 OAT Sisipan/FDC Sisipan Paket
206 Obat Batuk Hitam (OBH) Cairan -100 ml Botol
207 OBH Plus Botol 20
208 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial
209 Oksitetrasiklin HCl Salep Kulit 3 % Tube
210 Oksitetrasiklin HCl 1 % Salep mata Tube
211 Oksitoksin inj 10 IU/ml- 1 ml Ampul
212 Omeprazol Kapsul
213 Omeprazol Injeksi Vial
214 Papaverin tab Tablet 500
215 Paraformaldehid Tablet
216 Parasetamol drop (Pasidol Drop) Botol
217 Parasetamol sirup 120 mg / 5ml Botol 40
218 Parasetamol tablet 100 mg Tablet
219 Parasetamol tablet 500 mg Tablet 1,800
220 Parafin Liquqid Botol
221 Pehakain Ampul
222 Permetrin Krim 5% (Scabimite) Tube
223 PGA 2 75 C + Jarum 1/2 40 M Pcs
224 Pirantel Pamoat 125 mg Tablet
225 Piralent Inj Ampul
226 Pirazinamid 500 mg Tablet
227 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 700
228 Piroxicam 10 mg Tablet
229 Plester 5 yard x 2 inch Roll
230 Plester 7,5 cm x 5 m Buah
231 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs
232 Povidon Iodiada 10 %-30 ml Botol
233 Povidon Iodiada 10 %-300 ml Botol
234 Prednison tablet 5 mg Tablet 300
235 Probenesid 500 mg Tablet
236 Propiltiourasil tablet 100 mg Tablet
237 Propanolol HCl tablet 10 mg Tablet
238 Propanolol HCl tablet 40 mg Tablet
239 Ranitidine 150 mg Tablet 500
240 Ranitidin inj Ampul
241 Reserpin tablet 0,25 mg Tablet
242 Retinol (VIT A) Kapsul 100.000 IU Kapsul
243 Retinol (VIT A) Kapsul 200.000 IU Kapsul
244 Rifampisin kapsul 300 mg Kapsul
245 Rifampisin kapsul 450 mg (Indofarma) Kapsul
246 Ringer Laktat Larutan Infus Steril Botol
247 Rivanol 300 ml Botol
248 Salbutamol tablet 2 mg Tablet 200
249 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 5
250 Salisil Spiritus Botol
251 Sarung Tangan non steril no 6,5 Pasang
252 Sarung tangan steril no 7 Pasang
253 Sarung tangan steril no 7,5 Pasang 100
254 Sarung tangan steril no 6,5 Pasang
255 Semen Seng Fosfat Serbuk Cairan Set
256 Semillas non Woven Medical Tape Pcs
257 Serum antibisa ular Polivalen inj 5 ml (SABU) I Ampul
258 Serum anti tetanus (ATS) / Tetagam Ampul
259 Silk Black PFM 2/0 100 m Roll
260 Silk Black 2/0 DS 24 MM Sase
261 Silk Black 2/0 HR 26 MM Sase
262 Silk Black 3/0 DS 24 MM Sase 10
263 Silk Black 3/0 HR 26 MM Sase
264 Silk 3/0 75 C + Jarum 3/8 26M C Sase
265 Silk 2/0 75 C + Jarum 1/2 30M R Sase
266 Simvastatin tablet 10 mg Tablet
267 Simvastatin tablet 20 mg Tablet
268 Siprofloksasin 500 mg Tablet
269 Spironolakton 25 mg Tablet
270 Streptomisin Inj Vial
271 Sulfasetamid Natrium Tetes mata 15 % Ples
272 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet 1,500
273 Temporary Filling Material (Fermin) Botol
274 Temporary Stopping Fletcher serbuk &cairan Set
275 Tetrakain HCl tetes mata 0,5 % Botol
276 Tetrasiklin Kapsul 250 mg Kapsul
277 Tetrasiklin Kapsul 500 mg Kapsul
278 Tiamin HCL (Vit B1) tablet 50 mg Tablet 500
279 Transfusion Set Set
280 Triheksifenidil HCl tablet 2 mg Tablet
281 Trikesol Formalin (TKF) Botol
282 Umbilical cord klem steril Pcs
283 Urine bag pcs
284 Ventolin nebules Nebule
285 Vitamin B Kompleks tablet (KF) Tablet 500
286 Vitamin B 12 Injeksi Ampul
287 Vitamin B 12 tab Tablet 400
288 Wing Nedle no 25 Tablet
289 Zink Tablet 200
290 Anacetin Sirup Botol
291 Anabion Sirup Botol
292 Anstrep Sirup Botol
293 Curviplex Sirup Botol
294 Ever (Vit) Buah
295 Fondazen (Vit) ` Tablet
296 Fortusin syr Botol
297 Gigadril Sirup Botol
298 Grotavit Syrup Botol
299 Hemafort Tablet
300 Lodecon Forte Tablet
301 Ponflu Syrup Botol
302 Scandonest Ampul
303 Seledril Tablet Tablet
304 Solafluz Botol
305 Solacort krim /Armacort Tube
306 Soldextam Tablet
307 Solvitral Tablet
308 Solvitron Kapsul
309 Truvit Syr Botol
310 Vitromega kapsul Tablet
311 Widahest infus Botol
312 Piroxicam 20 mg Tablet
 PP Polindes Polindes
Karedok Kadujaya Cijeungjing

50 30 20

5 5 -

100 50 50
15 5 10

500 500 500

100 100 100

700 400 400

200 100 -
 5 5 5

200 200 200

100 50 50
 10 10 10

200 - 100

200 100 100

5 - 5
200 100 100

5 3 2
500 100 200

200 - 100

6 2 2

600 100 300

5 - 5
 300 - 200

10 5 5

100 100 300

20 10 10

1,000 300 500

500 - 200

100 100 100

300 100 100

100 50 50
- 5 -

60 20 20

5 - 5
500 500 500

200 100 200

100 100 300

200 - 200

100 50 50