DAFTAR PERBEKALAN FARMASI JKN

TAHUN 2018
PKM KARAWACI BARU
DINAS KESEHATAN KOTA TANGERANG

NO NAMA PERBEKALAN FARMASI SATUAN

1 2 3

O B A T / PERBEKALAN KESEHATAN

1 Alopurinol tablet 100 mg Tablet

2 Ambroxol 15 mg/5 ml Sirup Botol

3 Ambroxol 30 mg Tablet

4 Amlodipine 5 mg Tablet

5 Amlodipine 10 mg Tablet

6 Betahistin Mesilate 6 mg Tablet

7 Asam Askorbat (Vitamin C) tablet 50 mg Tablet

8 Asam folat / Profolat Tablet

9 Asam Mefenamat 500 mg Tablet

10 Attapulgit Tablet 630 mg/New Antides Tablet

11 Betametason Krim 0.1 % (sebagai valerat) - 5 gr Tube

12 Bisacodyl 5 mg / Dulcolax Tablet Tablet

13 Chloramfenikol 250 mg Kapsul

14 Ciprofloxacin 500 mg Tablet

15 Deksametason tablet 0,5 mg Tablet

16 Garam Oralit Sachet

17 Gentamycin salep kulit 0,1% - 5 gr Tube

18 Glibenklamide 5 mg Tablet

19 Glimepiride 2 mg Tablet

20 Ibuprofen suspensi 100mg/5 ml Botol

21 Isosorbid dinitrat (ISDN) tablet sublingual 5 mg Tablet

22 Kaptopril tablet 12,5 mg Tablet

23 Kaptopril tablet 25 mg Tablet

24 Kloramfenikol salep mata 1% - 5 gr Tube

25 Klorfeniramin maleat (CTM) tablet 4 mg Tablet

26 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg Tablet

27 Mikonazol krim/ salep 2 % (Nitrat) - 10 gr Tube

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28 Omeprazole 20 mg Kapsul

29 Parasetamol 120mg/5 ml sirup Botol

30 Parasetamol Drops 15 ml Botol

31 Polikresulen (kondensasi) 10 ml / Albothyl Botol

32 Prednison 5 mg Tablet

33 Propanolol Tablet

34 Ranitidine 150 mg Tablet

35 Salbutamol 2mg/5 ml sirup Botol

36 Salep 2-4 kombinasi : Asam Salisilat 2 % ++C11:C27 Belerang endap 4 % - 30 gr Pot

37 Simvastatin 20 mg Tablet

38 Tablet tambah darah Neo Tablet

39 Thiamfenikol 500 mg Kapsul

40 Vitamin B Kompleks Tablet

41 Zink Kid 10mg/5 ml Sirup Botol

42 Zink Sulphate 20 mg Tablet

43 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200 mg /5 ml - 60 ml Botol

44 Flixotide Nebule Nebules

45 Loperamid tablet 2 mg Tablet

46 Methylprednisolon 8 mg Tablet

47 Asam Asetilsalisilat tablet 80 mg / MINIASPI Tablet

48 Domperidon Suspensi 5mg/5ml Botol

49 Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) Tablet

50 Bioplacenton Tulle Box

51 Povidon Iodida larutan 10 % - 60 ml Botol

52 Povidon Iodida larutan 10 % - 30 ml Botol

53 Ringer Laktat larutan infus - 500 ml Botol

54 Sodium Klorida larutan infus 0,9% - 500 ml Botol

55 Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 ml Ampul

56 Kloramfenikol Salep Kulit / Bufacetin salep Tube

57 Sarung Tangan Kotak

58 Masker Kotak

59 Plester non Alergi Roll

60 Infuset Anak piece

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1 2 3

61 Infuset Dewasa piece

62 Folley Catether piece

63 Safety Box piece

64 Plester Anti Air Bok

65 Handiplast Bok

66 Aqua bidest Botol

67 Larutan Clorin 5,25% - 1 L (Desinfektan Alat) Botol

68 Vaseline Swab piece

69 Alat Suntik 1 ml piece

70 Alat Suntik 3 ml piece

71 Etanol 70%-1 L Botol

72 Kapas Pembalut 250 gram Roll

73 Kassa Hidrofil 16x16 Bok

74 Kassa Hidrofil 40x80 Roll

75 Kassa pembalut 4x10 Roll

76 Alkohol Swab Bok

77 Asepton Botol

78 Jell Doppler Galon

79 Ikat Tali Pusat ( Umbilical Cord klem ) Piece

80 Disposafe safety box 2,5 Liter Box

81 Cosmomed Underpad Piece

82 E-Care Plester kertas 1 piece

83 E-Care Plester kertas 2 piece

84 Apron Plastik Bag

85 Hansaplast Plester Roll Kain 1,25 cm x 1m Roll

86 Safeglove Surgical 7 Psg

87 Safeglove Surgical PF 7 Psg

88 Jarum Hecting kulit 14-15 set

89 Jarum Hecting Otot 14-16 set

90 Benang Catgut Cromic 2/0 3/0 Piece

91 Benang Silk 2/0 3/0 Piece

92 Abbocat Terumo 22 Piece

93 Lancet @100 Box

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1 2 3

94 Kantong Steril Box

95 H2O2 Botol

96 TRO - UROCOL PLUS URINE BAG STERIL Piece

97 Alkohol Swab One Med Box

98 Piece
PETER SILK 3/0, 1/2 TP 18mm, 75cm - 2PTR5261E

99 Piece
PETER SILK 2/0, 1/2 TP 25mm, 75cm - 2PTR5339E

100 Bottle
ALKACIDE 1L High Level Disinfectant

101 Pharmafix 5 x 500 CM Roll

102 Blood Transfusion Set Piece

103 Vitamin B12 Tablet

104 Aminofilin 200 Mg Tablet

105 Ranitidine Injeksi Ampul

106 Kloramfenikol Tetes Mata / Decacetine Tetes Mata Botol

107 Ketokonazole Cream Tube

108 Vasofix IV G18x33 M piece

109 Vasofix IV G20x33 M piece

110 Metformin 850 mg Tablet

111 Salbutamol 2mg Tablet

112 Buscopan Injeksi Ampul

113 Decadryl Injeksi Vial

114 Ventolin Nebules 2,5 mg Nebules

115 Dexamethasone Injeksi Ampul

116 Tongue Spatel Box

117 Safe Glove Jayamas /Sarung tangan Box

118 Masker N 95 Jayamas Box

119 Sarung Tangan Latex Box

120 Pharmafix 10 x 500 CM Roll

121

122

123

124

125

126

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1 2 3

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1 2 3

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1 2 3

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1 2 3

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1 2 3

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300

Page 10
N

NG

HARGA SATUAN HARGA SATUAN

SMT I SMT II

4 5

Rp 181.32

Rp 3,297.00

Rp 130.62 Rp -

Rp 133.33 Rp -

Rp 180.00 Rp -

Rp 149.00 Rp -

Rp 94.55 Rp -

Rp 63.00 Rp -

Rp 9,636.00 Rp -

Rp 131.82 Rp -

Rp 1,880.58 Rp -

Rp 1,363.65 Rp -

Rp 456.63 Rp -

Rp 255.45 Rp -

Rp 44.00 Rp -

Rp 240.00 Rp -

Rp 1,933.00 Rp -

Rp 84.00 Rp -

Rp 262.73 Rp -

Rp 2,250.00 Rp -

Rp 137.50 Rp -

Rp 53.64 Rp -

Rp 125.10 Rp -

Rp 1,635.00 Rp -

Rp 38.18 Rp -

Rp 137.27 Rp -

Rp 2,955.00 Rp -

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HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp 145.45 Rp -

Rp 2,872.00 Rp -

Rp 4,727.00 Rp -

Rp 35,905.00 Rp -

Rp 87.27 Rp -

Rp 54.55 Rp -

Rp 229.77 Rp -

Rp 4,318.18 Rp -

Rp 2,429.00 Rp -

Rp 229.10 Rp -

Rp 363.64 Rp -

Rp 895.10 Rp -

Rp 104.55 Rp -

Rp 13,618.18 Rp -

Rp 467.27 Rp -

Rp 1,840.91 Rp -

Rp 17,923.74 Rp -

Rp 77.27 Rp -

Rp 280.91 Rp -

Rp 103.64 Rp -

Rp 2,727.27 Rp -

Rp 78.18 Rp -

Rp 94,545.00 Rp -

Rp 3,363.00 Rp -

Rp 2,636.00 Rp -

Rp 5,527.00 Rp -

Rp 6,500.00 Rp -

Rp 1,845.00 Rp -

Rp 2,734.55 Rp -

Rp 39,545.00 Rp -

Rp 20,000.00 Rp -

Rp 27,720.00 Rp -

Rp 14,545.45 Rp -

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HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp 10,000.00 Rp -

Rp 15,909.09 Rp -

Rp 50,000.00 Rp -

Rp 25,000.00 Rp -

Rp 31,818.18 Rp -

Rp 26,363.64 Rp -

Rp 20,000.00 Rp -

Rp 11,500.00 Rp -

Rp 1,818.18 Rp -

Rp 909.09 Rp -

Rp 33,409.09 Rp -

Rp 19,590.91 Rp -

Rp 3,636.36 Rp -

Rp 109,090.91 Rp -

Rp 1,863.64 Rp -

Rp 15,000.00 Rp -

Rp 40,000.00 Rp -

Rp 227,272.73 Rp -

Rp 2,500.00 Rp -

Rp 162,268.00 Rp -

Rp 7,800.00 Rp -

Rp 8,166.67 Rp -

Rp 15,333.34 Rp -

Rp 23,640.00 Rp -

Rp 5,481.00 Rp -

Rp 3,910.00 Rp -

Rp 6,540.00 Rp -

Rp 20,000.00 Rp -

Rp 20,000.00 Rp -

Rp 10,000.00 Rp -

Rp 10,000.00 Rp -

Rp 16,000.00 Rp -

Rp 20,000.00 Rp -

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HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp 160,000.00 Rp -

Rp 70,000.00 Rp -

Rp 2,421.00 Rp -

Rp 9,999.00 Rp -

Rp 39,481.00 Rp -

Rp 39,481.00 Rp -

Rp 2,702,700.00 Rp -

Rp 27,000.00 Rp -

Rp 4,454.54 Rp -

Rp 51.00 Rp -

Rp 91.00 Rp -

Rp 1,458.00 Rp -

Rp 3,249.00 Rp -

Rp 2,360.00 Rp -

Rp 7,954.55 Rp -

Rp 7,954.55 Rp -

Rp 156.00 Rp -

Rp 78.00 Rp -

Rp 31,850.00 Rp -

Rp 7,648.34 Rp -

Rp 45,878.71 Rp -

Rp 3,952.00 Rp -

Rp 17,000.00 Rp -

Rp 35,618.00 Rp -

Rp 130,240.00 Rp -

Rp 43,500.00 Rp -

Rp 51,305.00 Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

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HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Page 15
HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Page 16
HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Page 17
HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Page 18
HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Page 19
HARGA SATUAN HARGA SATUAN
SMT I SMT II

4 5

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

Rp - Rp -

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