RKO - KLINIK AMMARIZ Tahun 2018 Sisipan

1.
SATUAN KERJA ADALAH NAMA APOTEK, KLINIK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. JUMLAH KEBUTUHAN TAHUN 2018 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2016 DIKALI 18 BULAN DALAM SA
3. RENCANA KEBUTUHAN TAHUN 2018 ADALAH RENCANA KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI D
4. RENCANA PENGADAAN TAHUN 2018 ADALAH RENCANA OBAT DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLE
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
SATUAN KERJA : KLINIK AMMARIZ
NO NAMA OBAT SATUAN
1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44 Tab

mg Ca/Na EDTMP, 5-46 ?g samarium, dan 1850 ± 185 mbq samarium 153
per ml
2 Adefovir dipivoksil tab 10 mg Tab

3 Afatinib tab sal selaput 20 mg Tab
4 Afatinib tab sal selaput 30 mg Tab
5 Afatinib tab sal selaput 40 mg Tablet
6 Air untuk injeksi amp 20 ml Ampul
7 Air untuk injeksi amp 25 ml Ampul
8 Air untuk irigasi lar inf 1000 ml Botol
9 Akarbose tab 100 mg Tab
10 Akarbose tab 50 mg Tab
11 Albendazol susp 200 mg/5 ml Botol
12 Albendazol tab 400 mg Tab
13 Albumin serum normal (human albumin) inj 20% 100 ml Botol
20 Alendronat Tab 70 mg Tab
21 Alopurinol tab 100 mg Tab
22 Alopurinol tab 300 mg Tab
23 Alprazolam tab 0,25 mg Tab
24 Alprazolam tab 0,5 mg Tab
25 Alprazolam tab 1 mg Tab
26 Alteplase serb inj 50 mg/vial Vial
27 Amfoterisin B inj 50 mg/10 ml (i.v.) Ampul
28 Amfoterisin B salep mata 1% Tube
29 Amfoterisin B salep mata 3% Tube
30 Amikasin inj 250 mg/ml Vial
31 Aminofilin inj 24 mg/ml Ampul
32 Aminofilin tab 150 mg Tab
33 Aminofilin Tab 200 mg Tab
34 Amiodaron inj 150 mg/3 ml Ampul
35 Amiodaron tab 200 mg Tab
36 Amitriptilin tab sal 25 mg Tab sal
37 Amlodipin tab 10 mg Tab
38 Amlodipin tab 5 mg Tab
39 Amoksisilin drops 100 mg/ml Botol
40 Amoksisilin sir forte 250 mg/5 ml Botol
41 Amoksisilin sir kering 125 mg/5 ml Botol
42 Amoksisilin tab 250 mg Tab
43 Amoksisilin tab 500 mg Tab
44 Ampisilin serb inj 1000 mg/vial Vial
45 Ampisilin serb inj 250 mg/vial Vial
46 Analog insulin : fast acting inj 100 UI/ml (kemasan vial, cartridge Vial/Cartridge
disposible, penfil cartridge)
47 Analog insulin : intermediate acting inj 100 UI/ml (kemasan vial, cartridge vial/cartridge
disposible, penfill cartridge)
48 Analog insulin : mix insulin (inj 100 UI/ml) Vial/Cartridge
49 Analog insulin intermediate acting combine with short or long acting inj Penfill
100 IU/ml, vial/cartridge diposible/penfill cartridge
50 Analog Insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill Vial/Cartridge/Penf
cartridge
51 Anastrozol tab 1 mg Tab
52 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 Vial
ml
53 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Tab
hidroksida 200 mg
54 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Botol
hidroksida 200 mg
55 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps
56 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin B 10.000 UI/g Tube
57 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Tube

58 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Botol
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
59 Aripiperazol oral solution 1 mg/ml Botol

60 Aripiperazol tab discmelt 10 mg Tab
61 Aripiperazol tab discmelt 15 mg Tab
62 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
63 Articulating paper kertas warna penanda oklusi Kertas warna pena
64 Asam asetat tetes telinga 2% Botol
65 Asam asetilsalisilat (asetosal) tab 100 mg Tab
66 Asam asetilsalisilat (asetosal) tab 80 mg Tab
67 Asam askorbat (vitamin C) tab 250 mg Tab
68 Asam askorbat (vitamin C) tab 50 mg Tab
69 Asam folat tab 0,4 mg Tab
70 Asam folat tab 1 mg Tab
71 Asam folat tab 5 mg Tab
72 Asam fusidat tts mata 1% Botol
73 Asam ibandronat inj 1 mg/ml Vial
74 Asam mefenamat kaps 250 mg Kaps
75 Asam mefenamat kaps 500 mg Kaps
76 Asam pipemidat kaps 400 mg Kaps
77 Asam retinoat krim 0,1% Tube
78 Asam salisilat lar 0,1% Botol
79 Asam salisilat salep 10% Tube
82 Asam traneksamat inj 100 mg/ml Ampul
83 Asam traneksamat inj 50 mg/ml Ampul
84 Asam traneksamat tab 500 mg Tab
85 Asam ursodeoksikolat kaps 250 mg Kaps
86 Asam zoledronat inf 4 mg/100 ml Vial
87 Asam Zoledronat Inf 5 mg/100 ml Botol
88 Asetazolamid tab 250 mg Tab
89 Asiklovir salep mata 3% Tube
90 Asiklovir tab 200 mg Tab
91 Asiklovir tab 400 mg Tab
92 Asparaginase serb inj 10.000 UI/vial Vial
93 Atapulgit 600 mg Tab
94 Atapulgit tab 630 mg Tablet
95 Atapulgit tablet 650 mg Tab
96 Atapulgit tablet 750 mg Tab
97 Atenolol tab 100 mg Tab
98 Atenolol tab 50 mg Tab
99 Atorvastatin tab 10 mg Tab
100 Atorvastatin tab 20 mg Tab
101 Atrakurium inj 10 mg/ml (i.v) Vial
102 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
103 Atropin tab 0,5 mg Tab
104 Atropin tts mata 0,5% Botol
105 Atropin tts mata 1% Botol
106 Azatioprin tab 50 mg Tab
107 Azitromisin serb inj 500 mg Vial
108 Azitromisin sir kering 200 mg/5 ml Botol
109 Azitromisin tab 250 mg Tab
110 Azitromisin tab 500 mg Tab
111 Bahan tumpatan sementara lar, serb Botol
112 Barium sulfat serb 92 g/100 ml Botol
113 Barium sulfat susp 2,2% Botol
114 Barium sulfat susp 55% Botol
115 Barium sulfat susp 65% Botol
116 Basiliksimab Inj 20 mg Vial
117 Bedak salisil serb 2% Botol
118 Bendamustin serb inj 100 mg Vial
119 Bendamustin serb inj 25 mg Vial
120 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial
121 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial
122 Beractant susp 25 mg/ml (intratekal) Botol
123 Beraprost sodium tab 20 mcg Tab
124 Betahistin tab 24 mg Tab
125 Betahistin tab 6 mg Tab
126 Betaksolol tts mata 0,5% Botol
127 Betametason krim 0,1% Tube
128 Betametason krim 0,5 mg/g Tube
129 Betametason salep 0,1% Tube
130 Betametason tts mata 1 mg/ml Botol
131 Bevasizumab inj 25 mg/ml Vial
132 Bikalutamid tab sal 150 mg Tab
133 Bikalutamid tab sal 50 mg Tab
134 Bisakodil sup 10 mg Botol
135 Bisakodil sup 5 mg Botol
136 Bisakodil tab sal 5 mg Tab sal
137 Bisoprolol tab 1,25 mg Tab
138 Bisoprolol tab 10 mg Tab
139 Bisoprolol tab 2,5 mg Tab
140 Bisoprolol tab 5 mg Tab
141 Bleomisin serb inj 15 mg/ml Vial
142 Brinzolamid tetes mata Botol
143 Bromokriptin tab 2,5 mg Tab
144 Budesonid cairan ih 0,25mg/ml Botol
145 Budesonid ih 200 mcg/dosis Botol
146 Budesonid serb ih 100 mcg/dosis Botol
147 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 120 Botol
dosis
148 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 60 dosis Botol
149 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol

150 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% Ampul
151 Bupivakain inj 5 mg/ml (p.v.) Ampul
152 Busulfan tab salut 2 mg Tab
153 Coal tar lar 5 % Botol
154 Copper T set/buah
155 Dabigatran eteksilat kaps 110 mg Kaps
156 Dabigatran eteksilat kaps 75 mg Kaps
157 Dakarbazin serb inj 100 mg/vial Vial
158 Dakarbazin serb inj 200 mg/vial Vial
159 Daktinomisin inj 0,5 mg/vial (i.v.) Vial
160 Dapson tab scored 100 mg Tab
161 Daunorubisin serb inj 20 mg/vial Vial
162 Deferasiroks tab disp 250 mg Tab
163 Deferasiroks tab disp 500 mg Tab
164 Deferipron lar oral 100 mg/ml Botol
165 Deferipron tab sal 500 mg Botol
166 Deferoksamin mesilat serb inj 500 mg/vial Vial
167 Deksametason inj 5 mg/ml (i.v./i.m.) Vial
168 Deksametason tab 0,5 mg Tab
169 Deksametason tab 4 mg Tab
170 Deksmedetomidin Inj 100 mcg/ml Ampul
171 Desmopresin nasal spray 10 mcg/puf Botol
172 Desmopresin tab 0,1 mg Tab
173 Desmopresin tab 0,2 mg Tab
174 Desogestrel tab 75 mcg Tab
175 Desoksimetason gel 0,05% Tube
176 Desoksimetason krim 0,25% Tube 15 g
177 Desoksimetason salep 0,25% Tube 10 g
178 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 1,5% Botol
179 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 12,5% Botol
180 Dialisa peritoneal lar intraperitonial Botol
181 Diazepam inj 5 mg/ml (i.v./i.m.) Vial
182 Diazepam lar rektal 10 mg/2,5 ml Botol
183 Diazepam lar rektal 5 mg/2,5 ml Botol
184 Diazepam tab 2 mg Tab
185 Diazepam tab 5 mg Tab
186 Dienogest tab 2 mg Tablet
187 Dietilkarbamazin tab 100 mg Tab
188 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul
189 Diflukortolon valerat salep berlemak 0,1% Tube
190 Digoksin inj 0,25 mg/ml Vial
191 Digoksin tab 0,25 mg Tab
192 Diltiazem hcl inj 5 mg/5 ml Ampul
193 Diltiazem hcl tab 30 mg Tab
194 Diltiazem inj 25 mg/5 ml Ampul
195 Diltiazem kaps SR 100 mg Kaps
196 Diltiazem kaps SR 200 mg Kaps
197 Diltiazem serb inj 10 mg/10 ml Ampul
198 Diltiazem serb inj 50 mg/vial Vial
199 Diltiazem tab 30 mg Tab
200 Dimenhidrinat tab 50 mg Tab
201 Dinatrium edetat tts mata 0,35% Botol
202 Dinatrium klodronat inj 60 mg/ml Botol
203 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic Vial
acid/vial
204 Dobutamin inj 12,5 mg/ml Vial
205 Dobutamin inj 25 mg/ml Vial
206 Dobutamin inj 50 mg/ml Vial
207 Doksazosin mesilat tab 1 mg Tab
208 Doksazosin mesilat tab 2 mg Tab
209 Doksazosin tab 1 mg Tab
210 Doksazosin tab 2 mg Tab
211 Doksisiklin kaps 100 mg Kaps
212 Doksisiklin kaps 50 mg Kaps
213 Doksorubisin serb inj 10 mg/vial (i.v.) Vial
214 Doksorubisin serb inj 50 mg/vial Vial
215 Domperidon susp 5 mg/5 ml Botol
216 Domperidon tab 10 mg Tab
217 Domperidon tts 5 mg/ml Botol
218 Donepezil tab 5 mg Tab
219 Donepezil tab ef 10 mg Tab ef
220 Dopamin inj 40 mg/ml Vial
221 Dosetaksel Inj 40 mg/ml (vial 0,5 ml) Ampul
222 Dosetaksel inj 40 mg/ml (vial 2 ml) Ampul
223 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial
calcium trisodium/ml
224 Dutasterid kaps 0,5 mg Kaps
225 Efavirens tab sal 600 mg Tab sal
226 Efavirenz tab 200 mg Tablet
227 Efedrin inj 50 mg/ml Ampul
228 Eksemestan tab 25 mg Tab
229 Enoksaparin sodium inj 20 mg/0,2 ml Ampul
232 Entekavir tab sal selaput 0,5 mg Tablet
233 Entekavir tab sal selaput 1 mg Tablet
234 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul
235 Epinefrin (adrenalin) inj 1 mg/ml Ampul
236 Epirubisin serb inj 2 mg/ml Vial
237 Epirubisin serb inj 50 mg Vial
238 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps
239 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol
240 Ergotamin tab 1 mg Tab
241 Eritromisin kaps 250 mg Kaps
242 Eritromisin sir 200 mg/5 ml Botol
243 Eritromisin tab 500 mg Tab
244 Eritropoetin-alfa inj 10.000 UI/ml Vial
247 Eritropoetin-beta inj 2000 UI/0,3 ml Vial
248 Eritropoietin-Alfa Inj 4000 IU/0,5 ml Ampul
249 Erlotinib tab sal selaput 100 mg Tab
250 Erlotinib tab sal selaput 150 mg Tab
251 Esomeprazole inj 40 mg/vial Vial
252 Estrogen terkonjugasi tab sal 0,625 mg Tab sal
253 Etambutol tab 250 mg Tab
256 Etanol 70% cairan 70% Botol
257 Etil klorida semprot 100 ml Botol
258 Etinilestradiol tab 0,05 mg Tab
259 Etinilestradiol tab 0,5 mg Tab
260 Etonogestrel implan 68 mg Set
261 Etoposid inj 20 mg/ml Vial
262 Etoposid kaps 100 mg Kaps
263 Eugenol Botol
264 Everolimus tab 0,25 mg Tab
265 Everolimus tab 0,5 mg Tab
266 Faktor IX Kompleks Inj 50 IU/mL Vial
267 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial
268 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial
269 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi Vial
IX 25 UI, faktor koagulasi X 14-35 serb inj 250 IU/10 ml
270 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi Vial
IX 25 UI, faktor koagulasi X 14-35 serb inj 500 UI/10 ml UI
271 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi Vial
272 Faktor VIII (konsentrat) serb inj 230 -340 UI Vial

273 Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5 ml Vial
274 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial
275 Faktor VIII (konsentrat) serb inj 500 UI/vial + pelarut 5 ml Vial
276 Faktor VIII serb inj 1000 mg/vial Vial
277 Faktor VIII serb inj 2000 mg/vial Vial
278 Fenitoin Na inj 100 mg/2 ml Ampul
279 Fenitoin Na inj 50 mg/ml Ampul
280 Fenitoin Na kaps 100 mg Kaps
281 Fenitoin Na kaps 30 mg Kaps
282 Fenobarbital inj 50 mg/ml Ampul
283 Fenobarbital tab 100 mg Tab
284 Fenobarbital tab 30 mg Tab
285 Fenofibrat kaps 100 mg Kaps
286 Fenofibrat kaps 300 mg Kaps
287 Fenoksimetil penisilin (penisilin V) tab 125 mg Tab
290 Fenoterol hbr aerosol 100 mcg/puf Botol
291 Fenoterol hbr cairan ih 0,1% Botol
292 Fentanil inj 0,05 mg/ml (ampul 10 ml) Vial
293 Fentanil inj 0,05 mg/ml (ampul 2 ml) Vial
294 Fentanil patch 12,5 mcg/jam Pack
295 Fentanil patch 25 mcg/jam Pack
296 Fentanil patch 50 mcg/jam Pack
297 Ferrakrilum cairan 1% Botol
298 Ferro fumarat kaps lunak 300 mg Kaps lunak
299 Ferro sulfat sir. 150 mg/5 ml Botol
300 Ferro sulfat tab salut 300 mg Tab sal
301 Filgrastim inj 300 mcg/ml Vial
302 Finasterid tab 5 mg Tab
303 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial
304 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
305 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul
306 Fludarabin inj 50 mg/vial Vial
307 Fludarabin tab sal 10 mg Tab
308 Flufenazin inj 25 mg/ml (i.m.) Vial
309 Flukonazol inj 2 mg/ml Ampul
310 Flukonazol kaps 150 mg Kaps
311 Flukonazol kaps 50 mg Kaps
312 Fluoksetin kaps 10 mg Kaps
313 Fluoksetin kaps 20 mg Kaps
314 Fluor kapl 1 mg Kaplet
315 Fluor sediaan topikal Tube
316 Fluoresein injeksi 10% Ampul
317 Fluoresein tts mata 2,5 mg/ml Botol
318 Fluoro deoxy glucose (FDG) Vial
319 Fluorometolon tts mata 0,1% Botol
320 Fluorourasil Inj 25 mg/ml Vial
321 Fluorourasil inj 250 mg/ml Ampul
322 Fluorourasil inj 50 mg/mL (@ 10 mL) Ampul
323 Fluorourasil inj 50 mg/mL (@ 5 mL) Ampul
324 Fluorourasil serb inj 250 mg Ampul
325 Flusinolon asetonid krim 0,025% Tube 5 g
326 Flusinolon asetonid salep 0,025% Tube 10 g
327 Flutikason furoat intranasal spray Botol
328 Flutikason propionat cairan ih 0,5 mg/dosis Botol
329 Fondaparinuks inj 2,5 mg/0,5 ml Vial
330 Formokresol Botol
331 Fraksi protein plasma lar inf 5% Botol
332 Framisetin Sulfat Tulle 1% Patch
333 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul
334 Furosemid tab 40 mg Tab
335 Gabapentin kaps 100 mg Kaps
336 Gabapentin kaps 300 mg Kaps
337 Gadobutrol Macrocyclic 5 mg Macrocyclic
338 Gadobutrol Macrocyclic 7,5 mg Macrocyclic
339 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial
340 Galactose microparticle 200-400 mg micropart/ml Vial
341 Gansiklovir serb inj 500 mg/vial Vial
342 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + Sachet
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
343 Gefitinib tab 250 mg Tab
344 Gemfibrozil kaps 300 mg Kaps
345 Gemfibrozil kaps 600 mg Kaps
346 Gemsitabin inj 1000 mg/vial Vial
347 Gemsitabin inj 200 mg/vial Vial
348 Gentamisin inj 10 mg/ml Ampul
351 Gentamisin salep mata 0,3% Tube
352 Gentamisin tts mata 0,3% Botol
353 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g Sachet
354 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol

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

Triple FDC
575 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg Vial
576 Kombinasi : artemether 20 mg + lumefantrin 120 mg Kaps
577 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
578 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
579 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab
580 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut Tablet
581 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0,05 mg Botol
aerosol
582 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg Tab
583 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab

584 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25 Vial
mg + 5 mg
585 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial
586 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab

587 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 mg Tab
588 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube

589 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab
590 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Botol
591 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
592 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab
593 Kombinasi: natrium klorida 8,664 mg + kalium klorida 1,32 mg (tetes Botol
mata)
594 Kombinasi: parafin + gliserin + fenolftalein Botol
595 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 Botol
mcg/puf
mcg/puf
mcg/puf
598 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol
mcg/puf
599 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg Tab
600 Komposit resin Set
601 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab
trimetoprim 80 mg
602 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ Tab
trimetoprim 160 mg
603 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : sulfametoksazol Botol
200 mg + trimetoprim 40 mg
604 Kuinin inj 25% (i.v.) Vial
605 Kuinin tab 200 mg Tab
606 Laktulosa sir 3,335 g/5 ml Botol
607 Lamivudin (3TC) tab 150 mg Tab
608 Lamivudin tab 100 mg Tab
609 Lamotrigin Tab 100 mg Tab
610 Lamotrigin tab 50 mg Tablet
611 Lamotrigin tab dispersible 25 mg Tablet
612 Lansoprazol inj 30 mg/ml Vial
613 Lansoprazol kaps 30 mg Kaps
614 Lapatinib tab 250 mg Tab
615 Larutan mengandung Asam Amino (Asam Amino 10%) Botol
616 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Botol
Na+ 2 mEq, Asetat 120 mEq)
617 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl- Botol
52 mEq)
618 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 1000 ml
619 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 500 ml
620 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, Botol
L-Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)
621 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol
Taurine 0,24 gr/l) : Aminosteril Infant 6%
622 Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Botol
Amino esensial: Asam Amino non esensial = 60 : 40)
623 Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N 11.53 g, Botol
AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)
624 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Botol
Na+ 14 mEq, Cl 94 mEq)
625 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N- Botol
Hepa
626 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 Botol
g/L)
627 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Botol
Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)
628 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, Botol
vitamin dan elektrolit)
629 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 34gr, Botol
Glukosa: 97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal, Akses
peripheral))
630 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 45gr, Botol
Glukosa: 130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400 kkal, Akses
peripheral))
631 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 Botol
gr + Asam Amino 48 gr dgn akses sentral)
632 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 Botol
gr + Asam Amino 40 gr)
633 Larutan mengandung Elektrolit (Kalium Klorida) Botol
634 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Botol
Asetat 28 mEq)
635 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) Botol
636 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
637 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Botol

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)
638 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Xylitol Botol
100 g/ L)
639 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol
g/ L)
640 Larutan mengandung Karbohidrat (Maltose 100 gr) Botol
641 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g Botol
sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)
642 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol
Sorbitol 50 gr/L)
643 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 100 gr/L, elektrolit)
644 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 75 gr/L, elektrolit)
645 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, glucose 66 Botol
g, Xylitol 60 g/ L + elektrolit)
646 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, Botol
KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
647 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
648 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol
g)
649 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 Botol
g)
650 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol
g)
651 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi Botol
infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ,
Asetat 38mEQ, Sorbitol 50g)
652 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol
5%)
653 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
654 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
655 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat Botol
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
656 Larutan mengandung Lipid (Emulsi lemak 20%) Botol
657 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol
658 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml) Botol
659 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Botol
Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
662 Latanoprost tts mata 0,005% Botol
663 Leflunomid tab sal selaput 20 mg Tablet
664 Lenograstim inj 263 mcg/vial Vial
665 Letrozol tab 2,5 mg Tab
666 Leuprorelin asetat serb inj 1,88 mg Vial
671 Levetirasetam tab 250 mg Tablet
672 levetirasetam tab 500 mg Tablet
673 Levofloksasin inf 5 mg/ml Botol
674 Levofloksasin tab 500 mg Tab
675 Levofloksasin tts mata 0,5% Botol
676 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) Set
677 Levotiroksin tab 100 mcg Tab
678 Levotiroksin tab 50 mcg Tab
679 Lidokain gel 2% Tube
680 Lidokain inj 1 % (infltr) Vial
681 Lidokain inj 100 mg, vial (i.v.) Vial
682 Lidokain inj 2% (infiltr/p.v.) Ampul
683 Lidokain inj 5% + glukosa (dekstrosa) 5 % Ampul
684 Lidokain spray oral 10% Botol
685 Linestrenol tab 0,5 mg Tab
686 Linestrenol tablet 5 mg Tab
687 Lisinopril tab 10 mg Tab
690 Litium karbonat tab 200 mg Tab
691 Litium karbonat tab 400 mg Tab
692 Loperamid tab 2 mg Tab
693 Loratadin tab 10 mg Tab
694 Lorazepam tab 0,5 mg Tab
695 Lorazepam tab 1 mg Tab
696 Lorazepam tab sal 2 mg Tab sal
697 Low molecular weight iron dextran inj 100mg/2 ml Ampul
698 Low molecule feri sucrose inj amp 100 mg/5 ml Ampul
699 Lugol Botol
700 MAA (macro agregate albumin) 0,11-2,5 mg albumin Vial
aggregated/reaction vial
701 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial
702 Magnesium sulfat inj 20% Vial
703 Magnesium sulfat inj 40% Vial
704 Magnesium sulfat serb, ktg 30 g Sachet
705 Manitol lar infus 20% Botol
706 Maprotilin hcl tab sal 25 mg Tab sal
707 Maprotilin hcl tab sal 50 mg Tab sal
708 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml Vial
709 Mebendazol sir 100 mg/5 ml Botol

710 Mebendazol tab 100 mg Tan
711 Mebendazol tab 500 mg Tab
712 Medroksi progesteron asetat inj 150 mg/ml Vial
713 Medroksi progesteron asetat inj 200 mg/ml Vial
714 Medroksi Progesteron Asetat Inj 50 mg/ml Vial
715 Medroksi progesteron asetat tab 10 mg Tab
719 Melfalan tab 2 mg Tab
720 Merkaptopurin tab 50 mg Tab
721 Meropenem serb inj 1000 mg/vial Vial
722 Meropenem serb inj 500 mg/vial Vial
723 Mesalazin tab sal 250 mg Tab
724 Mesna inj 100 mg/ml Vial
725 Metadon sir 50 mg/5 ml Botol 1000 ml
726 Metamizol Inj 500 mg/ml Ampul
727 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut
728 Metformin tab 500 mg Tab

729 Metformin tab 850 mg Tab
730 Metildopa tab sal 250 mg Tab
731 Metilergometrin inj 0,2 mg/ml Ampul
732 Metilergometrin tab salut 0,125 mg Tab sal
733 Metilfenidat tab SR 10 mg Tab
734 Metilfenidat tab SR 20 mg Tab
735 Metilprednisolon inj 125 mg/2 ml Vial
736 Metilprednisolon inj 500 mg/8 ml Vial
737 Metilprednisolon tab 16 mg Tab
740 Metoklopramid drop botol 10 ml Botol
741 Metoklopramid inj 5 mg/ml Vial
742 Metoklopramid sir 5 mg/5 ml Botol
743 Metoklopramid tab 10 mg Tab
744 Metoklopramid tab 5 mg Tab
745 Metoprolol tartat inj 1 mg/ml Ampul
746 Metotreksat Inj 10 mg/ml Vial
747 Metotreksat inj 2,5 mg/ml Vial
748 Metotreksat serb inj 25 mg/ml Vial
749 Metotreksat serb inj 5 mg/vial Vial
750 Metotreksat tab 2,5 mg Tab
751 Metronidazol lar inf 5 mg/ml Botol
752 Metronidazol ovula 500 mg Supp
753 Metronidazol sir 125 mg/5 Ml Botol
754 Metronidazol sup 500 mg Botol
755 Metronidazol tab 250 mg Tab
756 Metronidazol tab 500 mg Tab
757 MIBG (meta-iodobenzylguanidine) Vial
758 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial
759 Midazolam inj 1 mg/ml (i.v.) Vial
760 Midazolam inj 5 mg/ml (i.v.) Vial
761 Mikafungin Na serb inj 50 mg/vial Vial
762 Mikofenolat mofetil tab 500 mg Tab
763 Mikofenolat Sodium Tab Sal 180 mg Tablet
764 Mikofenolat Sodium Tab Sal 360 mg Tablet
765 Mikonazol krim 2% Tube
766 Mikonazol serb 2% Tube
767 Mitomisin serb inj 10 mg Vial
768 Mitomisin serb inj 2 mg Vial
769 Modified fluid gelatine BM 30 000 lar inf 4% Botol
770 Moksifloksasin inf 1,6 mg/mL Botol
771 Moksifloksasin tab 400 mg Tab
772 Moksifloksasin tts mata 0,5% Botol
773 Mometason furoat krim 0,1% Tube
774 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial
775 Morfin Hcl tab 10 mg Tab
776 Morfin Hcl tab SR 10 mg Tab
779 N-asetil sistein granula 200 mg Kaps
780 N-asetil sistein ih 100 mg/ml Botol
781 N-asetil sistein kaps 200 mg Kaps
782 NaCl 0,9% Larutan Botol
783 Nadroparin inj 10 mg/ml Vial
784 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml Vial
785 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml Vial
786 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml Vial
787 Nalokson inj 0,4 mg/ml Ampul
788 Natamisin tts mata 5% Botol
789 Natamisin tts mata 50 mg/ml Botol
790 Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul
791 Natrium bikarbonat High alert medicine. Vial
792 Natrium bikarbonat inj 8,4% (i.v.) Vial
793 Natrium bikarbonat tab 500 mg Tab
794 Natrium diklofenak tab 25 mg Tab
795 Natrium diklofenak tab 50 mg Tab
796 Natrium Diklofenak Tetes Mata 1 mg/ml Botol
797 Natrium fluoresein tts mata 2% Botol
798 Natrium fosfat btl, 133 ml Botol
799 Natrium fosfat lar oral 45 ml Botol
800 Natrium fusidat krim 20 mg/g Tube
801 Natrium fusidat salep 20 mg/g Tube
802 Natrium hialuronat gel Tube
803 Natrium hipoklorit cairan konsentrat 5% Botol
804 Natrium tiosulfat inj 25% (i.v.) Ampul
805 Neostigmin inj 0,5 mg/ml Vial
806 Nevirapin tab 200 g Tab
807 Nifedipin kaps 10 mg Kaps
808 Nifedipin tab SR 20 mg Tab
809 Nifedipin tab SR 30 mg Tab
810 Nikardipin inj 10 mg/vial Vial
811 Nikotinamid tab 100 mg Tab
812 Nikotinamid tab 5 mg Tab
813 Nilotinib kaps 150 mg Kaps
814 Nilotinib tab 200 mg Tab
815 Nimodipin inf 0,2 mg/ml Botol
816 Nimodipin tab 30 mg Tab
817 Nistatin susp 100.000 UI/ml Botol
818 Nistatin tab salut 500.000 UI Tab
819 Nistatin tab vaginal 100.000 UI Tab
820 Nitrofurantoin tab 50 mg Tab
821 Nitrogen oksida ih, gas dlm tabung Botol
822 Nomegestrol asetat Kaps/tab 5 mg Tablet
823 Norepinefrin inj 1 mg/ml Ampul
824 Noretisteron tab 5 mg Tab
825 Obat Anti Tuberculosis FDC Kategori Anak Paket
826 Obat Anti Tuberculosis FDC Kategori I Paket
827 Obat Anti Tuberculosis FDC Kategori II Paket
828 Obat Anti Tuberculosis FDC Kategori Sisipan Paket
829 Obat Anti Tuberculosis Kombipak Anak Paket
830 Obat Anti Tuberculosis Kombipak Dewasa Paket
831 Octreotide acetate 0,05 - 6 mg/ml Botol
832 Ofloksasin tab 200 mg Tab
833 Ofloksasin tab 400 mg Tab
834 Ofloksasin tts telinga 3% Botol
835 Oksaliplatin serb inj 100 mg/vial Vial
836 Oksaliplatin serb inj 50 mg/vial Vial
837 Oksigen ih, gas dlm tabung Botol
838 Oksimetazolin tts hidung 0,025% Botol
839 Oksimetazolin tts hidung 0,050% Botol
840 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial
841 Oksitosin inj 10 UI/ml Ampul
842 Oktreotid asetat 0,05 - 6 mg/ml Vial
843 Oktreotid serb inj 20 mg Ampul
844 Oktreotid serb inj 30 mg vial
845 Olanzapin inj 10 mg/2 ml Ampul
846 Olanzapin tab sal 10 mg Tab sal
847 Olanzapin tab sal 5 mg Tab
848 Olodaterol cairan ih 2,5 mcg/semprot Botol
849 Olopatadin tts mata 0,1% Botol
850 Omeprazol inj 40 mg/10 ml Vial
851 Omeprazol kaps 20 mg Kaps
852 Ondansetron inj 2 mg/ml Vial
853 Ondansetron tab 4 mg Tab
854 Ondansetron tab 8 mg Tab
855 Paklitaksel inj 100 mg/vial Vial
858 Paklitaksel Inj 6 mg/ml Ampul
859 Paliperidon palmitat Inj 100 mg/mL Ampul
860 Paliperidon palmitat Inj 150 mg/1,5 mL Ampul
863 Pankuronium inj 2 mg/ml Ampul
864 Paraformaldehid lar bufer 10% Botol
865 Paraformaldehid tab 1 g Tab
866 Parasetamol drips (infus) 1000 mg/100 ml Botol
867 Parasetamol sir 120 mg/5 ml Botol
868 Parasetamol tab 500 mg Tab
869 Parasetamol tts 60 mg/0,6 ml Botol
870 Pasta devitalisasi (non arsen) Tube
871 Pasta pengisi saluran akar (pasta) Tube
872 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Vial
873 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Vial
874 Pegylated interferon alfa-2b serb inj 100 mcg/ml Vial
878 Pemetreksed serb inj 500 mg Vial
879 Pengganti plasma kombinasi : poligelin (ekivalen dengan 0,63 g nitrogen Botol
17,5 g ; natrium klorida 0,19 g ; kalsium klorida 0,19 g ; kalsium (terikat
pada polipeptida) 0,125 g
880 Perak nitrat lar 20% Botol

881 Perak sulfadiazin krim 1% Tube
882 Perindoprilarginin tab 5 mg Tab
883 Permetrin krim 5 % Tube
884 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial
885 Pilokarpin tts mata 2% Botol
886 Pioglitazon tab 15 mg Tab
887 Pioglitazon tab 30 mg Tab
888 Pirantel pamoat susp 125 mg/5 ml Botol
889 Pirantel pamoat tab 500 mg Tab
890 Pirantel pamoat tab scored 125 mg Tab
891 Pirantel pamoat tab scored 250 mg Tab
892 Pirazinamid tab 500 mg Tab
893 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
894 Piridoksin (vitamin B6) tab 10 mg Tab
895 Piridoksin (vitamin B6) tab 25 mg Tab
896 Piridostigmin tab sal 60 mg Tab sal
897 Pirimetamin tab 25 mg Tablet
898 Podofilin tingtur 25 % Botol
899 Polietilen glikol Botol
900 Polikresulen Botol
901 Povidon iodin lar 100 mg/ml Botol 300 ml
905 Pramipeksol tab 0,125 mg Tablet
906 Pramipeksol tab ER 0,375 mg Tab
907 Pramipeksol tab ER 0,750 mg Tab
908 Pravastatin tab 10 mg Tab
909 Pravastatin tab 20 mg Tab
910 Prazikuantel tab scored 300 mg Tab
911 Prazikuantel tab scored 600 mg Tab
912 Prednisolon tts mata 10 mg/ml Botol
913 Prednison tab 5 mg Tab
914 Primakuin tab 15 mg Tab
915 Probenesid tab 500 mg Tab
916 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial
917 Prokaterol HCl cairan ih 30 mcg Botol
918 Prokaterol HCl cairan ih 50 mcg Botol
919 Prokaterol HCl serb ih 10 mcg Botol
920 Propiltiourasil tab 100 mg Tab
921 Propofol inj 1% (i.v. Bolus) Ampul
922 Propranolol inj 1 mg/ml (i.v.) Ampul
923 Propranolol tab 10 mg Tab
924 Propranolol tab 40 mg Tab
925 Prostaglandin (PGE 1) Inj 500 mcg/ml Vial
926 Protamin sulfat inj 10 mg/ml (i.m.) Ampul
927 Quetiapin tab SR 200 mg Tab
930 Ramipril tab 10 mg Tab
931 Ramipril tab 2,5 mg Tab
932 Ramipril tab 5 mg Tab
933 Ranibizumab inj 10 mg/ml Vial
934 Ranitidin inj 25 mg/ml Ampul
935 Ranitidin tab 150 mg Tab
936 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak
937 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak
938 Ribavirin tab 200 mg Tab
939 Rifampisin kaps 300 mg Kaps
940 Rifampisin tab 450 mg Tab
941 Rifampisin tab 600 mg Tab
942 Ringer Laktat Larutan Botol
943 Ringer Laktat Larutan 1000 ml Botol
944 Risedronat tab sal selaput 35 mg Tab
945 Risperidon tab 3 mg Tab
946 Risperidon tab sal 1 mg Tab sal
947 Risperidon tab sal 2 mg Tab sal
948 Rituksimab inf 10 mg/ml (vial 10 ml) Vial
949 Rituksimab Inf 10 mg/ml (vial 50 ml) Vial
950 Rituksimab inj 100 mg/ml Ampul
951 Rituksimab inj 500 mg/ml Ampul
952 Rivaroksaban tab sal 10 mg Tab sal
955 Rokuronium inj 50 mg/5 ml (i.v.) Vial
956 Ropinirol tab lepas lambat 2 mg Tab
959 Ropivakain Inj 7,5 mg/ml Ampul
960 Rosuvastatin tab 10 mg Tab
961 Salbutamol aerosol 100 mcg Botol
962 Salbutamol cairan ih 0,1% Botol
963 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol
964 Salbutamol lar ih 0,5 % Botol
965 Salbutamol nebules vial 2,5 mg Vial
966 Salbutamol sir 2 mg/5 ml Botol
967 Salbutamol tab 2 mg Tab
968 Salbutamol tab 4 mg Tab
969 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube
970 Sefadroksil kaps 250 mg Vial
971 Sefadroksil kaps/tab 500 mg Tab
972 Sefadroksil sir kering 125 mg/5 ml Botol
973 Sefadroksil sir kering 250 mg/5 ml Botol
974 Sefaleksin kaps 250 mg Kaps
975 Sefaleksin kaps 500 mg Kaps
976 Sefazolin serb inj 1 g/vial Vial
977 Sefepim serb inj 1000 mg/vial Vial
978 Sefiksim sir 100 mg/5 ml Botol
979 Sefiksim tab 100 mg Tab
980 Sefiksim Tab 200 mg Tablet
981 Sefoperazon serb inj 1.000 mg/vial Vial
982 Sefotaksim inj 500 mg/vial Vial
983 Sefotaksim serb inj 1.000 mg/vial Vial
984 Sefpirom serb inj 1000 mg Vial
985 Sefpodoksim proksetil tab sal 100 mg Tab
986 Seftazidim serb inj 1.000 mg/vial Vial
987 Seftriakson serb inj 1.000 mg/vial Vial
988 Sefuroksim serb inj 750 mg/vial Vial
989 Sefuroksim tab 250 mg Tab
990 Sefuroksim tab sal 500 mg Tab
991 Sertralin tab sal 50 mg Tab sal
992 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj (i.m./i.v.) Papua Vial
993 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial
994 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
995 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 20.000 UI/ Vial
996 Serum antirabies inj 100 UI/ml Vial
997 Serum antirabies inj 200 UI/ml Vial
998 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
999 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
1000 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
1001 Setirizin sir 5 mg/5 ml. Botol
1002 Setirizin tab 10 mg Tab
1003 Setuksimab inj 5 mg/ml Vial
1004 Sevelamer karbonat Tab 800 mg Tab
1005 Sevofluran cairan ih 250 ml Botol
1006 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial
1007 Sianokobalamin (vitamin B12) tab 50 mcg Tab
1008 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial
1011 Siklopentotat tetes mata 1% Botol
1012 Siklosporin inj 100 mg/ml Ampul
1013 Siklosporin inj 50 mg/ml Ampul
1014 Siklosporin kaps 100 mg Kaps
1015 Siklosporin kaps lunak 25 mg Kaps
1016 Siklosporin Kaps lunak 50 mg Kapsul
1017 Sildenafil Tab 20 mg Tab
1018 Silodosin tab 4 mg Tab
1019 Silostazol tab 100 mg Tab
1020 Simeprevir tab 150 mg Tablet
1021 Simvastatin tab sal 10 mg Tab sal
1022 Simvastatin tab sal 20 mg Tab sal
1023 Simvastatin tab sal selaput 40 mg Tab sal
1024 Siprofloksasin inf 2 mg/ml Botol
1025 Siprofloksasin tab scored 500 mg Tab
1026 Siprofloksasin tetes mata 3 mg/ml Botol
1027 Sisplatin serb inj 10 mg Vial
1028 Sisplatin serb inj 50 mg Vial
1029 Sitarabin inj 50 mg Vial
1030 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial
1031 Sofosbuvir tab sal selaput 400 mg Tablet
1032 Somatostatin serb Inj 3000 mcg/mL Vial
1033 Spiramisin tab 250 mg Tab
1034 Spiramisin tab 500 mg Tab
1035 Spironolakton tab 100 mg Tab
1036 Spironolakton tab 25 mg Tab
1037 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
1038 Stavudin tab 30 mg Tab
1039 Streptokinase serb inj 1,5 juta UI/vial Vial
1040 Streptomisin serb inj 1.000 mg/vial Vial
1041 Sufentanil inj 5 mcg/ml (i.v.) Ampul
1042 Sugammadeks inj 100 mg/ml Vial
1043 Sukralfat susp 500 mg/5 ml Botol
1044 Sukralfat tab 500 mg Tab
1045 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial
1046 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial
1047 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial
1048 Sulfadiazin tab 500 mg Tablet
1049 Sulfasalazin kapl sal enterik 500 mg Kaps salut
1050 Sulfur colloid 4,5 mg gelatin/reaction vial Vial
1051 Surfaktan susp 25 mg/ml (intratrakeal) Botol
1052 Surgical ginggival pack Tube
1053 Takrolimus kaps 0,5 mg Kaps
1054 Takrolimus kaps 1 mg Kaps
1055 Takrolimus kaps lepas lambat 0,5 mg Kaps
1056 Takrolimus kaps lepas lambat 1 mg Kaps
1057 Tamoksifen tab 10 mg Tablet
1058 Tamoksifen tab 20 mg Tab
1059 Tamsulosin tab 0,2 mg Tab
1060 Tamsulosin tab SR 0,4 mg Tab
1061 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set
1062 Telbivudin tab 600 mg Tab
1063 Telmisartan tab 40 mg Tab
1064 Telmisartan tab 80 mg Tab
1065 Temozolamid kaps 100 mg Kaps
1066 Temozolamid kaps 20 mg Kaps
1067 Tenofovir tab 300 mg Tab
1068 Teofilin tab 150 mg Tab
1069 Teofilin tab SR 300 mg Tab
1070 Terazosin hcl tab 1 mg Tab
1071 Terazosin hcl tab 2 mg Tab
1072 Terbinafrin tab 250 mg Tablet
1073 Terbutalin cairan ih 2,5 mg/ml Botol
1074 Terbutalin inj 0,5 mg/ml Vial
1075 Terbutalin serb ih 0,50 mg/dose Vial
1076 Terbutalin sir 1,5 mg/5 ml Botol
1077 Terbutalin tab 2,5 mg Tab
1078 Testosteron inj 250 mg/ml (vial 1 ml) Vial
1079 Testosteron Inj 250 mg/ml (vial 4 ml) Vial
1080 Testosteron kaps lunak 40 mg Kaps
1081 Testoteron kombinasi : benserazin 25 mg +levodopa 100 mg Kaps
1082 Tetanus toxoid inj Ampul
1083 Tetrakain tts mata 0,5% Botol
1084 Tetrasiklin kaps 250 mg Kaps
1085 Tetrasiklin kaps 500 mg Kaps
1086 Tetrasiklin Salep Mata 1% Tube
1087 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set
1088 Tiamazol tab 10 mg Tab
1089 Tiamazol tab 5 mg Tab
1090 Tiamin (vitamin B1) tab 50 mg Tab
1091 Tikagrelor tab 90 mg Tab
1092 Timolol tts mata 0,25% Botol
1093 Timolol tts mata 0,5% Botol
1094 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul
1095 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul
1096 Tiotropium respimat ih 5 mcg/semprot Botol
1097 Tiotropium serb ih 18 mcg + handihaller Botol
1098 Tiotropium serb ih 18 mcg, refill Botol
1099 Tobramisin tetes mata 0,3% Botol
1100 Topiramat tab 100 mg Tab
1103 Trastuzumab serb inj 440 mg/vial Vial
1104 Travoprost tts mata 0,004% Botol
1105 Triamsinolon asetonid nasal spray 55 mcg/puf Botol
1106 Triamsinolon inj 10 mg/ml Ampul
1107 Trifluoperazin tab sal 5 mg Tab sal
1108 Triheksifenidil tab 2 mg Tab
1109 Tropikamid tts mata 0,5% Botol
1110 Tropikamid tts mata 1% Botol
1111 Tuberkulin protein purified derivative 1:10 (i.k) Ampul
1112 Urea krim 10 % Tube
1113 Vaksin BCG inj (i.k) Vial
1114 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
1115 Vaksin campak inj (s.k.) Vial
1116 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml Vial
(i.m)
1117 Vaksin jerap difteri tetanus (DT) Vial
1118 Vaksin jerap difteri tetanus (Td) Vial
1119 Vaksin kombinasi DPT-HB-Hib Vial
1120 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
1121 Vaksin polio IPV inj 0,5 ml Vial
1122 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
1123 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
1124 Valasiklovir tab 500 mg Tab
1125 Valgansiklovir tab sal 450 mg Tab sal
1126 Valproat sir 250 mg/5 ml Botol
1127 Valproat tab sal 250 mg Tab sal
1128 Valproat tab sal 500 mg Tab sal
1129 Valproat tab sal enterik 200 mg Tab
1130 Valproat tab SR 250 mg Tab
1131 Valproat tab SR 500 mg Tab
1132 Valsartan tab 160 mg Tab
1133 Valsartan tab 80 mg Tab
1134 Vankomisin serb inj 500 mg/vial Vial
1135 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial
1136 Verapamil inj 2,5 mg/ml Vial
1137 Verapamil tab 240 mg Tab
1138 Verapamil tab 80 mg Tab
1139 Vinblastin inj 1 mg/ml Ampul
1140 Vinkristin inj 1 mg/ml (vial 1 mL) Vial
1141 Vinkristin inj 1 mg/ml (vial 2 mL) Vial
1142 Vinorelbin inj 10 mg/ml Vial
1143 Vitamin B kompleks Tab
1144 Warfarin tab 1 mg Tab
1145 Warfarin tab 2 mg Tab
1146 Zidovudin kaps 100 mg Kaps
1147 Zinc drops 10 mg/ml Botol
1148 Zinc serb 10 mg Sachet
1149 Zinc sir 10 mg/ml Botol
1150 Zinc sir 20 mg/5 ml Botol
1151 Zinc tab disp 20 mg Tab
dan KAB/KOTA
AMA 2016 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / P
NG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2016
KECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2018 BERDASA
N KERJA DAN DIBERI STEMPEL
S/KOLOM PADA FORMAT
RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2018 SISIPAN
SISA STOK PER 31 PEMAKAIAN JUMLAH RENCANA RENCANA RENCANA

DESEMBER 2016 RATA-RATA PER KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN
BULAN SELAMA TAHUN 2018 TAHUN 2018 TAHUN 2018 TAHUN 2017
2016
(a) (b) (c) = (b) x 18 (d) = (c) - (a) (e) (f)

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0 174 3132 3132 2500 0
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0 0 0 0 0 0
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0 893 16074 16074 16000 0
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0 45 810 810 600 0
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0 90 1620 1620 1500 0
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0 107 1926 1926 1500 0
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0 7 126 126 100 0
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0 88 1584 1584 0 0
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0 1 18 18 10 0
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0 1 18 18 0 0
0 39 702 702 0 0
0 120 2160 2160 500 0
0 170 3060 3060 1000 0
0 0 0 0 0 0
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0 29 522 522 200 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
/ VIAL / TUBE / SACCHET / PUFF
AKAN TAHUN 2018 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2018
REALISASI KETERANGAN
PENGADAAN
TAHUN 2016
(g) (h)
0
0
0
0
0
0
0
0
700
1200
0
0
4
0
0
0
0
0
0
0
500
300
0
500
400
0
0
0
0
0
10
0
0
0
0
6000
17000
0
0
10
5
0
700
0
0
150 novorapid
80 novomix
0
150 lantus
0
20
200
180
0
0
0
0
0
0
0
0
0
0
0
9500
0
0
0
4500
0
0
0
0
2000
200
0
0
0
0
0
120
0
100
1500
0
0
0
0
0
0
0
0
0
0
0
0
0
100
350
0
20
0
0
2
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2500
0
5
0
0
0
0
0
0
10
5
0
0
0
8000
2000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
50
300
0
0
0
0
0
0
0
0
0
0
0
0
10
5
5
4000
8000
0
0
200
0
0
2600
0
1600
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1100
0
500
40
10
0
0
0
0
0
0
5
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
180
4000
10000
4500
0
0
0
0
0
0
0
400
20
0
0
0
0
60
10
0
0
0
0
0
100
500
0
0
700
10
6000
0
1000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
300
0
0
0
0
25
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
8000
500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
600
0
0
0
0
0
0
900
500
0
0
0
0
0
0
0
10
0
0
600
0
0
0
0
0
0
800
1200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
300
800
700
0
0
0
0
0
0
9000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
7400
1000
0
0
0
0
300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
1200
0
0
0
0
0
0
0
600
0
0
0
0
5000
0
1200
0
0
400
6000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
9000
0
0
0
0
0
0
0
0
9000
5000
12000
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
400
100
0
0
0
800
700
0
0
0
0
0
0
0
0
0
0
0
0
3000
0
0
0
0
0
0
0
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0
0
0
0
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0
0
0
0
0
0
100
5000
200
0
150
0
0
0
0
0
0
0
0
0
0
0
0
150
1500
30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
900
0
0
0
800
0
0
0
0
0
0
0
1000
0
1000
4000
0
0
0
0
0
0
300
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1200
50
0
0
300
10
0
0
0
0
0
0
2500
3000
10
800
0
0
0
60
500
0
0
0
0
0
0
0
0
0
0
0
0
0
1200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1200
1200
0
80
2500
0
0
0
0
0
0
0
0
0
600
1300
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3000
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
500
500
1500
2000
0
0
0
0
0
0
0
0
0
800
0
0
0
0
0
0
0
0

RKO - KLINIK AMMARIZ Tahun 2018 Sisipan

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RKO - KLINIK AMMARIZ Tahun 2018 Sisipan

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1.

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJUT

SATUAN KERJA : KLINIK AMMARIZ

NO NAMA OBAT SATUAN

1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44 Tab

2 Adefovir dipivoksil tab 10 mg Tab

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

59 Aripiperazol oral solution 1 mg/ml Botol

149 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol

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

354 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol

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

583 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab

586 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab

588 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube

637 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Botol

709 Mebendazol sir 100 mg/5 ml Botol

728 Metformin tab 500 mg Tab

880 Perak nitrat lar 20% Botol

RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2018 SISIPAN

SISA STOK PER 31 PEMAKAIAN JUMLAH RENCANA RENCANA RENCANA

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

0 7 126 126 120 0

0 11 198 198 200 0

0 10 180 180 200 0

0 14 252 252 250 0

0 750 13500 13500 12000 0

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