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PAKET LSCS KANA, KAMBOJA & KENANGA

NAMA OBAT JML SATUAN HARGA SATUAN TOTAL


ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
ALKOHOL (30 cc) 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
BETADINE (30 cc) 250 ML Rp 62 Rp 15,500
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
CEFOTAXIME INJ 4 VIAL Rp 10,000 Rp 40,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC 30 mg INJ 3 AMPUL Rp 2,169 Rp 6,507
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MESS 21 1 PCS Rp 3,520 Rp 3,520
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXITOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
BENANG PLAIN NO 2 1 MTR Rp 33,000 Rp 33,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
BENANG SILK NO 3 1 MTR Rp 11,000 Rp 11,000
TOTAL Rp 979,475

PAKET LSCS KANA, KAMBOJA & KENANGA


OBAT & ALKES
NAMA OBAT JML SATUAN HARGA SATUAN TOTAL
ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
CEFOTAXIME INJ 4 VIAL Rp 10,000 Rp 40,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
KETOROLAC 30 mg INJ 3 AMPUL Rp 2,169 Rp 6,507
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MESS 21 1 PCS Rp 3,520 Rp 3,520
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXITOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
BENANG PLAIN NO 2 1 MTR Rp 33,000 Rp 33,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
BENANG SILK NO 3 1 MTR Rp 11,000 Rp 11,000
TOTAL Rp 765,975
30% Rp 995,768
PAKET LSCS KANA, KAMBOJA & KENANGA
BHP
NAMA OBAT JML SATUAN HARGA SATUAN TOTAL
ALKOHOL (30 cc) 250 ML Rp 26 Rp 6,500
BETADINE (30 cc) 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

PAKET LSCS KAMBOJA & KENANGA


PER ORAL
NAMA OBAT JML SATUAN HARGA SATUAN TOTAL
ASMEF / TROPISTAN 10 PCS Rp 800 Rp 8,000
CEFADROXIL 10 PCS Rp 2,000 Rp 20,000
LIVRON B-FLEK 10 PCS Rp 750 Rp 7,500
TOTAL Rp 35,500
30% Rp 46,150

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET LSCS KRISSAN, KUSUMA, KAMELIA
NAMA JML SATUAN HARGA Rp
ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
ALKOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 1 VIAL Rp 185,000 Rp 185,000
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
CEFOTAXIME INJ 2 VIAL Rp 10,000 Rp 20,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MAXCEF 10 PCS Rp 10,450 Rp 104,500
MEFIX 10 PCS Rp 1,293 Rp 12,930
MESS 21 1 PCS Rp 3,520 Rp 3,520
KETOSIC 3 AMPUL Rp 42,900 Rp 128,700
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXYTOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/ T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
PLAIN 3 1 METER Rp 33,000 Rp 33,000
SILK 3 1 METER Rp 11,000 Rp 11,000
VIT. C 6 AMPUL Rp 6,413 Rp 38,478
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIB 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BOTOL Rp 6,688 Rp 6,688
VITACHOL 10 PCS Rp 3,848 Rp 38,480
TOTAL Rp 1,461,056

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET LSCS KRISSAN, KUSUMA, KAMELIA
OBAT & ALKES
NAMA JML SATUAN HARGA Rp
ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
BIOXON / TRIJECT 1 VIAL Rp 185,000 Rp 185,000
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
CEFOTAXIME INJ 2 VIAL Rp 10,000 Rp 20,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MESS 21 1 PCS Rp 3,520 Rp 3,520
KETOSIC 3 AMPUL Rp 42,900 Rp 128,700
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXYTOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/ T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
PLAIN 3 1 METER Rp 33,000 Rp 33,000
SILK 3 1 METER Rp 11,000 Rp 11,000
VIT. C 6 AMPUL Rp 6,413 Rp 38,478
NS OK (CUCI) 1 BOTOL Rp 6,688 Rp 6,688
TOTAL Rp 1,091,646
30% Rp 1,419,140
PAKET LSCS KRISSAN, KUSUMA, KAMELIA
BHP
NAMA JML SATUAN HARGA Rp
ALKOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIB 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

PAKET LSCS VIP-VVIP


PER ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 PCS Rp 10,450 Rp 104,500
MEFIX 10 PCS Rp 1,293 Rp 12,930
VITACHOL 10 PCS Rp 3,848 Rp 38,480
TOTAL Rp 155,910
30% Rp 202,683

Pamekasan, 01 Oktober 2018

Mengetahui
Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes

PAKET LSCS KASANDRA


NAMA JML SATUAN HARGA Rp
ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
ALKOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 3 VIAL Rp 185,000 Rp 555,000
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MAXCEF 10 PCS Rp 10,450 Rp 104,500
MEFIX 10 PCS Rp 1,293 Rp 12,930
MESS 21 1 PCS Rp 3,520 Rp 3,520
KETOSIC 3 AMPUL Rp 42,900 Rp 128,700
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXYTOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/ T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
PLAIN 3 1 METER Rp 33,000 Rp 33,000
SILK 3 1 METER Rp 11,000 Rp 11,000
VIT. C 6 AMPUL Rp 6,413 Rp 38,478
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIB 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BOTOL Rp 6,688 Rp 6,688
TRUXANTHIN/ASTA PL 10 Rp 10,890 Rp 108,900
DUROGESIC 25 1 Rp 237,050 Rp 237,050
TOTAL Rp 2,118,526

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET LSCS KASANDRA
OBAT & ALKES
NAMA JML SATUAN HARGA Rp
ABBOCATH NO. 18 1 PCS Rp 9,500 Rp 9,500
ALKOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 3 VIAL Rp 185,000 Rp 555,000
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER NO. 16 1 PCS Rp 16,000 Rp 16,000
EGEMEN 2 PCS Rp 18,500 Rp 37,000
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 5% 1 AMPUL Rp 22,000 Rp 22,000
MESS 21 1 PCS Rp 3,520 Rp 3,520
KETOSIC 3 AMPUL Rp 42,900 Rp 128,700
MONOSYN 1 1 PCS Rp 126,500 Rp 126,500
MONOSYN 3/0 1 PCS Rp 106,700 Rp 106,700
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 2 BOTOL Rp 6,688 Rp 13,376
ONDANCETRONE 1 AMPUL Rp 8,000 Rp 8,000
OXYTOCYN INJ 4 AMPUL Rp 7,480 Rp 29,920
PETHIDINE 1 AMPUL Rp 13,191 Rp 13,191
RD 5 1 BOTOL Rp 8,748 Rp 8,748
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SAFIL 1/ T-VIO 1 1 PCS Rp 99,000 Rp 99,000
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
UROBAG 1 PCS Rp 3,750 Rp 3,750
VASODRIN 1 AMPUL Rp 44,000 Rp 44,000
FENTANYL 1 AMPUL Rp 48,400 Rp 48,400
PLAIN 3 1 METER Rp 33,000 Rp 33,000
SILK 3 1 METER Rp 11,000 Rp 11,000
VIT. C 6 AMPUL Rp 6,413 Rp 38,478
NS OK (CUCI) 1 BOTOL Rp 6,688 Rp 6,688
DUROGESIC 25 1 Rp 237,050 Rp 237,050
TOTAL Rp 1,688,596
30% Rp 2,195,175

PAKET LSCS KASANDRA


BHP
NAMA JML SATUAN HARGA Rp
ALKOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD/UNDERPAD 2 PCS Rp 3,200 Rp 6,400
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIB 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

PAKET LSCS KASANDRA


PER ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 PCS Rp 10,450 Rp 104,500
MEFIX 10 PCS Rp 1,293 Rp 12,930
TRUXANTHIN/ASTA PL 10 Rp 10,890 Rp 108,900
TOTAL Rp 226,330
30% Rp 294,229

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET CURET
NAMA JML SATUAN HARGA TOTAL
ABBOCATH 1 PCS Rp 9,500 Rp 9,500
ALKOHOL 100 ML Rp 26 Rp 2,600
AQUABIDEST 1 FLACON Rp 6,050 Rp 6,050
BETADINE 100 ML Rp 62 Rp 6,200
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CEFOTAXIME INJ 1 VIAL Rp 10,000 Rp 10,000
KETAMINE 100 MG Rp 320 Rp 32,000
MIDAZOLAM 1 AMPUL Rp 10,010 Rp 10,010
NS 1 BOTOL Rp 6,688 Rp 6,688
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
SENSIPAD/UNDERPAD 1 PCS Rp 3,200 Rp 3,200
OXITOCYN 2 AMPUL Rp 7,480 Rp 14,960
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
PLASTIK 2 PCS Rp 1,000 Rp 2,000
HANDSCOEN STERIL 3 PCS Rp 3,600 Rp 10,800
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 204,783

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET CURET
OBAT & ALKES
NAMA JML SATUAN HARGA TOTAL
ABBOCATH 1 PCS Rp 9,500 Rp 9,500
AQUABIDEST 1 FLACON Rp 6,050 Rp 6,050
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CEFOTAXIME INJ 1 VIAL Rp 10,000 Rp 10,000
KETAMINE 100 MG Rp 320 Rp 32,000
MIDAZOLAM 1 AMPUL Rp 10,010 Rp 10,010
NS 1 BOTOL Rp 6,688 Rp 6,688
RL 1 BOTOL Rp 7,325 Rp 7,325
SA 1 AMPUL Rp 2,200 Rp 2,200
OXITOCYN 2 AMPUL Rp 7,480 Rp 14,960
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
TOTAL Rp 129,983
30% Rp 168,978

PAKET CURET
BHP
NAMA JML SATUAN HARGA TOTAL
ALKOHOL 100 ML Rp 26 Rp 2,600
BETADINE 100 ML Rp 62 Rp 6,200
SENSIPAD/UNDERPAD 1 PCS Rp 3,200 Rp 3,200
PLASTIK 2 PCS Rp 1,000 Rp 2,000
HANDSCOEN STERIL 3 PCS Rp 3,600 Rp 10,800
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 74,800
30% Rp 97,240

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital


Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes
PAKET PARTUS
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 PCS Rp 9,500 Rp 9,500
ALKOHOL 70% 100 ML Rp 26 Rp 2,600
AQUABIDEST 1 FLACON Rp 6,050 Rp 6,050
BETADINE 100 ML Rp 62 Rp 6,200
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CEFOTAXIME INJ 1 VIAL Rp 10,000 Rp 10,000
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 2% INJ 1 AMPUL Rp 3,500 Rp 3,500
MSO 3 TABLET Rp 5,500 Rp 16,500
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 1 BOTOL Rp 6,688 Rp 6,688
OXYTOCIN INJ 2 AMPUL Rp 7,480 Rp 14,960
RD 1 BTL Rp 8,748 Rp 8,748
RL 1 BTL Rp 7,325 Rp 7,325
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
CHROMIC 2 (1 m) 2 MTR Rp 33,000 Rp 66,000
PLASTIK 2 PCS Rp 1,000 Rp 2,000
HANDSCOEN STERIL 4 PCS Rp 3,600 Rp 14,400
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 286,521

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET PARTUS
OBAT & ALKES
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 PCS Rp 9,500 Rp 9,500
AQUABIDEST 1 FLACON Rp 6,050 Rp 6,050
BLEDSTOP INJ 1 AMPUL Rp 8,250 Rp 8,250
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CEFOTAXIME INJ 1 VIAL Rp 10,000 Rp 10,000
KLEM TALPUS 1 PCS Rp 1,700 Rp 1,700
LIDOCAIN 2% INJ 1 AMPUL Rp 3,500 Rp 3,500
MSO 3 TABLET Rp 5,500 Rp 16,500
NEO - K INJ 1 AMPUL Rp 14,300 Rp 14,300
NS 1 BOTOL Rp 6,688 Rp 6,688
OXYTOCIN INJ 2 AMPUL Rp 7,480 Rp 14,960
RD 1 BTL Rp 8,748 Rp 8,748
RL 1 BTL Rp 7,325 Rp 7,325
SLEM BAYI 1 PCS Rp 8,500 Rp 8,500
SPUIT 1 cc 2 PCS Rp 1,800 Rp 3,600
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
CHROMIC 2 (1 m) 2 MTR Rp 33,000 Rp 66,000
TOTAL Rp 204,921
30% Rp 266,397

PAKET PARTUS
BHP
NAMA JML SATUAN HARGA Rp
ALKOHOL 70% 100 ML Rp 26 Rp 2,600
BETADINE 100 ML Rp 62 Rp 6,200
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
PLASTIK 2 PCS Rp 1,000 Rp 2,000
HANDSCOEN STERIL 4 PCS Rp 3,600 Rp 14,400
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 81,600
30% Rp 106,080

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital


Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes
LAPARATOMY KENANGA, KAMBOJA & KANA

NAMA JML SATUAN HARGA Rp


ABBOCATH 18 1 Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 18 1 Rp 16,000 Rp 16,000
CEFOTAXIME 3 Rp 10,000 Rp 30,000
EGEMEN 2 Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC 30 mg 3 Rp 1,700 Rp 5,100
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MASKER HIJAB 8 Rp 450 Rp 3,600
MESS 21 1 Rp 3,520 Rp 3,520
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
OKSIGEN 3 Rp 20,000 Rp 60,000
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1 1 Rp 99,000 Rp 99,000
SENSIPAD 2 Rp 3,200 Rp 6,400
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
TOPI OPERASI 8 Rp 450 Rp 3,600
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
ASMEF / TROPISTAN 10 PCS Rp 800 Rp 8,000
CEFADROXIL 10 PCS Rp 2,000 Rp 20,000
LIVRON B-FLEK 10 PCS Rp 750 Rp 7,500
PLASTIK 5 Rp 1,000 Rp 5,000
H.SCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
TOTAL Rp 1,219,576

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


ALKES & OBAT
LAPARATOMI KENANGA, KAMBOJA, & KANA
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 PCS Rp 9,500 Rp 9,500
AQUABIDEST 2 PCS Rp 6,050 Rp 12,100
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 18 1 PCS Rp 16,000 Rp 16,000
CEFOTAXIME 3 VIAL Rp 10,000 Rp 30,000
EGEMEN 2 Rp 18,500 Rp 37,000
KETOROLAC 30 mg 3 Rp 1,700 Rp 5,100
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MESS 21 1 Rp 3,520 Rp 3,520
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1 1 Rp 99,000 Rp 99,000
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
TOTAL Rp 970,576
30% Rp 1,261,749
LAPARATOMY KENANGA, KAMBOJA & KANA
BHP
NAMA JML SATUAN HARGA Rp
ALCOHOL 250 ML Rp 26 Rp 6,500
HANDSCOEN STERIL 8 PCS Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
BETADINE 250 ML Rp 62 Rp 15,500
H.SCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

LAPAROTOMY KELAS KENANGA, KAMBOJA & KANA


PERORAL
ASMEF / TROPISTAN 10 PCS Rp 800 Rp 8,000
CEFADROXIL 10 PCS Rp 2,000 Rp 20,000
LIVRON B-FLEK 10 PCS Rp 750 Rp 7,500
TOTAL Rp 35,500
30% Rp 46,150

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


LAPAROTOMY KUSUMA - KAMELIA - KRISSAN

NAMA JML SATUAN HARGA Rp


ABBOCATH 18 1 Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 1 Rp 185,000 Rp 185,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
CEFOTAXIME 2 Rp 10,000 Rp 20,000
EGEMEN 2 Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MASKER HIJAB 8 Rp 450 Rp 3,600
MAXCEF 10 TAB Rp 10,450 Rp 104,500
MEFIX 10 TAB Rp 1,293 Rp 12,930
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SENSIPAD 2 Rp 3,200 Rp 6,400
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
TOPI OPERASI 8 Rp 450 Rp 3,600
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VITACHOL 10 Rp 3,848 Rp 38,480
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
SILK 3 5 MTR Rp 11,000 Rp 55,000
TOTAL Rp 1,638,586

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


LAPAROTOMY KUSUMA,KAMELIA,KRISSAN
ALKES & OBAT
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 Rp 9,500 Rp 9,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BIOXON / TRIJECT 1 Rp 185,000 Rp 185,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
CEFOTAXIME 2 Rp 10,000 Rp 20,000
EGEMEN 2 Rp 18,500 Rp 37,000
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
SILK 3 5 MTR Rp 11,000 Rp 55,000
TOTAL Rp 1,269,176
30% Rp 1,649,929
LAPAROTOMY KUSUMA.KAMELIA,KRISSAN
BHP
NAMA JML SATUAN HARGA Rp
ALCOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD 2 Rp 3,200 Rp 6,400
TOPI OPERASI 8 Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

LAPAROTOMY KUSUMA,KAMELIA,KRISSAN
ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 TAB Rp 10,450 Rp 104,500
MEFIX 10 TAB Rp 1,293 Rp 12,930
VITACHOL 10 Rp 3,848 Rp 38,480
TOTAL Rp 155,910
30% Rp 202,683

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


LAPAROTOMY KASANDRA

NAMA JML SATUAN HARGA Rp


ABOCATH 18 1 Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 3 Rp 185,000 Rp 555,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
EGEMEN 2 Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MASKER HIJAB 8 Rp 450 Rp 3,600
MAXCEF 10 Rp 10,450 Rp 104,500
MEFIX 10 Rp 1,293 Rp 12,930
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SENSIPAD 2 Rp 3,200 Rp 6,400
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
TOPI OPERASI 8 Rp 450 Rp 3,600
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
ASTA PLUS / TRUXANTHIN 10 Rp 10,890 Rp 108,900
PLASTIK 5 Rp 5,000 Rp 25,000
HANDSCOEN DISPOS 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
DUROGESIC 1 Rp 237,050 Rp 237,050
TOTAL Rp 2,316,056

Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


LAPAROTOMY KASANDRA
ALKES & OBAT
NAMA JML SATUAN HARGA Rp
ABOCATH 18 1 Rp 9,500 Rp 9,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BIOXON / TRIJECT 3 Rp 185,000 Rp 555,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
EGEMEN 2 Rp 18,500 Rp 37,000
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
DUROGESIC 1 Rp 237,050 Rp 237,050
TOTAL Rp 1,856,226
30% Rp 2,413,094

LAPAROTOMY KASANDRA
BHP
NAMA JML SATUAN HARGA Rp
ALCOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 Rp 3,600 Rp 28,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD 2 Rp 3,200 Rp 6,400
TOPI OPERASI 8 Rp 450 Rp 3,600
PLASTIK 5 Rp 1,000 Rp 5,000
HANDSCOEN DISPOS 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 213,500
30% Rp 277,550

LAPAROTOMY KASANDRA
ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 Rp 10,450 Rp 104,500
MEFIX 10 Rp 1,293 Rp 12,930
ASTA PLUS / TRUXANTHIN 10 Rp 10,890 Rp 108,900
TOTAL Rp 226,330
30% Rp 294,229
Pamekasan, 01 Oktober 2018

Mengetahui

Ketua Yayasan Puspa Medika Direktur Kusuma Hospital

Dr. Rani Evadewi Dr. Tri Susandhi Juliarto, M.Mkes


PAKET LOKAL BEDAH

NAMA JML HARGA Rp


AQUABIDEST 1 Rp 6,050 Rp 6,050
LIDOCAIN 2 % 1 Rp 3,520 Rp 3,520
SPUIT 1 cc 1 Rp 1,800 Rp 1,800
SPUIT 3 cc 1 Rp 1,050 Rp 1,050
TOTAL Rp 12,420
30% Rp 16,146
PAKET KECIL BEDAH
NAMA KECIL SATUAN HARGA JUMLAH
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
ABBOCATH no. 18 1 PCS Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
ASAM TRANEXAMAT 1 AMP Rp 11,600 Rp 11,600
BACTIGRAS 1 PCS Rp 25,000 Rp 25,000
BETADINE 250 ML Rp 62 Rp 15,500
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER 1 PCS Rp 16,000 Rp 16,000
CEFTRIAXONE 3 VIAL Rp 10,000 Rp 30,000
CHROMIC 3 (1 m) 1 PCS Rp 33,000 Rp 33,000
DAFILON 3/0 1 Rp 55,000 Rp 55,000
EGEMEN 1 Rp 18,500 Rp 18,500
ETT 7,5 1 PCS Rp 62,500 Rp 62,500
FENTANYL 1 Rp 48,400 Rp 48,400
HANDSCOEN 8 PCS Rp 3,600 Rp 28,800
HANDSCOEN DISPOSS 1 BOX Rp 50,000 Rp 50,000
HYPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC AMP 3 AMP Rp 2,169 Rp 6,507
LIDOCAIN 2% 1 AMP Rp 27,800 Rp 27,800
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MESS 21 1 PCS Rp 3,520 Rp 3,520
NGT 16 1 PCS Rp 25,400 Rp 25,400
NORAGES 1 Rp 9,185 Rp 9,185
NS 2 FLS Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRON 2 AMP Rp 8,000 Rp 16,000
PETHIDINE 1 AMP Rp 13,191 Rp 13,191
PLAIN 2 (1 m) 1 PCS Rp 33,000 Rp 33,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
PROFOFOL 1 200ML Rp 107,300 Rp 107,300
RANITIDINE AMP 2 AMP Rp 7,150 Rp 14,300
RL INF 3 FLS Rp 7,325 Rp 21,975
SAFIL 1 / TVIO 1 PCS Rp 99,000 Rp 99,000
SAVLON 0 Rp -
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
SILK 1 (1 m) 1 PCS Rp 11,000 Rp 11,000
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
T-NYLON 5-0 1 PCS Rp 58,300 Rp 58,300
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VIT K 1 PCS Rp 14,300 Rp 14,300
TOTAL Rp 1,036,004
30% Rp 1,346,805
PAKET SEDANG BEDAH
NAMA KECIL SATUAN HARGA JUMLAH
AQUABIDEST 2 FLACON Rp 6,050 Rp 12,100
ABBOCATH no. 18 1 PCS Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
ASAM TRANEXAMAT 1 AMP Rp 11,600 Rp 11,600
BACTIGRAS 1 PCS Rp 25,000 Rp 25,000
BETADINE 250 ML Rp 62 Rp 15,500
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER 1 PCS Rp 16,000 Rp 16,000
CEFTRIAXONE 3 VIAL Rp 10,000 Rp 30,000
CHROMIC 3 (1 m) 1 PCS Rp 33,000 Rp 33,000
DAFILON 3/0 1 Rp 55,000 Rp 55,000
EGEMEN 1 Rp 18,500 Rp 18,500
ETT 7,5 1 PCS Rp 62,500 Rp 62,500
FENTANYL 1 Rp 48,400 Rp 48,400
HANDSCOEN 8 PCS Rp 3,600 Rp 28,800
HANDSCOEN DISPOSS 1 BOX Rp 50,000 Rp 50,000
HYPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC AMP 3 AMP Rp 2,169 Rp 6,507
LIDOCAIN 2% 1 AMP Rp 27,800 Rp 27,800
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MESS 21 1 PCS Rp 3,520 Rp 3,520
NGT 16 1 PCS Rp 25,400 Rp 25,400
NORAGES 1 Rp 9,185 Rp 9,185
NS 2 FLS Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRON 2 AMP Rp 8,000 Rp 16,000
PETHIDINE 1 AMP Rp 13,191 Rp 13,191
PLAIN 2 (1 m) 1 PCS Rp 33,000 Rp 33,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
PROFOFOL 1 200ML Rp 107,300 Rp 107,300
RANITIDINE AMP 2 AMP Rp 7,150 Rp 14,300
RL INF 4 FLS Rp 7,325 Rp 29,300
SAFIL 1 / TVIO 1 PCS Rp 99,000 Rp 99,000
SAVLON 0 Rp -
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
SILK 1 (1 m) 1 PCS Rp 11,000 Rp 11,000
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
T-NYLON 5-0 1 PCS Rp 58,300 Rp 58,300
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VIT K 1 PCS Rp 14,300 Rp 14,300
TOTAL Rp 1,043,329
30% Rp 1,356,328
PAKET BESAR BEDAH
NAMA KECIL SATUAN HARGA JUMLAH
AQUABIDEST 3 FLACON Rp 6,050 Rp 18,150
ABBOCATH no. 18 1 PCS Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
ASAM TRANEXAMAT 1 AMP Rp 11,600 Rp 11,600
BACTIGRAS 1 PCS Rp 25,000 Rp 25,000
BETADINE 250 ML Rp 62 Rp 15,500
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER 1 PCS Rp 16,000 Rp 16,000
CEFTRIAXONE 5 VIAL Rp 10,000 Rp 50,000
CHROMIC 3 (1 m) 1 PCS Rp 33,000 Rp 33,000
DAFILON 3/0 1 Rp 55,000 Rp 55,000
EGEMEN 1 Rp 18,500 Rp 18,500
ETT 7,5 1 PCS Rp 62,500 Rp 62,500
FENTANYL 1 Rp 48,400 Rp 48,400
HANDSCOEN 8 PCS Rp 3,600 Rp 28,800
HANDSCOEN DISPOSS 1 BOX Rp 50,000 Rp 50,000
HYPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC AMP 5 AMP Rp 2,169 Rp 10,845
LIDOCAIN 2% 1 AMP Rp 27,800 Rp 27,800
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MESS 21 1 PCS Rp 3,520 Rp 3,520
NGT 16 1 PCS Rp 25,400 Rp 25,400
NORAGES 1 Rp 9,185 Rp 9,185
NS 2 FLS Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRON 3 AMP Rp 8,000 Rp 24,000
PETHIDINE 1 AMP Rp 13,191 Rp 13,191
PLAIN 2 (1 m) 1 PCS Rp 33,000 Rp 33,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
PROFOFOL 1 200ML Rp 107,300 Rp 107,300
RANITIDINE AMP 3 AMP Rp 7,150 Rp 21,450
RL INF 5 FLS Rp 7,325 Rp 36,625
SAFIL 1 / TVIO 1 PCS Rp 99,000 Rp 99,000
SAVLON 0 Rp -
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
SILK 1 (1 m) 1 PCS Rp 11,000 Rp 11,000
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
T-NYLON 5-0 1 PCS Rp 58,300 Rp 58,300
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VIT K 1 PCS Rp 14,300 Rp 14,300
TOTAL Rp 1,096,192
30% Rp 1,425,050
PAKET KHUSUS BEDAH
NAMA KECIL SATUAN HARGA JUMLAH
AQUABIDEST 3 FLACON Rp 6,050 Rp 18,150
ABBOCATH no. 18 1 PCS Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
ASAM TRANEXAMAT 1 AMP Rp 11,600 Rp 11,600
BACTIGRAS 1 PCS Rp 25,000 Rp 25,000
BETADINE 250 ML Rp 62 Rp 15,500
BLOODSET 1 PCS Rp 16,500 Rp 16,500
CATHETER 1 PCS Rp 16,000 Rp 16,000
CEFTRIAXONE 5 VIAL Rp 10,000 Rp 50,000
CHROMIC 3 (1 m) 1 PCS Rp 33,000 Rp 33,000
DAFILON 3/0 1 Rp 55,000 Rp 55,000
DUROGESIK 1 PATCH Rp 237,050 Rp 237,050
EGEMEN 1 Rp 18,500 Rp 18,500
ETT 7,5 1 PCS Rp 62,500 Rp 62,500
FENTANYL 1 Rp 48,400 Rp 48,400
HANDSCOEN 8 PCS Rp 3,600 Rp 28,800
HANDSCOEN DISPOSS 1 BOX Rp 50,000 Rp 50,000
HYPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
KETOROLAC AMP 5 AMP Rp 2,169 Rp 10,845
LIDOCAIN 2% 1 AMP Rp 27,800 Rp 27,800
MASKER HIJAB 8 PCS Rp 450 Rp 3,600
MESS 21 1 PCS Rp 3,520 Rp 3,520
NGT 16 1 PCS Rp 25,400 Rp 25,400
NORAGES 1 Rp 9,185 Rp 9,185
NS 2 FLS Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRON 3 AMP Rp 8,000 Rp 24,000
PETHIDINE 1 AMP Rp 13,191 Rp 13,191
PLAIN 2 (1 m) 1 PCS Rp 33,000 Rp 33,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
PROFOFOL 1 200ML Rp 107,300 Rp 107,300
RANITIDINE AMP 3 AMP Rp 7,150 Rp 21,450
RL INF 6 FLS Rp 7,325 Rp 43,950
SAFIL 1 / TVIO 1 PCS Rp 99,000 Rp 99,000
SAVLON 0 Rp -
SENSIPAD 2 PCS Rp 3,200 Rp 6,400
SILK 1 (1 m) 1 PCS Rp 11,000 Rp 11,000
SPUIT 1 cc 1 PCS Rp 1,800 Rp 1,800
SPUIT 10 cc 1 PCS Rp 1,900 Rp 1,900
SPUIT 3 cc 1 PCS Rp 1,050 Rp 1,050
SPUIT 5 cc 1 PCS Rp 1,750 Rp 1,750
T-NYLON 5-0 1 PCS Rp 58,300 Rp 58,300
TOPI OPERASI 8 PCS Rp 450 Rp 3,600
UROBAG 1 PCS Rp 3,750 Rp 3,750
VIT K 1 PCS Rp 14,300 Rp 14,300
TOTAL Rp 1,340,567
30% Rp 1,742,737
LAPAROTOMY KUSUMA - KAMELIA - KRISSAN
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 1 Rp 185,000 Rp 185,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
CEFOTAXIME 2 Rp 10,000 Rp 20,000
EGEMEN 2 Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 Rp 7,350 Rp 58,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MASKER HIJAB 8 Rp 450 Rp 3,600
MAXCEF 10 TAB Rp 10,450 Rp 104,500
MEFIX 10 TAB Rp 1,293 Rp 12,930
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SENSIPAD 2 Rp 3,200 Rp 6,400
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
TOPI OPERASI 8 Rp 450 Rp 3,600
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VITACHOL 10 Rp 3,848 Rp 38,480
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
SILK 3 5 MTR Rp 11,000 Rp 55,000
TOTAL Rp 1,668,586
30% Rp 2,169,162

LAPAROTOMY KUSUMA - KAMELIA - KRISSAN


ALKES & OBAT
NAMA JML SATUAN HARGA Rp
ABBOCATH 18 1 Rp 9,500 Rp 9,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BIOXON / TRIJECT 1 Rp 185,000 Rp 185,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
CEFOTAXIME 2 Rp 10,000 Rp 20,000
EGEMEN 2 Rp 18,500 Rp 37,000
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
SILK 3 5 MTR Rp 11,000 Rp 55,000
TOTAL Rp 1,269,176
30% Rp 1,649,929
LAPAROTOMY KUSUMA - KAMELIA - KRISSAN
BHP
NAMA JML SATUAN HARGA Rp
ALCOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 Rp 7,350 Rp 58,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD 2 Rp 3,200 Rp 6,400
TOPI OPERASI 8 Rp 450 Rp 3,600
PLASTIK 5 PCS Rp 1,000 Rp 5,000
HANDSCOEN DISPOSIBLE 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 243,500
30% Rp 316,550

LAPAROTOMY KUSUMA - KAMELIA - KRISSAN


ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 TAB Rp 10,450 Rp 104,500
MEFIX 10 TAB Rp 1,293 Rp 12,930
VITACHOL 10 Rp 3,848 Rp 38,480
TOTAL Rp 155,910
30% Rp 202,683
LAPAROTOMY KASANDRA
NAMA JML SATUAN HARGA Rp
ABOCATH 18 1 Rp 9,500 Rp 9,500
ALCOHOL 250 ML Rp 26 Rp 6,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BETADINE 250 ML Rp 62 Rp 15,500
BIOXON / TRIJECT 3 Rp 185,000 Rp 555,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
EGEMEN 2 Rp 18,500 Rp 37,000
HANDSCOEN STERIL 8 Rp 7,350 Rp 58,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MASKER HIJAB 8 Rp 450 Rp 3,600
MAXCEF 10 Rp 10,450 Rp 104,500
MEFIX 10 Rp 1,293 Rp 12,930
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SENSIPAD 2 Rp 3,200 Rp 6,400
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
TOPI OPERASI 8 Rp 450 Rp 3,600
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VITACHOL 10 Rp 3,848 Rp 38,480
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
ASTA PLUS / TRUXANTHIN 1 Rp 10,890 Rp 10,890
PLASTIK 5 Rp 5,000 Rp 25,000
HANDSCOEN DISPOS 1 BOX Rp 50,000 Rp 50,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
DUROGESIC 1 Rp 237,050 Rp 237,050
TOTAL Rp 2,286,526
30% Rp 2,972,484

LAPAROTOMY KASANDRA
ALKES & OBAT
NAMA JML SATUAN HARGA Rp
ABOCATH 18 1 Rp 9,500 Rp 9,500
AQUABIDEST 2 Rp 6,050 Rp 12,100
BIOXON / TRIJECT 3 Rp 185,000 Rp 555,000
BLOODSET 1 Rp 16,500 Rp 16,500
CATHETER FOLEY NO. 16 1 Rp 16,000 Rp 16,000
EGEMEN 2 Rp 18,500 Rp 37,000
LIDOCAIN 5% 1 Rp 22,000 Rp 22,000
MESS 21 1 Rp 3,520 Rp 3,520
KETOSIC 3 Rp 42,900 Rp 128,700
MONOSYN 1 1 Rp 126,500 Rp 126,500
MONOSYN 3/0 1 Rp 106,700 Rp 106,700
NS 2 Rp 6,688 Rp 13,376
ONDANCETRONE 1 Rp 8,000 Rp 8,000
PETHIDINE 1 Rp 13,191 Rp 13,191
RD5 1 Rp 8,748 Rp 8,748
RL 1 Rp 7,325 Rp 7,325
SA 1 Rp 2,200 Rp 2,200
SAFIL 1/T-VIO 1 1 Rp 99,000 Rp 99,000
SPUIT 1 CC 1 Rp 1,800 Rp 1,800
SPUIT 10 CC 1 Rp 1,900 Rp 1,900
SPUIT 3 CC 1 Rp 1,050 Rp 1,050
SPUIT 5 CC 1 Rp 1,750 Rp 1,750
UROBAG 1 Rp 3,750 Rp 3,750
VASODRINE 1 Rp 44,000 Rp 44,000
VIT C 6 Rp 6,413 Rp 38,478
FENTANYL 1 Rp 48,400 Rp 48,400
CHROMIC 3 5 MTR Rp 33,000 Rp 165,000
PLAIN 2 2 MTR Rp 33,000 Rp 66,000
SILK 3 5 MTR Rp 11,000 Rp 55,000
NS OK (CUCI) 1 BTL Rp 6,688 Rp 6,688
DUROGESIC 1 Rp 237,050 Rp 237,050
TOTAL Rp 1,856,226
30% Rp 2,413,094
LAPAROTOMY KASANDRA
BHP
NAMA JML SATUAN HARGA Rp
ALCOHOL 250 ML Rp 26 Rp 6,500
BETADINE 250 ML Rp 62 Rp 15,500
HANDSCOEN STERIL 8 Rp 7,350 Rp 58,800
HIPAVIX 50 CM Rp 132 Rp 6,600
KASA HIDROFIL 0.25 ROLL Rp 110,000 Rp 27,500
MASKER HIJAB 8 Rp 450 Rp 3,600
OKSIGEN 3 JAM Rp 20,000 Rp 60,000
SENSIPAD 2 Rp 3,200 Rp 6,400
TOPI OPERASI 8 Rp 450 Rp 3,600
PLASTIK 5 Rp 5,000 Rp 25,000
HANDSCOEN DISPOS 1 BOX Rp 50,000 Rp 50,000
TOTAL Rp 263,500
30% Rp 342,550

LAPAROTOMY KASANDRA
ORAL
NAMA JML SATUAN HARGA Rp
MAXCEF 10 Rp 10,450 Rp 104,500
MEFIX 10 Rp 1,293 Rp 12,930
VITACHOL 10 Rp 3,848 Rp 38,480
ASTA PLUS / TRUXANTHIN 1 Rp 10,890 Rp 10,890
TOTAL Rp 166,800
30% Rp 216,840