A APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA

KALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
G DIHITUNG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2015
BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2017 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPE
US DI TANDATANGANI OLEH KEPALA SATUAN KERJA DAN DIBERI STEMPEL
ENAMBAHAN MAUPUN PENGURANGAN BARIS/KOLOM PADA FORMAT

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJUT

SATUAN KERJA : RSU DEWI SARTIKA

NO NAMA OBAT SATUAN

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

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

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

54 Antimalaria kombinasi : sulfadoksin 500 mg + primetamin 25 mg Kaps

55 Aripiperazol oral solution 1 mg/ml Botol
56 Aripiperazol tab discmelt 10 mg Tab
57 Aripiperazol tab discmelt 15 mg Tab
58 Artemether inj 80 mg/ml Ampul
59 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
60 Articulating paper kertas warna penanda oklusi Kertas warna pena
61 Asam asetilsalisilat (asetosal) tab 100 mg Tab
 62 Asam asetilsalisilat (asetosal) tab 80 mg Tab
63 Asam askorbat (vitamin C) tab 250 mg Tab
64 Asam askorbat (vitamin C) tab 50 mg Tab
65 Asam folat tab 0,4 mg Tab
66 Asam folat tab 1 mg Tab
67 Asam folat tab 5 mg Tab
68 Asam fusidat tts mata 1% Botol
69 Asam ibandronat inj 6 mg/6 ml Vial
70 Asam mefenamat kaps 250 mg Kaps
71 Asam mefenamat kaps 500 mg Kaps
72 Asam pipemidat kaps 400 mg Kaps
73 Asam retinoat krim 0,1% Tube
74 Asam salisilat lar 0,1% Botol
75 Asam salisilat salep 10% Tube
76 Asam salisilat salep 2% Tube
77 Asam salisilat salep 5% Tube
78 Asam traneksamat inj 100 mg/ml Ampul
79 Asam traneksamat inj 50 mg/ml Ampul
80 Asam traneksamat tab 500 mg Tab
81 Asam ursodeoksikolat kaps 250 mg Kaps
82 Asam zoledronat inj 4 mg/5 ml Vial
83 Asetazolamid tab 250 mg Tab
84 Asiklovir salep mata 3% Tube
85 Asiklovir tab 200 mg Tab
86 Asiklovir tab 400 mg Tab
87 Asparaginase serb inj 10.000 UI/vial Vial
88 Atapulgit 600 mg Tab
89 Atapulgit tablet 650 mg Tab
90 Atapulgit tablet 750 mg Tab
91 Atenolol tab 100 mg Tab
92 Atenolol tab 50 mg Tab
93 Atorvastatin tab 10 mg Tab
94 Atorvastatin tab 20 mg Tab
95 Atrakurium inj 25 mg/2,5 ml Vial
96 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
97 Atropin inj 1 mg/ml (i.m./i.v./s.k) Ampul
98 Atropin tab 0,5 mg Tab
99 Atropin tts mata 0,5% Botol
100 Atropin tts mata 1% Botol
101 Azatioprin tab 50 mg Tab
102 Azitromisin serb inj 500 mg Vial
103 Azitromisin sir kering 200 mg/5 ml Botol
104 Azitromisin tab 250 mg Tab
105 Azitromisin tab 500 mg Tab
106 Bahan tumpatan sementara lar, serb Botol
107 Barium sulfat serb 92 g/100 ml Botol
108 Barium sulfat susp 2,2% Botol
109 Barium sulfat susp 55% Botol
110 Barium sulfat susp 65% Botol
111 Bedak salisil serb 2% Botol
112 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial
113 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial
114 Beractant susp 25 mg/ml (intratekal) Botol
115 Beraprost sodium tab 20 mcg Tab
116 Betahistin tab 24 mg Tab
117 Betahistin tab 6 mg Tab
118 Betaksolol tts mata 0,5% Botol
119 Betametason krim 0,1% Tube
120 Betametason krim 0,5 mg/g Tube
121 Betametason salep 0,1% Tube
122 Betametason tts mata 1 mg/ml Botol
123 Bevasizumab inj 25 mg/ml Vial
124 Bikalutamid tab sal 150 mg Tab
125 Bikalutamid tab sal 50 mg Tab
126 Bisakodil sup 10 mg Botol
127 Bisakodil sup 5 mg Botol
128 Bisakodil tab sal 5 mg Tab sal
129 Bisoprolol tab 1,25 mg Tab
130 Bisoprolol tab 10 mg Tab
131 Bisoprolol tab 2,5 mg Tab
132 Bisoprolol tab 5 mg Tab
133 Bleomisin serb inj 15 mg/ml Vial
134 Brinzolamid tetes mata Botol
135 Bromokriptin tab 2,5 mg Tab
136 Budesonid cairan ih 0,25mg/ml Botol
137 Budesonid ih 200 mcg/dosis Botol
138 Budesonid serb ih 100 mcg/dosis Botol
139 Budesonid-formoterol (fixed combination)* ih 160/4,5 mcg Botol
140 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol
141 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% Ampul
142 Bupivakain inj 5 mg/ml (p.v.) Ampul
143 Busulfan tab salut 2 mg Tab
144 Coal tar lar 5 % Botol
145 Copper T set/buah
146 Dabigatran eteksilat kaps 110 mg Kaps
147 Dabigatran eteksilat kaps 75 mg Kaps
148 Dakarbazin serb inj 100 mg/vial Vial
149 Dakarbazin serb inj 200 mg/vial Vial
150 Daktinomisin inj 0,5 mg/vial (i.v.) Vial
151 Dapson tab scored 100 mg Tab
152 Daunorubisin serb inj 20 mg/vial Vial
153 Deferasiroks tab disp 250 mg Tab
154 Deferasiroks tab disp 500 mg Tab
155 Deferipron lar oral 100 mg/ml Botol
156 Deferipron tab sal 500 mg Botol
157 Deferoksamin mesilat serb inj 500 mg/vial Vial
158 Deksametason inj 5 mg/ml (i.v./i.m.) Vial
159 Deksametason tab 0,5 mg Tab
160 Deksametason tab 4 mg Tab
161 Deksmedetomidin Inj 100 mcg/ml Ampul
162 Desmopresin tab 0,1 mg Tab
163 Desmopresin tab 0,2 mg Tab
164 Desogestrel tab 75 mcg Tab
165 Desoksimetason gel 0,05% Tube
166 Desoksimetason krim 0,25% Tube
167 Desoksimetason salep 0,25% Tube
168 Dialisa peritoneal lar intraperitonial Botol
169 Diazepam inj 5 mg/ml (i.v./i.m.) Vial
170 Diazepam lar rektal 10 mg/2,5 ml Botol
171 Diazepam lar rektal 5 mg/2,5 ml Botol
172 Diazepam tab 2 mg Tab
173 Diazepam tab 5 mg Tab
174 Dietilkarbamazin tab 100 mg Tab
175 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul
176 Diflukortolon valerat salep berlemak 0,1% Tube
177 Digoksin inj 0,25 mg/ml Vial
178 Digoksin tab 0,25 mg Tab
179 Diltiazem hcl inj 5 mg/5 ml Ampul
180 Diltiazem hcl tab 30 mg Tab
181 Diltiazem inj 25 mg/5 ml Ampul
182 Diltiazem kaps SR 100 mg Kaps
183 Diltiazem kaps SR 200 mg Kaps
184 Diltiazem serb inj 10 mg/10 ml Ampul
185 Diltiazem serb inj 50 mg/vial Vial
186 Diltiazem tab 30 mg Tab
187 Dimenhidrinat tab 50 mg Tab
188 Dinatrium edetat tts mata 0,35% Botol
189 Dinatrium klodronat infus kons 60 mg/ml Botol
190 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic Vial
acid/vial
191 Dobutamin inj 12,5 mg/ml Vial
192 Dobutamin inj 25 mg/ml Vial
193 Dobutamin inj 50 mg/ml Vial
194 Doksazosin mesilat tab 1 mg Tab
195 Doksazosin mesilat tab 2 mg Tab
196 Doksazosin tab 1 mg Tab
197 Doksazosin tab 2 mg Tab
198 Doksisiklin kaps 100 mg Kaps
199 Doksisiklin kaps 50 mg Kaps
200 Doksorubisin serb inj 10 mg/vial (i.v.) Vial
201 Doksorubisin serb inj 50 mg/vial Vial
202 Domperidon susp 5 mg/5 ml Botol
203 Domperidon tab 10 mg Tab
204 Domperidon tts 5 mg/ml Botol
205 Donepezil tab 5 mg Tab
206 Donepezil tab eff 10 mg Tab eff
207 Dopamin inj 40 mg/ml Vial
208 Dosetaksel inj 20 mg/0,5 ml Ampul
209 Dosetaksel inj 80 mg/2 ml Ampul
210 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial
calcium trisodium/ml
211 Dutasterid kaps 0,5 mg Kaps
212 Efavirens tab sal 600 mg Tab sal
213 Efedrin inj 50 mg/ml Ampul
214 Eksemestan tab 25 mg Tab
215 Enoksaparin sodium inj 20 mg/0,2 ml Ampul
216 Enoksaparin sodium inj 40 mg/0,4 ml Ampul
217 Enoksaparin sodium inj 60 mg/0,6 ml Ampul
218 Entekavir tab sal selaput 0,5 mg Tablet
219 Entekavir tab sal selaput 1 mg Tablet
220 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul
221 Epinefrin (adrenalin) inj 1 mg/ml Ampul
222 Epirubisin serb inj 10 mg/5 ml Vial
223 Epirubisin serb inj 50 mg/25 ml Vial
224 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps
225 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol
226 Ergotamin tab 1 mg Tab
227 Eritromisin kaps 250 mg Kaps
228 Eritromisin sir 200 mg/5 ml Botol
229 Eritromisin tab 500 mg Tab
230 Eritropoetin-alfa inj 10.000 UI/ml Vial
231 Eritropoetin-alfa inj 2.000 UI/ml Vial
232 Eritropoetin-alfa inj 3.000 UI/ml Vial
233 Eritropoetin-beta inj 2000 UI/0,3 ml Vial
234 Erlotinib tab sal selaput 100 mg Tab
235 Erlotinib tab sal selaput 150 mg Tab
236 Esomeprazole inj 40 mg/vial Vial
237 Estrogen terkonjugasi tab sal 0,3 mg Tab sal
238 Estrogen terkonjugasi tab sal 0,625 mg Tab sal
239 Etambutol tab 250 mg Tab
240 Etambutol tab 400 mg Tab
241 Etambutol tab 500 mg Tab
242 Etanol 70% cairan 70% Botol
243 Etil klorida semprot 100 ml Botol
244 Etinilestradiol tab 0,05 mg Tab
245 Etinilestradiol tab 0,5 mg Tab
246 Etoposid inj 20 mg/ml Vial
247 Etoposid kaps 100 mg Kaps
248 Eugenol Botol
249 Everolimus tab 0,25 mg Tab
250 Everolimus tab 0,5 mg Tab
251 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial
252 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial
253 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
254 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
255 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi Vial
256 Faktor VIII (konsentrat) serb inj 230 -340 UI Vial
257 Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5 ml Vial
258 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial
259 Faktor VIII (konsentrat) serb inj 500 UI/vial + pelarut 5 ml Vial
260 Faktor VIII serb inj 1000 mg/vial Vial
261 Faktor VIII serb inj 2000 mg/vial Vial
262 Fenitoin Na inj 100 mg/2 ml Ampul
263 Fenitoin Na inj 50 mg/ml Ampul
264 Fenitoin Na kaps 100 mg Kaps
265 Fenitoin Na kaps 30 mg Kaps
266 Fenobarbital inj 50 mg/ml Ampul
267 Fenobarbital tab 100 mg Tab
268 Fenobarbital tab 30 mg Tab
269 Fenofibrat kaps 100 mg Kaps
270 Fenofibrat kaps 300 mg Kaps
271 Fenoksimetil penisilin (penisilin V) tab 125 mg Tab
272 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
273 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
274 Fenoterol hbr aerosol 100 mcg/puff Botol
275 Fenoterol hbr cairan ih 0,1% Botol
276 Fentanil inj 0,05 mg/ml (i.v.) Vial
277 Fentanil patch 12,5 mcg/jam Pack
278 Fentanil patch 25 mcg/jam Pack
279 Fentanil patch 50 mcg/jam Pack
280 Ferrakrilum cairan 1% Botol
281 Ferro fumarat kaps lunak 300 mg Kaps lunak
282 Ferro sulfat sir. 15 mg/5 ml Botol
283 Ferro sulfat tab salut 300 mg Tab sal
284 Filgrastim inj 300 mcg/ml Vial
285 Finasterid tab 5 mg Tab
286 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial
287 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
288 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul
289 Fludarabin inj 50 mg/vial Vial
290 Fludarabin tab sal 10 mg Tab
291 Flufenazin inj 25 mg/ml (i.m.) Vial
292 Flukonazol inj 2 mg/ml Ampul
293 Flukonazol kaps 150 mg Kaps
294 Flukonazol kaps 50 mg Kaps
295 Fluoksetin kaps 10 mg Kaps
296 Fluoksetin kaps 20 mg Kaps
297 Fluor kapl 1 mg Kaplet
298 Fluor sediaan topikal Tube
299 Fluor tab 0,5 mg Tab
300 Fluoresein injeksi 10% Ampul
301 Fluoresein tts mata 2,5 mg/ml Botol
302 Fluoro deoxy glucose (FDG) Vial
303 Fluorometolon tts mata 0,1% Botol
304 Fluorourasil inj 250 mg/ml Ampul
305 Fluorourasil inj 50 mg/ml (i.v.) Ampul
306 Fluorourasil serb inj 250 mg Ampul
307 Flusinolon asetonid krim 0,025% Tube
308 Flusinolon asetonid salep 0,025% Tube
309 Flutikason furoat intranasal spray Botol
310 Flutikason propionat cairan ih 0,5 mg/dosis Botol
311 Fondaparinuks inj 2,5 mg/0,5 ml Vial
312 Formokresol Botol
313 Fraksi protein plasma lar inf 5% Botol
314 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul
315 Furosemid tab 40 mg Tab
316 Gabapentin kaps 100 mg Kaps
317 Gabapentin kaps 300 mg Kaps
318 Gadobutrol macrocyclic Macrocyclic
319 Gadodiamid inj 287 mg/10 ml Vial
320 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial
321 Galactose microparticle 200-400 mg micropart/ml Vial
322 Gansiklovir serb inj 500 mg/vial Vial
323 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + Sachet
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
324 Gefitinib tab 250 mg Tab
325 Gemfibrozil kaps 300 mg Kaps
326 Gemfibrozil kaps 600 mg Kaps
327 Gemsitabin inj 1000 mg/vial Vial
328 Gemsitabin inj 200 mg/vial Vial
329 Gentamisin inj 10 mg/ml Ampul
330 Gentamisin inj 40 mg/ml Ampul
331 Gentamisin inj 80 mg/ml Ampul
332 Gentamisin salep mata 0,3% Tube
333 Gentamisin tts mata 0,3% Botol
334 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g Sachet

335 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol

336 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
337 Glibenklamid tab 2,5 mg Tab
338 Glibenklamid tab 5 mg Tab
339 Gliklazid tab 80 mg Tab
340 Gliklazid tab MR 30 mg Tab
341 Gliklazid tab SR 60 mg Tab
342 Glikuidon tab 30 mg Tab
343 Glimepirid tab 1 mg Tab
344 Glimepirid tab 2 mg Tab
345 Glimepirid tab 3 mg Tab
346 Glimepirid tab 4 mg Tab
347 Glipizid tab 10 mg Tab
348 Glipizid tab 5 mg Tab
349 Gliseril trinitrat inj 10 mg/ml Ampul
350 Gliseril trinitrat inj 50 mg/ml Ampul
351 Gliseril trinitrat kaps SR 2,5 mg Kaps
352 Gliseril trinitrat kaps SR 5 mg Kaps
353 Gliseril trinitrat tab sublingual 0,5 mg Tab sub
354 Gliserin lar 50% Botol
355 Gliserin tts 10 mg/ml Botol
356 Gliserin tts 100 mg/ml Botol
357 Glukosa Larutan Infus 10% steril 100 ml Botol
358 Glukosa Larutan Infus 10% steril 250 ml Botol
359 Glukosa Larutan Infus 10% steril 500 ml Botol
360 Glukosa Larutan Infus 5% steril 100 ml Botol
361 Glukosa Larutan Infus 5% steril 250 ml Botol
362 Glukosa Larutan Infus 5% steril 500 ml Botol
363 Goserelin asetat inj 10,8 mg/vial Vial
364 Goserelin asetat inj 3,6 mg/vial Vial
365 Griseofulvin (micronized) tab 125 mg Tab
366 Griseofulvin (micronized) tab 500 mg Tab
367 Griseofulvin (micronized) tab scored 250 mg Tab
368 Gutta percha dan paper points 15 - 40 mm Roll
369 Gutta percha dan paper points 45 - 80 mm Roll
370 Haloperidol inj 5 mg/ml (i.m.) Vial
371 Haloperidol inj 50 mg/ml Vial
372 Haloperidol tab 0,5 mg Tab
373 Haloperidol tab 1,5 mg Tab
374 Haloperidol tab 2 mg Tab
375 Haloperidol tab 5 mg Tab
376 Haloperidol tts 2 mg/ml Botol
377 Halotan ih Botol
378 Hemodialisa lar konsentrat basis asetat Botol
379 Hemodialisa lar konsentrat basis natrium bikarbonat Botol
380 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial
381 Hepatitis B imunoglobulin (human) inj 0,5 ml Ampul
382 Hidrogen peroksida cairan 3% Botol
383 Hidrogen peroksida lar. Konsentrat 3% Botol
384 Hidroklorotiazid tab 12,5 mg Tab
385 Hidroklorotiazid tab 25 mg Tab
386 Hidrokortison inj 100 mg/vial Vial
387 Hidrokortison krim 1% Tube
388 Hidrokortison krim 2,5% Tube
389 Hidrokortison serb inj 100 mg/vial Vial
390 Hidrokortison tab 10 mg Tab
391 Hidroksi Klorokuin Inj 50 mg/ml Ampul
392 Hidroksi klorokuin tab 200 mg Tab
393 Hidroksi klorokuin tab 400 mg Tab
394 Hidroksi progesteron inj 125 mg/ml Vial
395 Hidroksi urea tab 500 mg Tab
396 Hidroxyl ethyl starch lar inf 6% Botol
397 Hiosina butilbromida inj 20 mg/ml Ampul
398 Hiosina butilbromida tab 10 mg Tab
399 Homatropin tts mata 2% Botol
400 Human insulin : fast acting inj 100 UI/ml (kemasan cartridge, penfill Cartridge, Penfill
cartridge)
401 Human insulin : intermediate acting inj 100 UI/ml (kemasan vial/ Vial
cartridge disposible, penfill cartridge)
402 Human insulin : mix insulin inj 100 UI/ml (kemasan vial, cartridge Vial
disposible, penfill cartridge)
403 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
404 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
405 Hydromorphone HCl tab oros 16 mg Tab
406 Hydromorphone HCl tab oros 8 mg Tab
407 Ibuprofen sir 100 mg/5 ml Botol
408 Ibuprofen sir 200 mg/5 ml Botol
409 Ibuprofen tab 200 mg Tab
410 Ibuprofen tab 400 mg Tab
411 Idarubisin serb inj 20 mg Vial
412 Ifosfamid serb inj 1000 mg/vial Vial
413 Ifosfamid serb inj 2000 mg/vial Vial
414 Ifosfamid serb inj 500 mg/vial Vial
415 Imatinib mesilat tab 100 mg Tab
416 Imatinib Mesilat tab 400 mg Tab
417 Imidapril tab 10 mg Tab
418 Imidapril tab 5 mg Tab
419 Imunoglobullin Intravena inj 250 mg/50 ml Botol
420 Indakaterol serb ih 150 mcg Vial
421 Indakaterol serb ih 300 mcg Vial
422 Interferon alfa inj 18 miu Set
423 Iodiksanol vial 320 mg Iodium/50 ml Vial
424 Iodium 131 Botol
425 Iodohippurate sodium I 132 37-74 mbq/ multiple-dose Vial
426 Ioheksol 180-300 mg Iodium/ml Vial
427 Ioheksol 240-350 mg Iodium/ml Vial
428 Ioheksol inj 140-350 mg Iodium/ml Vial
429 Iopamidol 200-300 mg Iodium/ml Vial
430 Iopamidol 300-370 mg Iodium/ml Vial
431 Iopamidol inj 200-370 mg Iodium/ml Vial
432 Iopromid 240 -370 mg Iodium/ml Vial
433 Iopromid 300-370 mg Iodium/ml Vial
434 Ipratropium bromida ih 20mcg/puff Botol
435 Ipratropium bromida ih padat 20 mcg Puff
436 Ipratropium bromida nebulizer 0,025% Botol
437 Irbesartan tab 150 mg Tab
438 Irbesartan tab 300 mg Tab
439 Irinotekan inf 20 mg/ml Ampul
440 Irinotekan inj 20 mg/ml Ampul
441 Isofluran inhalasi 100 ml Botol
442 Isofluran inhalasi 250 ml Botol
443 Isoniazid tab 100 mg Tab
444 Isoniazid tab 300 mg Tab
445 Isosorbid dinitrat inj 10 mg/10 ml Vial
446 Isosorbid dinitrat tab 10 mg Tab
447 Isosorbid dinitrat tab 5 mg Tab
448 k.y jelly Tube gel
449 Kalamin Tube
450 Kalium aspartat tab 300 mg Tab
451 Kalium klorida tab siap larut 300 mg Tab
452 Kalium klorida tab SR 600 mg Tab
453 Kalsium folinat (leukovorin, Ca) inj 3 mg/ml Vial
454 Kalsium folinat (leukovorin, Ca) inj 50 mg/ml Vial
455 Kalsium folinat (leukovorin, Ca) tab 15 mg Tab
456 Kalsium glukonat inj 100 mg/ml Ampul
457 Kalsium hidroksida bubuk, pasta Tube
458 Kalsium karbonat tab 500 mg Tab
459 Kalsium laktat (kalk) tab 500 mg Tab
460 Kalsium polistirena sulfonat ktg 5 g Sachet
461 Kanamisin inj 1.000 mg/ vial Vial
462 Kandesartan tab 16 mg Tab
463 Kandesartan tab 8 mg Tab
464 Kapesitabin tab sal 500 mg Tab sal
465 Kaptopril tab 12,5 mg Tab
466 Kaptopril tab 25 mg Tab
467 Kaptopril tab 50 mg Tab
468 Karbamazepin sir 100 mg/5 ml Botol
469 Karbamazepin tab 100 mg Tab
470 Karbimazol tab 5 mg Tab
471 Karbo adsorben tab 0,5 g Tab
472 Karbogliserin tts telinga 10 % Botol
473 Karboksimetilselulosa tts mata Botol
474 Karboplatin inj 150 mg/15 ml Vial
475 Karboplatin inj 450 mg/45 ml Vial
476 Karboplatin inj 50 mg/5 ml Vial
477 Karvediol kaps 6,25 mg Kaps
478 Ketamin inj 100 mg/ml (i.v.) Ampul
479 Ketamin inj 50 mg/ml (i.v.) Ampul
480 Ketokonazol krim 2% Tube
481 Ketokonazol scalp sol 2% Tube
482 Ketokonazol tab 200 mg Tab
483 Ketoprofen sup 100 mg Botol
484 Ketorolak inj 30 mg/ml Ampul
485 Klaritromisin sir kering 125 mg/5 ml Botol
486 Klaritromisin sir kering 250 mg/5 ml Botol
487 Klaritromisin tab 500 mg Tab
488 Klindamisin kaps 150 mg Kaps
489 Klindamisin kaps 300 mg Kaps
490 Klobazam tab 10 mg Tab
491 Klofazimin, micronizedkaps 100 mg kapsul
492 Klomifen sitrat tab 50 mg Tab
493 Klomipramin tab 25 Tab
494 Klonazepam kaps 2 mg Botol
495 Klonidin inj 150 mcg/ml Vial
496 Klonidin tab 0,15 mg Tab
497 Klopidogrel tab 75 mg Tab
498 Klopidogrel tab sal selaput 300 mg Tab
499 Kloral hidrat lar Botol
500 Klorambusil tab 2 mg Tab
501 Klorambusil tab sal selaput 5 mg Tab
502 Kloramfenikol kaps 250 mg Kaps
503 Kloramfenikol kaps 500 mg Kaps
504 Kloramfenikol salep kulit 2% Tube
505 Kloramfenikol salep mata 1% Tube
506 Kloramfenikol serb inj 1.000 mg/ml Vial
507 Kloramfenikol susp 125 mg/5 ml Botol
508 Kloramfenikol tts mata 0,5% Botol
509 Kloramfenikol tts mata 1% Botol
510 Klorfeniramin tab 4 mg Tab
511 Klorfenol kamfer mentol (CHKM) Botol
512 Klorheksidin lar 0,2% Botol
513 Klorheksidin lar 15% Botol
514 Klorokuin tab 250 mg Tablet
515 Klorpromazin inj 25 mg/ml (i.m.) Ampul
516 Klorpromazin inj 5 mg/ml (i.m.) Ampul
517 Klorpromazin tab sal 100 mg Tab sal
518 Klorpromazin tab sal 25 mg Tab sal
519 Klortalidon tab 50 mg Tab
520 Klotrimazol tab vagina 100 mg Tab
521 Klozapin tab 100 mg Tab
522 Klozapin tab 25 mg Tab
523 Kodein tab 10 mg Tab
524 Kodein tab 15 mg Tab
525 Kodein tab 20 mg Tab
526 Kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg Kaps lunak
527 Kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg Kaps lunak
528 Kolestiramin serb, 4 g Ampul
529 Kolkisin tab 500 mcg Tab
530 Koloid HES BM 130 000 lar inf 6% Botol
531 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 mg Vial

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

533 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg Vial
534 Kombinasi : artemether 20 mg + lumefantrin 120 mg Kaps
535 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
536 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
537 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab
538 Kombinasi : ferro sulfat 200 mg+ as. Folat 0,25 mg Tab sal
539 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg Tab
540 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab
541 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25 Vial
mg + 5 mg
542 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial
543 Kombinasi : Spironolakton 25 mg + Tiabutazid 2,5 mg Tablet
544 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube
545 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab
546 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Botol
547 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
548 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab
549 Kombinasi: natrium klorida 8,664 mg + kalium klorida 1,32 mg (tetes Botol
mata)
550 Kombinasi: parafin + gliserin + fenolftalein Botol
551 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 Botol
mcg/puff
552 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 mcg ih 50 Botol
mcg/puff
553 Kombinasi: salmeterol 50 mcg +flutikason propionat 100 mcg ih 50 Botol
mcg/puff
554 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol
mcg/puff
555 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg Tab
556 Komposit resin Set
557 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab
trimetoprim 80 mg
558 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ Tab
trimetoprim 160 mg
559 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : sulfametoksazol Botol
200 mg + trimetoprim 40 mg
560 Kuinin inj 25% (i.v.) Vial
561 Kuinin tab 200 mg Tab
562 Kuinin tab 222 mg Tab
563 Kuinin tab 250 mg Tab
564 Laktulosa sir 3,335 g/5 ml Botol
565 Lamivudin (3TC) tab 150 mg Tab
566 Lamivudin tab 100 mg Tab
567 Lamotrigin tab 50 mg Tablet
568 Lamotrigin tab dispersible 25 mg Tablet
569 Lansoprazol inj 30 mg/ml Vial
570 Lansoprazol kaps 30 mg Kaps
571 Lapatinib tab 250 mg Tab
572 Larutan mengandung Asam Amino (Asam Amino 10%) Botol
573 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Botol
Na+ 2 mEq, Asetat 120 mEq)
574 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl-52 Botol
mEq)
575 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 1000 ml
576 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 500 ml
577 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)

578 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol
Taurine 0,24 gr/l) : Aminosteril Infant 6%
579 Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Botol
Amino esensial: Asam Amino non esensial = 60 : 40)
580 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)
581 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Botol
Na+ 14 mEq, Cl 94 mEq)
582 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N- Botol
Hepa
583 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 Botol
g/L)
584 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Aspartate Botol
10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)

585 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, Botol
vitamin dan elektrolit)
586 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 34gr, Botol
Glukosa: 97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal, Akses
peripheral))

587 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 45gr, Botol
Glukosa: 130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400 kkal, Akses
peripheral))

588 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 Botol
gr + Asam Amino 48 gr dgn akses sentral)
589 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 Botol
gr + Asam Amino 40 gr)
590 Larutan mengandung Elektrolit (Kalium Klorida) Botol
591 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Botol
Asetat 28 mEq)
592 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) Botol
593 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

594 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)

595 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol 60 Botol

g/ L + elektrolit)
596 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol
g/ L)
597 Larutan mengandung Karbohidrat (Maltose 100 gr) Botol
598 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)

599 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol
Sorbitol 50 gr/L)
600 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 100 gr/L, elektrolit)
601 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 75 gr/L, elektrolit)
602 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 g, glucose 33 Botol
g, Xylitol 30 g/ L)
603 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)
604 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
605 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol
g)
606 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 Botol
g)
607 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol
g)
608 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)

609 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol
5%)
610 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
611 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
612 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 Botol
gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
613 Larutan mengandung Lipid (Emulsi lemak 20%) Botol
614 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol

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

616 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Botol
Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
617 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Botol
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
618 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Botol
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
619 Latanoprost tts mata 0,005% Botol
620 Latanoprost tts mata 0,01% Botol
621 Leflunomid tab sal selaput 20 mg Tablet
622 Lenograstim inj 263 mcg/vial Vial
623 Letrozol tab 2,5 mg Tab
624 Leuprorelin asetat serb inj 1,88 mg Vial
625 Leuprorelin asetat serb inj 11,25 mg Vial
626 Leuprorelin asetat serb inj 3,75 mg Vial
627 Levetirasetam tab 250 mg Tablet
628 levetirasetam tab 500 mg Tablet
629 Levofloksasin inf 5 mg/ml Botol
630 Levofloksasin tab 500 mg Tab
631 Levofloksasin tts mata 0,5% Botol
632 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) Set
633 Levotiroksin tab 100 mcg Tab
634 Levotiroksin tab 50 mcg Tab
635 Lidokain gel 2% Tube
636 Lidokain gel 2% Tube
637 Lidokain inj 1 % (infltr) Vial
638 Lidokain inj 100 mg, vial (i.v.) Vial
639 Lidokain inj 2% (infiltr/p.v.) Ampul
640 Lidokain inj 5% + glukosa (dekstrosa) 5 % Ampul
641 Lidokain spray oral 10% Botol
642 Linestrenol tab 0,5 mg Tab
643 Linestrenol tablet 5 mg Tab
644 Lisinopril tab 10 mg Tab
645 Lisinopril tab 20 mg Tab
646 Lisinopril tab 5 mg Tab
647 Litium karbonat tab 200 mg Tab
648 Litium karbonat tab 400 mg Tab
649 Loperamid tab 2 mg Tab
650 Loratadin tab 10 mg Tab
651 Lorazepam tab 0,5 mg Tab
652 Lorazepam tab 1 mg Tab
653 Lorazepam tab sal 2 mg Tab sal
654 Low molecular weight iron dextran inj 100mg/2 ml Ampul
655 Low molecule feri sucrose inj amp 100 mg/5 ml Ampul
656 Lugol Botol
657 MAA (macro agregate albumin) 0,11-2,5 mg albumin aggregated/reaction Vial
vial
658 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial
659 Magnesium sulfat inj 20% Vial
660 Magnesium sulfat inj 40% Vial
661 Magnesium sulfat serb, ktg 30 g Sachet
662 Manitol lar infus 20% Botol
663 Maprotilin hcl tab sal 25 mg Tab sal
664 Maprotilin hcl tab sal 50 mg Tab sal
665 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml Vial

666 Mebendazol sir 50 mg/ml Botol

667 Mebendazol tab 100 mg Tan
668 Mebendazol tab 500 mg Tab
669 Medroksi progesteron asetat inj 200 mg/ml Vial
670 Medroksi Progesteron Asetat Inj 50 mg/ml Vial
671 Medroksi progesteron asetat inj depo 150 mg Set/buah
672 Medroksi progesteron asetat tab 10 mg Tab
673 Medroksi progesteron asetat tab 100 mg Tab
674 Medroksi progesteron asetat tab 250 mg Tab
675 Medroksi progesteron asetat tab 5 mg Tab
676 Medroksi progesteron asetat tab 500 mg Tab
677 Melfalan tab 2 mg Tab
678 Merkaptopurin tab 50 mg Tab
679 Meropenem serb inj 1000 mg/vial Vial
680 Meropenem serb inj 500 mg/vial Vial
681 Mesalazin tab sal 250 mg Tab
682 Mesna inj 100 mg/ml Vial
683 Metadon sir 50 mg/5 ml Botol 1000 ml
684 Metamizol Inj 500 mg/ml Ampul
685 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut

686 Metformin tab 500 mg Tab

687 Metformin tab 850 mg Tab
688 Metildopa tab sal 250 mg Tab
689 Metilergometrin inj 0,2 mg/ml Ampul
690 Metilergometrin tab salut 0,125 mg Tab sal
691 Metilfenidat tab SR 10 mg Tab
692 Metilfenidat tab SR 20 mg Tab
693 Metilprednisolon inj 125 mg/2 ml Vial
694 Metilprednisolon inj 500 mg/8 ml Vial
695 Metilprednisolon tab 16 mg Tab
696 Metilprednisolon tab 4 mg Tab
697 Metilprednisolon tab 8 mg Tab
698 Metoklopramid drop botol 10 ml Botol
699 Metoklopramid inj 5 mg/ml Vial
700 Metoklopramid sir 5 mg/5 ml Botol
701 Metoklopramid tab 10 mg Tab
702 Metoklopramid tab 5 mg Tab
703 Metoprolol tartat inj 1 mg/ml Ampul
704 Metotreksat Inj 10 mg/ml Vial
705 Metotreksat serb inj 5 mg/vial Vial
706 Metotreksat serb inj 50 mg/2 ml Vial
707 Metotreksat tab 2,5 mg Tab
708 Metronidazol lar inf 5 mg/ml Botol
709 Metronidazol ovula 500 mg Supp
710 Metronidazol sir 125 mg/5 Ml Botol
711 Metronidazol sup 500 mg Botol
712 Metronidazol tab 250 mg Tab
713 Metronidazol tab 500 mg Tab
714 MIBG (meta-iodobenzylguanidine) Vial
715 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial
716 Midazolam inj 1 mg/ml (i.v.) Vial
717 Midazolam inj 5 mg/ml (i.v.) Vial
718 Mikafungin Na serb inj 50 mg/vial Vial
719 Mikofenolat mofetil tab 500 mg Tab
720 Mikonazol krim 2% Tube
721 Mikonazol serb 2% Tube
722 Mitomisin C (crystallin) inj 2 mg/ml Vial
723 Mitomisin C (crystallin) serb inj 10 mg/vial Vial
724 Modified fluid gelatine BM 30 000 lar inf 4% Botol
725 Moksifloksasin inf 1,6 mg/mL Botol
726 Moksifloksasin tab 400 mg Tab
727 Moksifloksasin tts mata 0,5% Botol
728 Mometason furoat krim 0,1% Tube
729 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial
730 Morfin Hcl tab 10 mg Tab
731 Morfin Hcl tab SR 10 mg Tab
732 Morfin Hcl tab SR 15 mg Tab
733 Morfin Hcl tab SR 30 mg Tab
734 N-asetil sistein ih 100 mg/ml Botol
735 N-asetil sistein kaps 200 mg Kaps
736 NaCl 0,9% Larutan Botol
737 Nadroparin inj 10 mg/ml Vial
738 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml Vial
739 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml Vial
740 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml Vial
741 Nalokson inj 0,4 mg/ml Ampul
742 Natamisin tts mata 5% Botol
743 Natamisin tts mata 50 mg/ml Botol
744 Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul
745 Natrium bikarbonat High alert medicine. Vial
746 Natrium bikarbonat inj 8,4% (i.v.) Vial
747 Natrium bikarbonat tab 500 mg Tab
748 Natrium diklofenak tab 25 mg Tab
749 Natrium diklofenak tab 50 mg Tab
750 Natrium fluoresein tts mata 2% Botol
751 Natrium fosfat btl, 133 ml Botol
752 Natrium fosfat lar oral 45 ml Botol
753 Natrium fusidat krim 20 mg/g Tube
754 Natrium fusidat salep 20 mg/g Tube
755 Natrium hialuronat gel Tube
756 Natrium hipoklorit cairan konsentrat 5% Botol
757 Natrium tiosulfat inj 25% (i.v.) Ampul
758 Neostigmin inj 0,5 mg/ml Vial
759 Nevirapin tab 200 g Tab
760 Nifedipin kaps 10 mg Kaps
761 Nifedipin tab SR 20 mg Tab
762 Nifedipin tab SR 30 mg Tab
763 Nikardipin inj 10 mg/vial Vial
764 Nikotinamid tab 100 mg Tab
765 Nikotinamid tab 20 mg Tab
766 Nikotinamid tab 5 mg Tab
767 Nilotinib kaps 150 mg Kaps
768 Nilotinib tab 200 mg Tab
769 Nimodipin inf 0,2 mg/ml Botol
770 Nimodipin tab 30 mg Tab
771 Nistatin susp 100.000 UI/ml Botol
772 Nistatin tab salut 500.000 UI Tab
773 Nistatin tab vaginal 100.000 UI Tab
774 Nitrofurantoin tab 50 mg Tab
775 Nitrogen oksida ih, gas dlm tabung Botol
776 Nomegestrol asetat Kaps/tab 5 mg Tablet
777 Norepinefrin inj 1 mg/ml Ampul
778 Noretisteron tab 5 mg Tab
779 Obat Anti Tuberculosis FDC Kategori Anak Paket
780 Obat Anti Tuberculosis FDC Kategori I Paket
781 Obat Anti Tuberculosis FDC Kategori II Paket
782 Obat Anti Tuberculosis FDC Kategori Sisipan Paket
783 Obat Anti Tuberculosis Kombipak Anak Paket
784 Obat Anti Tuberculosis Kombipak Dewasa Paket
785 Octreotide acetate 0,05 - 6 mg/ml Botol
786 Ofloksasin tab 200 mg Tab
787 Ofloksasin tab 400 mg Tab
788 Ofloksasin tts telinga 3% Botol
789 Oksaliplatin serb inj 100 mg/vial Vial
790 Oksaliplatin serb inj 50 mg/vial Vial
791 Oksigen ih, gas dlm tabung Botol
792 Oksimetazolin tts hidung 0,025% Botol
793 Oksimetazolin tts hidung 0,050% Botol
794 Oksitetrasiklin hcl inj 250 mg/3 ml (i.m.) Vial
795 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial
796 Oksitetrasiklin hcl inj 500 mg/ml Vial
797 Oksitosin inj 10 UI/ml Ampul
798 Oktreotid inj 0,1 mg/ml Ampul
799 Oktreotid serb inj 20 mg Ampul
800 Oktreotid serb inj 30 mg vial
801 Olanzapin inj 10 mg/2 ml Ampul
802 Olanzapin tab sal 10 mg Tab sal
803 Olanzapin tab sal 5 mg Tab
804 Olopatadin tts mata 0,1% Botol
805 Omeprazol inj 40 mg/10 ml Vial
806 Omeprazol kaps 20 mg Kaps
807 Ondansetron inj 2 mg/ml Vial
808 Ondansetron tab 4 mg Tab
809 Ondansetron tab 8 mg Tab
810 Paklitaksel inj 100 mg/vial Vial
811 Paklitaksel inj 30 mg/vial Vial
812 Paklitaksel inj 300 mg/vial Vial
813 Pankuronium inj 2 mg/ml Ampul
814 Paraformaldehid lar buffer 10% Botol
815 Paraformaldehid tab 1 g Tab
816 Parasetamol drips (infus) 1000 mg/100 ml Botol
817 Parasetamol sir 120 mg/5 ml Botol
818 Parasetamol tab 500 mg Tab
819 Parasetamol tts 60 mg/0,6 ml Botol
820 Pasta devitalisasi (non arsen) Tube
821 Pasta pengisi saluran akar (pasta) Tube
822 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Vial
823 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Vial
824 Pegylated interferon alfa-2b serb inj 100 mcg/ml Vial
825 Pegylated interferon alfa-2b serb inj 120 mcg/ml Vial
826 Pegylated interferon alfa-2b serb inj 50 mcg/ml Vial
827 Pegylated interferon alfa-2b serb inj 80 mcg/ml Vial
828 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

829 Perak nitrat lar 20% Botol

830 Perak sulfadiazin krim 1% Tube
831 Perak sulfadiazin krim 2 % Tube
832 Perindoprilarginin tab 5 mg Tab
833 Permetrin krim 5 % Tube
834 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial
835 Pilokarpin tts mata 2% Botol
836 Pioglitazon tab 15 mg Tab
837 Pioglitazon tab 30 mg Tab
838 Pirantel pamoat susp 125 mg/5 ml Botol
839 Pirantel pamoat tab 500 mg Tab
840 Pirantel pamoat tab scored 125 mg Tab
841 Pirantel pamoat tab scored 250 mg Tab
842 Pirazinamid tab 500 mg Tab
843 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
844 Piridoksin (vitamin B6) tab 10 mg Tab
845 Piridoksin (vitamin B6) tab 25 mg Tab
846 Piridostigmin tab sal 60 mg Tab sal
847 Pirimetamin tab 25 mg Tablet
848 Podofilin tingtur 25 % Botol
849 Polietilen glikol Botol
850 Polikresulen Botol
851 Povidon iodin lar 100 mg/ml Botol 30 ml
852 Povidon iodin lar 100 mg/ml Botol 60 ml
853 Povidon iodin lar 100 mg/ml Botol 300 ml
854 Povidon iodin lar 100 mg/ml Botol 1000 ml
855 Pramipeksol tab ER 0,375 mg Tab
856 Pramipeksol tab ER 0,750 mg Tab
857 Pravastatin tab 10 mg Tab
858 Pravastatin tab 20 mg Tab
859 Prazikuantel tab scored 300 mg Tab
860 Prazikuantel tab scored 600 mg Tab
861 Prednisolon tts mata 10 mg/ml Botol
862 Prednison tab 5 mg Tab
863 Primakuin tab 15 mg Tab
864 Probenesid tab 500 mg Tab
865 Prokain benzilpenisilin serb inj 1 juta UI/vial (i.m.) Tab
866 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial
867 Prokaterol HCl cairan ih 30 mcg Botol
868 Prokaterol HCl cairan ih 50 mcg Botol
869 Prokaterol HCl serb ih 10 mcg Botol
870 Propiltiourasil tab 100 mg Tab
871 Propofol inj 1% (i.v. Bolus) Ampul
872 Propranolol inj 1 mg/ml (i.v.) Ampul
873 Propranolol tab 10 mg Tab
874 Propranolol tab 40 mg Tab
875 Protamin sulfat inj 10 mg/ml (i.m.) Ampul
876 Quetiapin tab SR 200 mg Tab
877 Quetiapin tab SR 300 mg Tab
878 Quetiapin tab SR 400 mg Tab
879 Ramipril tab 10 mg Tab
880 Ramipril tab 2,5 mg Tab
881 Ramipril tab 5 mg Tab
882 Ranitidin inj 25 mg/ml Ampul
883 Ranitidin tab 150 mg Tab
884 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak
885 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak
886 Ribavirin tab 200 mg Tab
887 Rifampisin kaps 300 mg Kaps
888 Rifampisin tab 450 mg Tab
889 Rifampisin tab 600 mg Tab
890 Ringer Laktat Larutan Botol
891 Ringer Laktat Larutan 1000 ml Botol
892 Risperidon tab 3 mg Tab
893 Risperidon tab sal 1 mg Tab sal
894 Risperidon tab sal 2 mg Tab sal
895 Rituksimab Inj 10 mg/ml Vial
896 Rituksimab inj 100 mg/ml Ampul
897 Rituksimab inj 500 mg/ml Ampul
898 Rivaroksaban tab sal 10 mg Tab sal
899 Rivaroksaban tab sal 15 mg Tab sal
900 Rivaroksaban tab sal 20 mg Tab sal
901 Rokuronium inj 50 mg/5 ml (i.v.) Vial
902 Ropinirol tab sal 2 mg Tab sal
903 Ropinirol tab sal 4 mg Tab sal
904 Ropinirol tab sal 8 mg Tab sal
905 Ropivakain Inj 7,5 mg/ml Ampul
906 Rosuvastatin tab 10 mg Tab
907 Salbutamol aerosol 100 mcg Botol
908 Salbutamol cairan ih 0,1% Botol
909 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol
910 Salbutamol inj 50 mcg/ml Botol
911 Salbutamol lar ih 0,5 % Botol
912 Salbutamol nebules vial 2,5 mg Vial
913 Salbutamol sir 2 mg/5 ml Botol
914 Salbutamol tab 2 mg Tab
915 Salbutamol tab 4 mg Tab
916 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube
917 Sefadroksil kaps 250 mg Vial
918 Sefadroksil kaps/tab 500 mg Tab
919 Sefadroksil sir kering 125 mg/5 ml Botol
920 Sefadroksil sir kering 250 mg/5 ml Botol
921 Sefaleksin kaps 250 mg Kaps
922 Sefaleksin kaps 500 mg Kaps
923 Sefazolin serb inj 1 g/vial Vial
924 Sefepim serb inj 1000 mg/vial Vial
925 Sefiksim sir 100 mg/5 ml Botol
926 Sefiksim tab 100 mg Tab
927 Sefoperazon serb inj 1.000 mg/vial Vial
928 Sefotaksim inj 500 mg/vial Vial
929 Sefotaksim serb inj 1.000 mg/vial Vial
930 Sefpirom serb inj 1000 mg Vial
931 Sefpodoksim proksetil tab sal 100 mg Tab
932 Seftazidim serb inj 1.000 mg/vial Vial
933 Seftriakson serb inj 1.000 mg/vial Vial
934 Sefuroksim serb inj 750 mg/vial Vial
935 Sefuroksim tab 250 mg Tab
936 Sefuroksim tab sal 500 mg Tab
937 Sertralin tab sal 50 mg Tab sal
938 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj (i.m./i.v.) Papua Vial

939 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial
940 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
941 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 20.000 UI/ Vial
942 Serum antirabies inj 100 UI/ml Vial
943 Serum antirabies inj 200 UI/ml Vial
944 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
945 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
946 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
947 Setirizin sir 5 mg/5 ml. Botol
948 Setirizin tab 10 mg Tab
949 Setuksimab inj 5 mg/ml Vial
950 Sevofluran cairan ih 250 ml Botol
951 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial
952 Sianokobalamin (vitamin B12) tab 50 mcg Tab
953 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial
954 Siklofosfamid serb inj 200 mg/vial (i.v.) Vial
955 Siklofosfamid serb inj 500 mg/vial (i.v.) Vial
956 Siklofosfamid tab sal 50 mg Tab
957 Siklosporin inj 100 mg/ml Ampul
958 Siklosporin inj 50 mg/ml Ampul
959 Siklosporin kaps 100 mg Kaps
960 Siklosporin kaps lunak 25 mg Kaps
961 Siklosporin Kaps lunak 50 mg Kapsul
962 Silostazol tab 100 mg Tab
963 Simvastatin tab sal 10 mg Tab sal
964 Simvastatin tab sal 20 mg Tab sal
965 Siprofloksasin inf 2 mg/ml Botol
966 Siprofloksasin tab scored 500 mg Tab
967 Sisplatin serb inj 10 mg Vial
968 Sisplatin serb inj 50 mg Vial
969 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial
970 Sitarabin serb inj 500 mg/10 ml Vial
971 Spiramisin tab 250 mg Tab
972 Spiramisin tab 500 mg Tab
973 Spironolakton tab 100 mg Tab
974 Spironolakton tab 25 mg Tab
 975 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
976 Stavudin tab 30 mg Tab
977 Streptokinase serb inj 1,5 juta UI/vial Vial
978 Streptomisin serb inj 1.000 mg/vial Vial
979 Sufentanil inj 5 mcg/ml (i.v.) Ampul
980 Sukralfat susp 500 mg/5 ml Botol
981 Sukralfat tab 500 mg Tab
982 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial
983 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial
984 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial
985 Sulfadiazin tab 500 mg Tablet
986 Sulfasalazin kapl sal enterik 500 mg Kaps salut
987 Sulfur colloid 4,5 mg gelatin/reaction vial Vial
988 Surgical ginggival pack Tube
989 Takrolimus kaps 0,5 mg Kaps
990 Takrolimus kaps 1 mg Kaps
991 Tamoksifen tab 20 mg Tab
992 Tamsulosin tab 0,2 mg Tab
993 Tamsulosin tab SR 0,4 mg Tab
994 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set
995 Telbivudin tab 600 mg Tab
996 Telmisartan tab 40 mg Tab
997 Telmisartan tab 80 mg Tab
998 Temozolamid kaps 100 mg Kaps
999 Temozolamid kaps 20 mg Kaps
1000 Tenofovir tab 300 mg Tab
1001 Teofilin SR 300 mg Tab
1002 Teofilin tab 100 mg Tab
1003 Teofilin tab 100 mg Tab
1004 Teofilin tab 150 mg Tab
1005 Teofilin tab 150 mg Tab
1006 Teofilin tab SR 300 mg Tab
1007 Terazosin hcl tab 1 mg Tab
1008 Terazosin hcl tab 2 mg Tab
1009 Terbinafrin tab 250 mg Tablet
1010 Terbutalin cairan ih 2,5 mg/ml Botol
1011 Terbutalin inj 0,5 mg/ml Vial
1012 Terbutalin serb ih 0,50 mg/dose Vial
1013 Terbutalin sir 1,5 mg/5 ml Botol
1014 Terbutalin tab 2,5 mg Tab
1015 Testosteron inj 250 mg/ml Tab
1016 Testosteron kaps lunak 40 mg Kaps
1017 Testoteron kombinasi : benserazin 25 mg +levodopa 100 mg Kaps
1018 Tetanus toxoid inj Ampul
1019 Tetrakain tts mata 0,5% Botol
1020 Tetrasiklin kaps 250 mg Kaps
1021 Tetrasiklin kaps 500 mg Kaps
1022 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set
1023 Tiamazol tab 10 mg Tab
1024 Tiamazol tab 5 mg Tab
1025 Tiamin (vitamin B1) tab 50 mg Tab
1026 Tikagrelor tab 90 mg Tab
1027 Timolol tts mata 0,25% Botol
1028 Timolol tts mata 0,5% Botol
1029 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul
1030 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul
1031 Tiotropium serb ih 18 mcg + handihaller Botol
1032 Tiotropium serb ih 18 mcg, refill Botol
1033 Tobramisin tetes mata 0,3% Botol
1034 Topiramat tab 100 mg Tab
1035 Topiramat tab 25 mg Tab
1036 Topiramat tab 50 mg Tab
1037 Tramadol inj 50 mg/ml Ampul
1038 Trastuzumab serb inj 440 mg/vial Vial
1039 Travoprost tts mata 0,004% Botol
1040 Triamsinolon asetonid nasal spray 55 mcg/puff Botol
1041 Triamsinolon inj 10 mg/ml Ampul
1042 Trifluoperazin tab sal 5 mg Tab sal
1043 Triheksifenidil tab 2 mg Tab
1044 Tropikamid tts mata 0,5% Botol
1045 Tropikamid tts mata 1% Botol
1046 Tuberkulin protein purified derivative 1:10 (i.k) Ampul
1047 Urea krim 10 % Tube
1048 Vaksin BCG inj (i.k) Vial
1049 Vaksin campak inj (s.k.) Vial
1050 Vaksin jerap difteri tetanus (DT) Vial
1051 Vaksin jerap difteri tetanus (Td) Vial
1052 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial
1053 Vaksin jerap tetanus (tetanus adsorbed toxoid) inj (i.m.) Vial
1054 Vaksin kombinasi DPT-HB-Hib Vial
1055 Vaksin polio IPV inj 0,5 ml Vial
1056 Vaksin polio t-OPV drops 10 dosis Vial
1057 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
1058 Valasiklovir tab 500 mg Tab
1059 Valgansiklovir tab sal 450 mg Tab sal
1060 Valproat sir 250 mg/5 ml Botol
1061 Valproat tab sal 250 mg Tab sal
1062 Valproat tab sal 500 mg Tab sal
1063 Valproat tab sal enterik 200 mg Tab
1064 Valproat tab SR 250 mg Tab
1065 Valproat tab SR 500 mg Tab
1066 Valsartan tab 160 mg Tab
1067 Valsartan tab 80 mg Tab
1068 Vankomisin serb inj 500 mg/vial Vial
1069 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial
1070 Verapamil inj 2,5 mg/ml Vial
1071 Verapamil tab 240 mg Tab
1072 Verapamil tab 80 mg Tab
1073 Vinblastin serb inj 10 mg/ml Vial
1074 Vinkristin serb inj 1 mg (i.v.) Vial
1075 Vinkristin serb inj 2 mg/2 ml (i.v.) Vial
1076 Vinorelbin inj 10 mg/ml Vial
1077 Vitamin B kompleks Tab
1078 Warfarin tab 1 mg Tab
1079 Warfarin tab 2 mg Tab
1080 Zidovudin kaps 300 mg Kaps
1081 Zinc serb 10 mg Sachet
1082 Zinc sir 10 mg/ml Botol
1083 Zinc sir 20 mg/5 ml Botol
1084 Zinc tab disp 20 mg Tab
VIAL / TUBE / SACCHET / PUFF

AN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2017

RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2017

PEMAKAIAN
SISA STOK PER JUMLAH RENCANA RENCANA
RATA-RATA PER
31 DESEMBER KEBUTUHAN KEBUTUHAN PENGADAAN
BULAN SELAMA
2015 TAHUN 2017 TAHUN 2017 TAHUN 2017
2015
(a) (b) (c) = (b) x 18 (d) = (c) - (a) (e)
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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 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 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
180 420 7560 7380
0 0 0 0
20 95 1710 1690
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
5 60 1080 1075
3 30 540 537
500 160 2880 2380
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
30 35 630 600
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
3 15 270 267
1 9 162 161
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
100 50 900 800
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
70 60 1080 1010
120 65 1170 1050
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
65 460 8280 8215
400 565 10170 9770
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
120 3700 66600 66480
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
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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 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 1100 19800 19200
6 14 252 246
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5 15 270 265
250 350 6300 6050
0 0 0 0
0 0 0 0
300 1200 21600 21300
0 0 0 0
 0 0 0 0
0 0 0 0
60 750 13500 13440
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
300 95 1710 1410
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
50 70 1260 1210
0 0 0 0
400 360 6480 6080
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
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0 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 0 0
0 0 0 0
0 0 0 0
0 0 0 0
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0 0 0 0
0 0 0 0
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0 0 0
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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 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
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0 0 0 0
0 0 0 0
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0 0 0 0
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0 0 0 0
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0 0 0 0
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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 0
0 0 0 0
0 0 0 0
 KETERANGAN

(f)