1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. JUMLAH KEBUTUHAN TAHUN 2020 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2018 DIKALI 18 BULAN DALAM SA
3. RENCANA KEBUTUHAN TAHUN 2020 ADALAH RENCANA KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI D
4. RENCANA PENGADAAN TAHUN 2020 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 :

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
14 Albumin serum normal (human albumin) inj 20% 50 ml Botol
15 Albumin serum normal (human albumin) inj 25% 100 ml Botol
16 Albumin serum normal (human albumin) inj 25% 20 ml Botol
17 Albumin serum normal (human albumin) inj 25% 50 ml Botol
18 Albumin serum normal (human albumin) inj 5% 250 ml Botol
19 Albumin serum normal (human albumin) inj 5% 50 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 (25% insulin lispro), vial/cartridge diposible/penfill cartridge

50 Analog insulin intermediate acting combine with short or long acting inj Penfill
100 IU/ml (50% insulin lispro), vial/cartridge diposible/penfill cartridge

51 Analog Insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill Vial/Cartridge/Penf
cartridge
52 Anastrozol tab 1 mg Tab
53 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 Vial
ml
54 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Tab
hidroksida 200 mg
55 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Botol
hidroksida 200 mg
56 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps
57 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiksin B 10.000 UI/g Tube
 58 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Tube
59 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Botol
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g

60 Aripiperazol oral solution 1 mg/ml Botol

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

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

151 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% Ampul
152 Bupivakain inj 5 mg/ml (p.v.) Ampul
153 Busulfan tab salut 2 mg Tab
154 Coal tar lar 5 % Botol
155 Copper T set/buah
156 Dabigatran eteksilat kaps 110 mg Kaps
157 Dabigatran eteksilat kaps 75 mg Kaps
158 Dakarbazin serb inj 100 mg/vial Vial
159 Dakarbazin serb inj 200 mg/vial Vial
160 Daklatasvir tab sal selaput 30 mg Tab
161 Daklatasvir tab sal selaput 60 mg Tab
162 Daktinomisin inj 0,5 mg/vial (i.v.) Vial
163 Dapson tab scored 100 mg Tab
164 Daunorubisin serb inj 20 mg/vial Vial
165 Deferasiroks tab disp 250 mg Tab
166 Deferasiroks tab disp 500 mg Tab
167 Deferipron lar oral 100 mg/ml Botol
168 Deferipron tab sal 500 mg Botol
169 Deferoksamin mesilat serb inj 500 mg/vial Vial
170 Deksametason inj 5 mg/ml (i.v./i.m.) Vial
171 Deksametason tab 0,5 mg Tab
172 Deksametason tab 4 mg Tab
173 Deksmedetomidin Inj 100 mcg/ml Ampul
174 Desfluran cairan ih Botol
175 Desmopresin nasal spray 10 mcg/puf Botol
176 Desmopresin tab 0,1 mg Tab
177 Desmopresin tab 0,2 mg Tab
178 Desogestrel tab 75 mcg Tab
179 Desoksimetason gel 0,05% Tube
180 Desoksimetason krim 0,25% Tube 15 g
181 Desoksimetason salep 0,25% Tube 10 g
182 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 1,5% Botol
183 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 2,5% Botol
184 Dialisa peritoneal lar intraperitonial Botol
185 Diazepam enema 10 mg/2,5 ml Botol
186 Diazepam enema 5 mg/2,5 ml Botol
187 Diazepam inj 5 mg/ml (i.v./i.m.) Vial
188 Diazepam tab 2 mg Tab
189 Diazepam tab 5 mg Tab
190 Dienogest tab 2 mg Tablet
191 Dietilkarbamazin tab 100 mg Tab
192 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul
193 Diflukortolon valerat salep berlemak 0,1% Tube
194 Digoksin inj 0,25 mg/ml Vial
195 Digoksin tab 0,25 mg Tab
196 Diltiazem hcl inj 5 mg/5 ml Ampul
197 Diltiazem hcl tab 30 mg Tab
198 Diltiazem inj 25 mg/5 ml Ampul
199 Diltiazem kaps SR 100 mg Kaps
200 Diltiazem kaps SR 200 mg Kaps
201 Diltiazem serb inj 10 mg/10 ml Ampul
202 Diltiazem serb inj 50 mg/vial Vial
203 Diltiazem tab 30 mg Tab
204 Dimenhidrinat tab 50 mg Tab
205 Dinatrium edetat tts mata 0,35% (3,5 mg/ml) Botol
206 Dinatrium klodronat inj 60 mg/ml Botol
207 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic Vial
acid/vial
208 Dobutamin inj 12,5 mg/ml Vial
209 Dobutamin inj 25 mg/ml Vial
210 Dobutamin inj 50 mg/ml Vial
211 Doksazosin mesilat tab 1 mg Tab
212 Doksazosin mesilat tab 2 mg Tab
213 Doksazosin tab 1 mg Tab
214 Doksazosin tab 2 mg Tab
215 Doksisiklin kaps 100 mg Kaps
216 Doksisiklin kaps 50 mg Kaps
217 Doksorubisin serb inj 10 mg/vial (i.v.) Vial
218 Doksorubisin serb inj 50 mg/vial Vial
219 Domperidon susp 5 mg/5 ml Botol
220 Domperidon tab 10 mg Tab
221 Domperidon tts 5 mg/ml Botol
222 Donepezil tab 5 mg Tab
223 Donepezil tab ef 10 mg Tab ef
224 Dopamin inj 40 mg/ml Vial
225 Dosetaksel inj 20 mg Vial
226 Dosetaksel inj 40 mg/ml (vial 0,5 ml) Vial
227 Dosetaksel inj 40 mg/ml (vial 2 ml) Vial
228 Dosetaksel inj 80 mg Vial
229 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial
calcium trisodium/ml
230 Dutasterid kaps 0,5 mg Kaps
231 Efavirens tab sal 600 mg Tab sal
232 Efavirenz tab 200 mg Tablet
233 Efedrin inj 50 mg/ml Ampul
234 Eksemestan tab 25 mg Tab
235 Eltrombopag tab sal selaput 25 mg Tab
236 Eltrombopag tab sal selaput 50 mg Tab
237 Enoksaparin sodium inj 20 mg/0,2 ml Ampul
238 Enoksaparin sodium inj 40 mg/0,4 ml Ampul
239 Enoksaparin sodium inj 60 mg/0,6 ml Ampul
240 Entekavir tab sal selaput 0,5 mg Tablet
241 Entekavir tab sal selaput 1 mg Tablet
242 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul
243 Epinefrin (adrenalin) inj 1 mg/ml Ampul
244 Epirubisin serb inj 2 mg/ml Vial
245 Epirubisin serb inj 50 mg Vial
246 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps
247 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol
248 Ergotamin tab 1 mg Tab
249 Eritromisin kaps 250 mg Kaps
250 Eritromisin sir 200 mg/5 ml Botol
251 Eritromisin tab 500 mg Tab
252 Eritropoetin-alfa inj 10.000 IU Vial
253 Eritropoetin-alfa inj 2.000 IU Vial
254 Eritropoetin-alfa inj 3.000 IU Vial
255 Eritropoetin-alfa inj 4.000 IU Vial
256 Eritropoetin-beta inj 2000 UI/0,3 ml Vial
257 Eritropoietin-Alfa Inj 4000 IU/0,5 ml Ampul
258 Erlotinib tab sal selaput 100 mg Tab
259 Erlotinib tab sal selaput 150 mg Tab
260 Esomeprazole inj 40 mg/vial Vial
261 Estrogen terkonjugasi tab sal 0,625 mg Tab sal
262 Etanol 70% cairan 70% Botol
263 Etil klorida semprot 100 ml Botol
264 Etinilestradiol tab 0,05 mg Tab
265 Etinilestradiol tab 0,5 mg Tab
266 Etonogestrel implan 68 mg Set
267 Etoposid inj 20 mg/ml Vial
268 Etoposid kaps 100 mg Kaps
269 Eugenol Botol
270 Everolimus tab 0,25 mg Tab
271 Everolimus tab 0,5 mg Tab
272 Faktor IX Kompleks Inj 50 IU/mL Vial
273 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial
274 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial
275 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
276 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/20 ml UI

277 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi Vial

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

279 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial
280 Faktor VIII serb inj 1000 mg/vial Vial
281 Faktor VIII serb inj 2000 mg/vial Vial
282 Faktor VIII serb inj 250 IU Vial
283 Faktor VIII serb inj 500 IU Vial
284 Fenilefrin drops 10% Botol
285 Fenitoin Na inj 100 mg/2 ml Ampul
286 Fenitoin Na inj 50 mg/ml Ampul
287 Fenitoin Na kaps 100 mg Kaps
288 Fenitoin Na kaps 30 mg Kaps
289 Fenobarbital inj 50 mg/ml Ampul
290 Fenobarbital tab 100 mg Tab
291 Fenobarbital tab 30 mg Tab
292 Fenofibrat kaps 100 mg Kaps
293 Fenofibrat kaps 300 mg Kaps
294 Fenoksimetil penisilin (penisilin V) tab 125 mg Tab
295 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
296 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
297 Fenoterol hbr aerosol 100 mcg/puf Botol
298 Fenoterol hbr cairan ih 0,1% Botol
299 Fentanil inj 0,05 mg/ml (ampul 10 ml) Vial
300 Fentanil inj 0,05 mg/ml (ampul 2 ml) Vial
301 Fentanil patch 12,5 mcg/jam Pack
302 Fentanil patch 25 mcg/jam Pack
303 Fentanil patch 50 mcg/jam Pack
304 Ferrakrilum cairan 1% Botol
305 Ferro fumarat kaps lunak 300 mg Kaps lunak
306 Ferro sulfat sir. 150 mg/5 ml Botol
307 Ferro sulfat tab salut 300 mg Tab sal
308 Filgrastim inj 300 mcg/ml Vial
309 Finasterid tab 5 mg Tab
310 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial
311 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
312 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul
313 Fludarabin inj 50 mg/vial Vial
314 Fludarabin tab sal 10 mg Tab
315 Flufenazin inj 25 mg/ml (i.m.) Vial
316 Flukonazol inj 2 mg/ml Ampul
317 Flukonazol kaps 150 mg Kaps
318 Flukonazol kaps 50 mg Kaps
319 Fluoksetin kaps 10 mg Kaps
320 Fluoksetin kaps 20 mg Kaps
321 Fluor kapl 1 mg Kaplet
322 Fluor sediaan topikal Tube
323 Fluoresein injeksi 10% Ampul
324 Fluoresein tts mata 2,5 mg/ml Botol
325 Fluoro deoxy glucose (FDG) Vial
326 Fluorometolon tts mata 0,1% Botol
327 Fluorourasil Inj 25 mg/ml Vial
328 Fluorourasil inj 250 mg/ml Ampul
329 Fluorourasil inj 50 mg/mL (@ 10 mL) Ampul
330 Fluorourasil inj 50 mg/mL (@ 5 mL) Ampul
331 Fluorourasil serb inj 250 mg Ampul
332 Flusinolon asetonid krim 0,025% Tube 5 g
333 Flusinolon asetonid salep 0,025% Tube 10 g
334 Flutikason furoat intranasal spray Botol
335 Flutikason propionat cairan ih 0,5 mg/dosis Botol
336 Flutikason Propionat MDI 50 mcg/semprot Botol
337 Fondaparinuks inj 2,5 mg/0,5 ml Vial
338 Formokresol Botol
339 Fosfomisin Trometamol granula 3 g Sachet
340 Fraksi protein plasma lar inf 5% Botol
341 Framisetin Sulfat Tulle 1% Patch
342 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul
343 Furosemid tab 40 mg Tab
344 Gabapentin kaps 100 mg Kaps
345 Gabapentin kaps 300 mg Kaps
346 Gadobutrol Macrocyclic 5 ml Macrocyclic
347 Gadobutrol Macrocyclic 7,5 ml Macrocyclic
348 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial
349 Galactose microparticle 200-400 mg micropart/ml Vial
350 Gansiklovir serb inj 500 mg/vial Vial
351 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + Sachet
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
352 Gefitinib tab 250 mg Tab
353 Gemfibrozil kaps 300 mg Kaps
354 Gemfibrozil kaps 600 mg Kaps
355 Gemsitabin inj 1000 mg/vial Vial
356 Gemsitabin inj 200 mg/vial Vial
357 Gentamisin inj 10 mg/ml Ampul
358 Gentamisin inj 40 mg/ml Ampul
359 Gentamisin inj 80 mg/ml Ampul
360 Gentamisin salep mata 0,3% Tube
361 Gentamisin tsts mata 1% Botol
362 Gentamisin tts mata 0,3% Botol
363 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g Sachet

364 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol

365 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
366 Glibenklamid tab 2,5 mg Tab
367 Glibenklamid tab 5 mg Tab
368 Gliklazid tab 80 mg Tab
369 Gliklazid tab MR 30 mg Tab
370 Gliklazid tab SR 60 mg Tab
371 Glikuidon tab 30 mg Tab
372 Glimepirid tab 1 mg Tab
373 Glimepirid tab 2 mg Tab
374 Glimepirid tab 3 mg Tab
375 Glimepirid tab 4 mg Tab
376 Glipizid tab 10 mg Tab
377 Glipizid tab 5 mg Tab
378 Gliseril trinitrat inj 10 mg/ml Ampul
379 Gliseril trinitrat inj 5 mg/ml Ampul
380 Gliseril trinitrat kaps lepas lambat 2,5 mg Kaps
381 Gliseril trinitrat kaps lepas lambat 5 mg Kaps
382 Gliseril trinitrat tab 0,5 mg Tab sub
383 Gliserin lar 50% Botol
384 Gliserin tts 100 mg/ml Botol
385 Glukosa Larutan Infus 10% steril 100 ml Botol
386 Glukosa Larutan Infus 10% steril 250 ml Botol
387 Glukosa Larutan Infus 10% steril 500 ml Botol
388 Glukosa Larutan Infus 5% steril 100 ml Botol
389 Glukosa Larutan Infus 5% steril 250 ml Botol
390 Glukosa Larutan Infus 5% steril 500 ml Botol
391 Goserelin asetat inj 10,8 mg/vial Vial
392 Goserelin asetat inj 3,6 mg/vial Vial
393 Griseofulvin (micronized) tab 125 mg Tab
394 Griseofulvin (micronized) tab 500 mg Tab
395 Griseofulvin (micronized) tab scored 250 mg Tab
396 Gutta percha dan paper points 15 - 40 mm Roll
397 Gutta percha dan paper points 45 - 80 mm Roll
398 Haloperidol inj 5 mg/ml (i.m.) Vial
399 Haloperidol inj 50 mg/ml (decanoat) Vial
400 Haloperidol tab 0,5 mg Tab
401 Haloperidol tab 1,5 mg Tab
402 Haloperidol tab 2 mg Tab
403 Haloperidol tab 5 mg Tab
404 Haloperidol tts 2 mg/ml Botol
405 Halotan ih Botol
406 Hemodialisa lar konsentrat basis asetat Botol
407 Hemodialisa lar konsentrat basis natrium bikarbonat Botol
408 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial
409 Hepatitis B imunoglobulin (human) inj 0,5 ml Ampul
410 Hepatitis B imunoglobulin (human) Inj 220 IU/ml Vial
411 Hidrogen peroksida cairan 3% Botol
412 Hidrogen peroksida lar. Konsentrat 3% Botol
413 Hidroklorotiazid tab 12,5 mg Tab
414 Hidroklorotiazid tab 25 mg Tab
415 Hidrokortison krim 1% Tube
416 Hidrokortison krim 2,5% Tube
417 Hidrokortison serb inj 100 mg Vial
418 Hidrokortison Tab 20 mg Tab
419 Hidroksi klorokuin tab 200 mg Tab
420 Hidroksi urea tab 500 mg Tab
421 Hiosina butilbromida inj 20 mg/ml Ampul
422 Hiosina butilbromida tab 10 mg Tab
423 Homatropin tts mata 2% Botol
424 Human insulin fast acting inj 100 IU/ml, cartridge disposible/penfill Cartridge, Penfill
cartridge
425 Human insulin fast acting inj 100 IU/ml, Vial 10 mL Vial
426 Human insulin fast acting inj 100 IU/ml, Vial 5 mL Vial
427 Human Insulin intermediate acting combine with short or long acting inj Cartridge, Penfill
100 IU/mL, cartridge disposible/penfill cartridge
428 Human insulin intermediate acting combine with short or long acting inj Vial
100 IU/mL, Vial 10 mL
429 Human Insulin intermediate acting inj 100 IU/ml, cartridge Cartridge, Penfill
disposible/penfill cartridge
430 Human insulin intermediate acting inj 100 IU/mL, Vial 10 mL Vial
431 Human Insulin intermediate acting inj 100 IU/Ml, Vial 10 mL Vial
432 Human Insulin intermediate acting inj 100 IU/mL, Vial 5 mL Vial
433 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
434 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
435 Hydromorphone HCl tab oros 16 mg Tab
436 Hydromorphone HCl tab oros 8 mg Tab
437 Ibuprofen sir 100 mg/5 ml Botol
438 Ibuprofen sir 200 mg/5 ml Botol
439 Ibuprofen tab 200 mg Tab
440 Ibuprofen tab 400 mg Tab
441 Idarubisin serb inj 20 mg Vial
442 Ifosfamid serb inj 1000 mg/vial Vial
443 Ifosfamid serb inj 2000 mg/vial Vial
444 Ifosfamid serb inj 500 mg/vial Vial
445 Imatinib mesilat tab 100 mg Tab
446 Imatinib Mesilat tab 400 mg Tab
447 Imidapril tab 10 mg Tab
448 Imidapril tab 5 mg Tab
449 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS (Guillain Bare Vial
Syndrom)
450 Imunoglobullin Intravena inj 250 mg/50 ml Botol
451 Indakaterol serb ih 150 mcg Kaps
452 Indakaterol serb ih 300 mcg Kaps
453 Iodiksanol vial 320 mg Iodium/50 ml Vial
454 Iodium 131 Botol
455 Iodohippurate sodium I 131 37-74 mbq/ multiple-dose Vial
456 Ioheksol 180 - 300 mg Iodium/mL (300 mg/20 mL) Vial
457 Ioheksol 240-350 mg Iodium/ml Vial
458 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/100 ml) Vial
459 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/50 ml) Vial
460 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/100 ml) Vial
461 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/50 ml) Vial
462 Iopamidol 200 - 300 mg Iodium/mL (300 mg/100 mL) Vial
463 Iopamidol 200 - 300 mg Iodium/mL (300 mg/200 mL) Vial
464 Iopamidol 200 - 300 mg Iodium/mL (300 mg/50 mL) Vial
465 Iopamidol 300 - 370 mg Iodium/mL (370 mg/100 mL) Vial
466 Iopamidol 300 - 370 mg Iodium/mL (370 mg/200 mL) Vial
467 Iopamidol 300 - 370 mg Iodium/mL (370 mg/50 mL) Vial
468 Iopamidol inj 200-370 mg Iodium/ml Vial
469 Iopromid 240 -370 mg Iodium/ml Vial
470 Iopromid 300 - 370 mg (300 mg/100 mL) Vial
471 Iopromid 300 - 370 mg (300 mg/50 mL) Vial
472 Iopromid 300 - 370 mg (370 mg/100 mL) Vial
473 Iopromid 300 - 370 mg (370 mg/50 mL) Vial
474 Ipratropium bromida aerosol 20 mcg/semprot Botol
475 Ipratropium bromida cairan ih 0,025% Botol
476 Ipratropium bromida ih 20mcg/puf Botol
477 Irbesartan tab 150 mg Tab
478 Irbesartan tab 300 mg Tab
479 Irinotekan inf 20 mg/ml Ampul
480 Irinotekan inj 20 mg/ml Ampul
481 Isofluran inhalasi 100 ml Botol
482 Isofluran inhalasi 250 ml Botol
483 Isoniazid tab 100 mg Tab
484 Isoniazid tab 300 mg Tab
485 Isosorbid dinitrat inj 1 mg/ml (i.v) Ampul
486 Isosorbid dinitrat tab 10 mg Tab
487 Isosorbid dinitrat tab 5 mg Tab
488 Itrakonazol Kaps 100 mg Kaps
489 IUD Cu T 380 A Set
490 IUD Levonorgestrel Set
491 Ivabradin tab 5 mg Tab
492 k.y jelly Tube gel
493 Kalamin Tube
494 Kalium aspartat tab 300 mg Tab
495 Kalium klorida tab siap larut 300 mg Tab
496 Kalium klorida tab SR 600 mg Tab
497 Kalsitriol kaps lunak 0,25 mcg Kapsul
498 Kalsitriol kaps lunak 0,5 mcg Kapsul
499 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml Ampul
500 Kalsium folinat (leukovorin, Ca) inj 3 mg/ml Vial
501 Kalsium folinat (leukovorin, Ca) inj 5 mg/ml Vial
502 Kalsium folinat (leukovorin, Ca) tab 15 mg Tab
503 Kalsium glukonat inj 100 mg/ml Ampul
504 Kalsium hidroksida bubuk, pasta Tube
505 Kalsium hipoklorit Sachet
506 Kalsium karbonat tab 500 mg Tab
507 Kalsium laktat (kalk) tab 500 mg Tab
508 Kalsium polistirena sulfonat ktg 5 g Sachet
509 Kanamisin inj 1.000 mg/ vial Vial
510 Kandesartan tab 16 mg Tab
511 Kandesartan tab 8 mg Tab
512 Kapesitabin tab sal 500 mg Tab sal
513 Kaptopril tab 12,5 mg Tab
514 Kaptopril tab 25 mg Tab
515 Kaptopril tab 50 mg Tab
516 Karbamazepin sir 100 mg/5 ml Botol
517 Karbamazepin tab 100 mg Tab
518 Karbamazepin Tab 200 mg Tablet
519 Karbimazol tab 5 mg Tab
520 Karbo adsorben tab 0,5 g Tab
521 Karbogliserin tts telinga 10 % Botol
522 Karboksimetilselulosa tts mata Botol
523 Karbon aktif tab 0,5 mg Tablet
524 Karboplatin Inj 10 mg (vial 45 ml) Vial
525 Karboplatin inj 10 mg/ml (vial 15 ml Vial
526 Karvedilol tab 25 mg Tablet
527 Karvediol kaps 6,25 mg Kaps
528 Ketamin inj 100 mg/ml (i.v.) Ampul
529 Ketamin inj 50 mg/ml (i.v.) Ampul
530 Ketokonazol krim 2% Tube 10 g
531 Ketokonazol scalp sol 2% Tube
532 Ketokonazol tab 200 mg Tab
533 Ketoprofen Inj 25 mg/ml Ampul
534 Ketoprofen sup 100 mg Botol
535 Ketorolak inj 30 mg/ml Ampul
536 Klaritromisin sir kering 125 mg/5 ml Botol
537 Klaritromisin sir kering 250 mg/5 ml Botol
538 Klaritromisin tab 500 mg Tab
539 Klindamisin kaps 150 mg Kaps
540 Klindamisin kaps 300 mg Kaps
541 Klobazam tab 10 mg Tab
542 Klofazimin, micronized kaps 50 mg Kapsul
543 Klofazimin, micronizedkaps 100 mg kapsul
544 Klomifen sitrat tab 50 mg Tab
545 Klomipramin tab 25 Tab
546 Klonazepam kaps 2 mg Botol
547 Klonidin inj 150 mcg/ml Vial
548 Klonidin tab 0,15 mg Tab
549 Klopidogrel tab 75 mg Tab
550 Klopidogrel tab sal selaput 300 mg Tab
551 Kloral hidrat lar Botol
552 Klorambusil tab 2 mg Tab
553 Klorambusil tab sal selaput 5 mg Tab
554 Kloramfenikol kaps 250 mg Kaps
555 Kloramfenikol kaps 500 mg Kaps
556 Kloramfenikol salep kulit 2% Tube
557 Kloramfenikol salep mata 1% Tube
558 Kloramfenikol serb inj 1.000 mg/ml Vial
559 Kloramfenikol susp 125 mg/5 ml Botol
560 Kloramfenikol tetes telinga 3% Botol
561 Kloramfenikol tts mata 0,5% Botol
562 Kloramfenikol tts mata 1% Botol
563 Klorfeniramin tab 4 mg Tab
564 Klorfenol kamfer mentol (CHKM) Botol
565 Klorheksidin lar 0,2% Botol
566 Klorheksidin lar 15% Botol
567 Klorokuin tab 250 mg Tablet
568 Klorpromazin inj 25 mg/ml (i.m.) Ampul
569 Klorpromazin inj 5 mg/ml (i.m.) Ampul
570 Klorpromazin tab sal 100 mg Tab sal
571 Klorpromazin tab sal 25 mg Tab sal
572 Klortalidon tab 50 mg Tab
573 Klotrimazol tab vagina 100 mg Tab
574 Klozapin tab 100 mg Tab
575 Klozapin tab 25 mg Tab
576 Kodein tab 10 mg Tab
577 Kodein tab 15 mg Tab
578 Kodein tab 20 mg Tab
579 Kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg Kaps lunak
580 Kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg Kaps lunak
581 Kolestiramin serb, 4 g Ampul
582 Kolkisin tab 500 mcg Tab
583 Koloid HES BM 130 000 lar inf 6% Botol
584 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab sal Tablet
selaput
585 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 mg Vial

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

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

Triple FDC
588 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg Vial
589 Kombinasi : artemether 20 mg + lumefantrin 120 mg Kaps
590 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
591 Kombinasi : Brinzolamid 1% + Timolol 0,5%, tts mata Botol
592 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
593 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab
594 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut Tablet
595 Kombinasi : Indakaterol 110 mcg + Glycopyrronium 50 mcg serb ih + alat Botol
breezhaler
596 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0,05 mg Botol
aerosol
597 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg Tab

598 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab

599 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25 Vial
mg + 5 mg
600 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial

601 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg Paket

602 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab
603 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 mg Tab

604 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata Botol

605 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube
606 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab
607 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Botol
608 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
609 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab
610 Kombinasi: natrium klorida 8,664 mg + kalium klorida 1,32 mg (tetes Botol
mata)
611 Kombinasi: parafin + gliserin + fenolftalein Botol
612 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 Botol
mcg/puf
613 Kombinasi: salmeterol 50 mcg + flutikason propionat 100 mcg ih 100 Botol
mcg/puf
614 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 mcg ih 500 Botol
mcg/puf
615 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol
mcg/puf
616 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg Tab
617 Komposit resin Set
618 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab
trimetoprim 80 mg
619 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ Tab
trimetoprim 160 mg
620 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : sulfametoksazol Botol
200 mg + trimetoprim 40 mg
621 Kuinin inj 25% (i.v.) Vial
622 Kuinin tab 200 mg Tab
623 Laktulosa sir 3,335 g/5 ml Botol
624 Lamivudin (3TC) tab 150 mg Tab
625 Lamivudin tab 100 mg Tab
626 Lamotrigin Tab 100 mg Tab
627 Lamotrigin tab 50 mg Tablet
628 Lamotrigin tab dispersible 25 mg Tablet
629 Lansoprazol inj 30 mg/ml Vial
630 Lansoprazol kaps 30 mg Kaps
631 Lapatinib tab 250 mg Tab
632 Larutan mengandung Asam Amino (Asam Amino 10%) Botol
633 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Botol
Na+ 2 mEq, Asetat 120 mEq)
634 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl- Botol
52 mEq)
635 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 1000 ml
636 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 500 ml
637 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)

638 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol
Taurine 0,24 gr/l) : Aminosteril Infant 6%
639 Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Botol
Amino esensial: Asam Amino non esensial = 60 : 40)
640 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)
641 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Botol
Na+ 14 mEq, Cl 94 mEq)
642 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N- Botol
Hepa
643 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 Botol
g/L)
644 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)

645 Larutan mengandung Asam Amino (Glutamine 20 g) Botol

646 Larutan mengandung Asam Amino (Kombinasi : asam amino, glukosa, Botol
dan lipid) (Lipid Peri 1250)
647 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak, Botol
dan asam amino) (Lipid Special 1250)
648 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak, Botol
dan asam amino) (Lipid Special 625)
649 Larutan mengandung asam amino (kombinasi AA 50 g/L, sorbitol 50 g/L, Botol
Xylitol 50 g/L, vit C 0,4 g/L, Inositol 0,5 g/L, Niasinamid 0,06 g/L, vit B6
0,04 g/L, Riboplavin Na Fosfat 2,5 mg/L, elektrolit)

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

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

653 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 Botol
gr + Asam Amino 48 gr dgn akses sentral)
654 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 Botol
gr + Asam Amino 40 gr)
655 Larutan mengandung Elektrolit (Kalium Klorida) Botol
656 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol
657 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
658 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Botol
Asetat 28 mEq)
659 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN Botol
1B)
660 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

661 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)

662 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0,15%+NaCl Botol

0,45%) (KDN1)
663 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0,3%+NaCl Botol
0,45%) (KDN2)
664 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol Botol
60 g/ L)
665 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Xylitol Botol
100 g/ L)
666 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol
g/ L)
667 Larutan mengandung Karbohidrat (Maltose 10%) Botol
668 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)

669 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol
Sorbitol 50 gr/L)
670 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 100 gr/L, elektrolit)
671 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 75 gr/L, elektrolit)
672 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL 0,45%, Botol
KCl) (HSD)
673 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, glucose 66 Botol
g, Xylitol 60 g/ L + elektrolit)
674 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)
675 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
676 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol
g)
677 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 Botol
g) (D5-1/4NS)
678 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol
g) (D5-1/2NS)
679 Larutan mengandung karbohidrat + elektrolit (Kombinasi NaCl 18,6 g, KCl Botol
0,3 g, CaCl2 0,48 g, dextrose 50 g per 1000 ml)
680 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)

681 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol
5%)
682 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
683 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Na Botol
Lactate 2.24 g, Glukosa 100 gr)
684 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
685 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat Botol
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
686 Larutan mengandung Lipid (Emulsi lemak 20%) Botol
687 Larutan mengandung Lipid (Highly refined fish oil 10 g, emulsion for i.v) Botol

688 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol

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

690 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Botol
Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
691 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Botol
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
692 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Botol
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
693 Latanoprost tts mata 0,005% Botol
694 Leflunomid tab sal selaput 20 mg Tablet
695 Lenograstim inj 263 mcg/vial Vial
696 Letrozol tab 2,5 mg Tab
697 Leuprorelin asetat serb inj 1,88 mg Vial
698 Leuprorelin asetat serb inj 11,25 mg Vial
699 Leuprorelin asetat serb inj 22,5 mg Vial
700 Leuprorelin asetat serb inj 3,75 mg Vial
701 Leuprorelin asetat serb inj 7,5 mg Vial
702 Levetirasetam tab 250 mg Tablet
703 levetirasetam tab 500 mg Tablet
704 Levofloksasin inf 5 mg/ml Botol
705 Levofloksasin tab 500 mg Tab
706 Levofloksasin tts mata 0,5% Botol
707 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) Set
708 Levotiroksin tab 100 mcg Tab
709 Levotiroksin tab 50 mcg Tab
710 Lidokain gel 2% Tube
711 Lidokain inj 1 % (infltr) Vial
712 Lidokain inj 100 mg, vial (i.v.) Vial
713 Lidokain inj 2% (infiltr/p.v.) Ampul
714 Lidokain inj 5% + glukosa (dekstrosa) 5 % Ampul
715 Lidokain spray oral 10% Botol
716 Linestrenol tab 0,5 mg Tab
717 Linestrenol tablet 5 mg Tab
718 Lisinopril tab 10 mg Tab
719 Lisinopril tab 20 mg Tab
720 Lisinopril tab 5 mg Tab
721 Litium karbonat tab 200 mg Tab
722 Litium karbonat tab 400 mg Tab
723 Loperamid tab 2 mg Tab
724 Lopinavir 100 mg + Ritonavir 25 mg Tab
725 Loratadin tab 10 mg Tab
726 Lorazepam tab 0,5 mg Tab
727 Lorazepam tab 1 mg Tab
728 Lorazepam tab sal 2 mg Tab sal
729 Low molecular weight iron dextran inj 100mg/2 ml Ampul
730 Low molecule feri sucrose inj amp 100 mg/5 ml Ampul
731 Lugol Botol
732 MAA (macro agregate albumin) 0,11-2,5 mg albumin Vial
aggregated/reaction vial
733 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial
734 Magnesium sulfat inj 20% Vial
735 Magnesium sulfat inj 40% Vial
736 Magnesium sulfat serb, ktg 30 g Sachet
737 Manitol lar infus 20% Botol
738 Maprotilin hcl tab sal 25 mg Tab sal
739 Maprotilin hcl tab sal 50 mg Tab sal
740 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml Vial

741 Mebendazol sir 100 mg/5 ml Botol

742 Mebendazol tab 100 mg Tan
743 Mebendazol tab 500 mg Tab
744 Medroksi progesteron asetat inj 150 mg/ml Vial
745 Medroksi progesteron asetat inj 200 mg/ml Vial
746 Medroksi Progesteron Asetat Inj 50 mg/ml Vial
747 Medroksi progesteron asetat tab 10 mg Tab
748 Medroksi progesteron asetat tab 100 mg Tab
749 Medroksi progesteron asetat tab 250 mg Tab
750 Medroksi progesteron asetat tab 5 mg Tab
751 Melfalan tab 2 mg Tab
752 Merkaptopurin tab 50 mg Tab
753 Meropenem serb inj 1000 mg/vial Vial
754 Meropenem serb inj 500 mg/vial Vial
755 Mesalazin tab sal 250 mg Tab
756 Mesna inj 100 mg/ml Vial
757 Metadon sir 50 mg/5 ml Botol 1000 ml
758 Metamizol Inj 500 mg/ml Ampul
759 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut

760 Metformin tab 500 mg Tab

761 Metformin tab 850 mg Tab
762 Metildopa tab sal 250 mg Tab
763 Metilergometrin inj 0,2 mg/ml Ampul
764 Metilergometrin tab salut 0,125 mg Tab sal
765 Metilfenidat tab SR 10 mg Tab
766 Metilfenidat tab SR 20 mg Tab
767 Metilprednisolon inj 125 mg/2 ml Vial
768 Metilprednisolon inj 500 mg/8 ml Vial
769 Metilprednisolon tab 16 mg Tab
770 Metilprednisolon tab 4 mg Tab
771 Metilprednisolon tab 8 mg Tab
772 Metoklopramid drop 2 mg/ml Botol
773 Metoklopramid inj 5 mg/ml Ampul
774 Metoklopramid sir 5 mg/5 ml Botol
775 Metoklopramid tab 10 mg Tab
776 Metoklopramid tab 5 mg Tab
777 Metoprolol tartat inj 1 mg/ml Ampul
778 Metotreksat Inj 10 mg/ml Vial
779 Metotreksat inj 2,5 mg/ml Vial
780 Metotreksat serb inj 25 mg/ml Vial
781 Metotreksat serb inj 5 mg/vial Vial
782 Metotreksat tab 2,5 mg Tab
783 Metronidazol lar inf 5 mg/ml Botol
784 Metronidazol ovula 500 mg Supp
785 Metronidazol sir 125 mg/5 Ml Botol
786 Metronidazol sup 500 mg Botol
787 Metronidazol tab 250 mg Tab
788 Metronidazol tab 500 mg Tab
789 MIBG (meta-iodobenzylguanidine) Vial
790 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial
791 Midazolam inj 1 mg/ml (i.v.) Vial
792 Midazolam inj 5 mg/ml (i.v.) Vial
793 Mikafungin Na serb inj 50 mg/vial Vial
794 Mikofenolat mofetil tab 500 mg Tab
795 Mikofenolat Sodium Tab Sal 180 mg Tablet
796 Mikofenolat Sodium Tab Sal 360 mg Tablet
797 Mikonazol krim 2% Tube
798 Mikonazol serb 2% Tube
799 Milrinone inj 1 mg/ml Ampul
800 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Sachet
Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Acetate)

801 Mitomisin serb inj 10 mg Vial

802 Mitomisin serb inj 2 mg Vial
803 Modified fluid gelatine BM 30 000 lar inf 4% Botol
804 Moksifloksasin inf 1,6 mg/mL Botol
805 Moksifloksasin tab 400 mg Tab
806 Moksifloksasin tts mata 0,5% Botol
807 Mometason furoat krim 0,1% Tube
808 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial
809 Morfin Hcl tab 10 mg Tab
810 Morfin Hcl tab SR 10 mg Tab
811 Morfin Hcl tab SR 15 mg Tab
812 Morfin Hcl tab SR 30 mg Tab
813 N-asetil sistein granula 200 mg Sachet
814 N-asetil sistein ih 100 mg/ml Botol
815 N-asetil sistein kaps 200 mg Kaps
816 NaCl 0,9% Larutan Botol
817 Nadroparin inj 10 mg/ml Vial
818 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml Vial
819 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml Vial
820 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml Vial
821 Nalokson inj 0,4 mg/ml Ampul
822 Natamisin tts mata 5% Botol
823 Natamisin tts mata 50 mg/ml Botol
824 Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul
825 Natrium bikarbonat High alert medicine. Vial
826 Natrium bikarbonat inj 8,4% (i.v.) Vial
827 Natrium bikarbonat tab 500 mg Tab
828 Natrium diklofenak tab 25 mg Tab
829 Natrium diklofenak tab 50 mg Tab
830 Natrium Diklofenak Tetes Mata 1 mg/ml Botol
831 Natrium fluoresein tts mata 2% Botol
832 Natrium fosfat btl, 133 ml Botol
833 Natrium fosfat lar oral 45 ml Botol
834 Natrium fusidat krim 20 mg/g Tube
835 Natrium fusidat salep 20 mg/g Tube
836 Natrium hialuronat gel Tube
837 Natrium hipoklorit cairan konsentrat 5% Botol
838 Natrium tiosulfat inj 25% (i.v.) Ampul
839 Neostigmin inj 0,5 mg/ml Vial
840 Nevirapin tab 200 g Tab
841 Nifedipin kaps 10 mg Kaps
842 Nifedipin tab SR 20 mg Tab
843 Nifedipin tab SR 30 mg Tab
844 Nikardipin inj 10 mg/vial Vial
845 Nikotinamid tab 100 mg Tab
846 Nikotinamid tab 5 mg Tab
847 Nilotinib kaps 150 mg Kaps
848 Nilotinib tab 200 mg Tab
849 Nimodipin inf 0,2 mg/ml Botol
850 Nimodipin tab 30 mg Tab
851 Nistatin susp 100.000 UI/ml Botol
852 Nistatin tab salut 500.000 UI Tab
853 Nistatin tab vaginal 100.000 UI Tab
854 Nitrofurantoin tab 50 mg Tab
855 Nitrogen oksida ih, gas dlm tabung Botol
856 Nomegestrol asetat Kaps/tab 5 mg Tablet
857 Norepinefrin inj 1 mg/ml Ampul
858 Noretisteron tab 5 mg Tab
859 Obat Anti Tuberculosis FDC Kategori Anak Paket
860 Obat Anti Tuberculosis FDC Kategori I Paket
861 Obat Anti Tuberculosis FDC Kategori II Paket
862 Obat Anti Tuberculosis FDC Kategori Sisipan Paket
863 Obat Anti Tuberculosis Kombipak Anak Paket
864 Obat Anti Tuberculosis Kombipak Dewasa Paket
865 Ofloksasin tab 200 mg Tab
866 Ofloksasin tab 400 mg Tab
867 Ofloksasin tts telinga 3% Botol
868 Oksaliplatin serb inj 100 mg/vial Vial
869 Oksaliplatin serb inj 50 mg/vial Vial
870 Oksigen ih, gas dlm tabung Botol
871 Oksikodon inj 10 mg/ml Ampul
872 Oksikodon kapsul 10 mg Kaps
873 Oksikodon kapsul 20 mg Kaps
874 Oksikodon tab lepas lambat 10 mg Tab
875 Oksikodon tab lepas lambat 15 mg Tab
876 Oksikodon tab lepas lambat 20 mg Tab
877 Oksimetazolin tts hidung 0,025% Botol
878 Oksimetazolin tts hidung 0,050% Botol
879 Oksitetrasiklin 1% Salep Mata Tube
880 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial
881 Oksitosin inj 10 UI/ml Ampul
882 Oktreotid asetat 0,05 - 6 mg/ml Vial
883 Oktreotid LAR serb inj 20 mg Vial
884 Oktreotid LAR serb inj 30 mg vial
885 Olanzapin inj 10 mg/2 ml Ampul
886 Olanzapin tab sal 10 mg Tab sal
887 Olanzapin tab sal 5 mg Tab
888 Olodaterol cairan ih 2,5 mcg/semprot Botol
889 Olopatadin tts mata 0,1% Botol
890 Omeprazol inj 40 mg/10 ml Vial
891 Omeprazol kaps 20 mg Kaps
892 Ondansetron inj 2 mg/ml Vial
893 Ondansetron tab 4 mg Tab
894 Ondansetron tab 8 mg Tab
895 Paklitaksel inj 6 mg/ml, vial@16,7 ml (inj 100 mg) Vial
896 Paklitaksel inj 6 mg/ml, vial@5 ml (inj 30 mg) Vial
897 Paklitaksel inj 6 mg/ml, vial@50 ml (inj 300 mg) Vial
898 Paliperidon palmitat Inj 100 mg/mL Ampul
899 Paliperidon palmitat Inj 150 mg/1,5 mL Ampul
900 Paliperidon palmitat Inj 50 mg/0,5 mL Ampul
901 Paliperidon palmitat Inj 75 mg/0,75 mL Ampul
902 Pankuronium inj 2 mg/ml Ampul
903 Paraformaldehid lar bufer 10% Botol
904 Paraformaldehid tab 1 g Tab
905 Parasetamol drips (infus) 1000 mg/100 ml Botol
906 Parasetamol sir 120 mg/5 ml Botol
907 Parasetamol tab 500 mg Tab
908 Parasetamol tts 60 mg/0,6 ml Botol
909 Pasta devitalisasi (non arsen) Tube
910 Pasta pengisi saluran akar (pasta) Tube
911 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Vial
912 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Vial
913 Pegylated interferon alfa-2b serb inj 100 mcg/ml Vial
914 Pegylated interferon alfa-2b serb inj 120 mcg/ml Vial
915 Pegylated interferon alfa-2b serb inj 50 mcg/ml Vial
916 Pegylated interferon alfa-2b serb inj 80 mcg/ml Vial
917 Pemetreksed serb inj 500 mg Vial
918 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

919 Perak nitrat lar 20% Botol

920 Perak sulfadiazin krim 1% Tube
921 Perindoprilarginin tab 5 mg Tab
922 Permetrin krim 5 % Tube
923 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial
924 Pilokarpin tts mata 2% Botol
925 Pioglitazon tab 15 mg Tab
926 Pioglitazon tab 30 mg Tab
927 Pirantel pamoat susp 125 mg/5 ml Botol
928 Pirantel pamoat tab 500 mg Tab
929 Pirantel pamoat tab scored 125 mg Tab
930 Pirantel pamoat tab scored 250 mg Tab
931 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
932 Piridoksin (vitamin B6) tab 10 mg Tab
933 Piridoksin (vitamin B6) tab 25 mg Tab
934 Piridostigmin tab sal 60 mg Tab sal
935 Pirimetamin tab 25 mg Tablet
936 Podofilin tingtur 25 % Botol
937 Polietilen glikol Botol
938 Polikresulen Botol
939 Povidon iodin lar 100 mg/ml Botol 30 ml
940 Povidon iodin lar 100 mg/ml Botol 1000 ml
941 Povidon iodin lar 100 mg/ml Botol 300 ml
942 Povidon iodin lar 100 mg/ml Botol 60 ml
943 Pramipeksol tab 0,125 mg Tablet
944 Pramipeksol tab ER 0,375 mg Tab
945 Pramipeksol tab ER 0,750 mg Tab
946 Pravastatin tab 10 mg Tab
947 Pravastatin tab 20 mg Tab
948 Prazikuantel tab scored 300 mg Tab
949 Prazikuantel tab scored 600 mg Tab
950 Prednisolon tts mata 10 mg/ml Botol
951 Prednison tab 5 mg Tab
952 Primakuin tab 15 mg Tab
953 Probenesid tab 500 mg Tab
954 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial
955 Prokaterol HCl cairan ih 30 mcg Botol
956 Prokaterol HCl cairan ih 50 mcg Botol
957 Prokaterol HCl serb ih 10 mcg Botol
958 Propiltiourasil tab 100 mg Tab
959 Propofol inj 1% (i.v. Bolus) Ampul
960 Propranolol inj 1 mg/ml (i.v.) Ampul
961 Propranolol tab 10 mg Tab
962 Propranolol tab 40 mg Tab
963 Prostaglandin (PGE 1) Inj 500 mcg/ml Vial
964 Protamin sulfat inj 10 mg/ml (i.m.) Ampul
965 Quetiapin tab SR 200 mg Tab
966 Quetiapin tab SR 300 mg Tab
967 Quetiapin tab SR 400 mg Tab
968 Ramipril tab 10 mg Tab
969 Ramipril tab 2,5 mg Tab
970 Ramipril tab 5 mg Tab
971 Ranibizumab inj 10 mg/ml Vial
972 Ranitidin inj 25 mg/ml Ampul
973 Ranitidin tab 150 mg Tab
974 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak
975 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak
976 Ribavirin tab 200 mg Tab
977 Rifampisin kaps 300 mg Kaps
978 Rifampisin tab 450 mg Tab
979 Rifampisin tab 600 mg Tab
980 Rilpivirine 25 mg Tab
981 Ringer Laktat Larutan Botol
982 Ringer Laktat Larutan 1000 ml Botol
983 Risedronat tab sal selaput 35 mg Tab
984 Risperidon tab 3 mg Tab
985 Risperidon tab sal 1 mg Tab sal
 986 Risperidon tab sal 2 mg Tab sal
987 Rituksimab inf 10 mg/ml (vial 10 ml) Vial
988 Rituksimab Inf 10 mg/ml (vial 50 ml) Vial
989 Rituksimab inj 100 mg/ml Ampul
990 Rituksimab inj 500 mg/ml Ampul
991 Rivaroksaban tab sal 10 mg Tab sal
992 Rivaroksaban tab sal 15 mg Tab sal
993 Rivaroksaban tab sal 20 mg Tab sal
994 Rokuronium inj 50 mg/5 ml (i.v.) Vial
995 Ropinirol tab lepas lambat 2 mg Tab
996 Ropinirol tab lepas lambat 4 mg Tab
997 Ropinirol tab lepas lambat 8 mg Tab
998 Ropivakain Inj 7,5 mg/ml Ampul
999 Rosuvastatin tab 10 mg Tab
1000 Salbutamol aerosol 100 mcg Botol
1001 Salbutamol cairan ih 0,1% Botol
1002 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol
1003 Salbutamol lar ih 0,5 % Botol
1004 Salbutamol nebules vial 2,5 mg Vial
1005 Salbutamol sir 2 mg/5 ml Botol
1006 Salbutamol tab 2 mg Tab
1007 Salbutamol tab 4 mg Tab
1008 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube
1009 Secukinumab serb inj 150 mg Vial
1010 Sefadroksil kaps 250 mg Vial
1011 Sefadroksil kaps/tab 500 mg Tab
1012 Sefadroksil sir kering 125 mg/5 ml Botol
1013 Sefadroksil sir kering 250 mg/5 ml Botol
1014 Sefaleksin kaps 250 mg Kaps
1015 Sefaleksin kaps 500 mg Kaps
1016 Sefazolin serb inj 1 g/vial Vial
1017 Sefepim serb inj 1000 mg/vial Vial
1018 Sefiksim sir 100 mg/5 ml Botol
1019 Sefiksim tab 100 mg Tab
1020 Sefiksim Tab 200 mg Tablet
1021 Sefoperazon serb inj 1.000 mg/vial Vial
1022 Sefotaksim inj 500 mg/vial Vial
1023 Sefotaksim serb inj 1.000 mg/vial Vial
1024 Sefpirom serb inj 1000 mg Vial
1025 Sefpodoksim proksetil tab sal 100 mg Tab
1026 Seftazidim serb inj 1.000 mg/vial Vial
1027 Seftriakson serb inj 1.000 mg/vial Vial
1028 Sefuroksim serb inj 750 mg/vial Vial
1029 Sefuroksim tab 250 mg Tab
1030 Sefuroksim tab sal 500 mg Tab
1031 Sertralin tab sal 50 mg Tab sal
1032 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj (i.m./i.v.) Papua Vial

1033 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial

1034 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
1035 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 20.000 UI/ Vial
1036 Serum antirabies inj 100 UI/ml Vial
1037 Serum antirabies inj 200 UI/ml Vial
1038 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
1039 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
1040 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
1041 Setirizin sir 5 mg/5 ml. Botol
1042 Setirizin tab 10 mg Tab
1043 Setuksimab inj 5 mg/ml Vial
1044 Sevelamer karbonat Tab 800 mg Tab
1045 Sevofluran cairan ih 250 ml Botol
1046 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial
1047 Sianokobalamin (vitamin B12) tab 50 mcg Tab
1048 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial
1049 Siklofosfamid serb inj 200 mg/vial (i.v.) Vial
1050 Siklofosfamid serb inj 500 mg/vial (i.v.) Vial
1051 Siklopentotat tetes mata 1% Botol
1052 Siklosporin inj 100 mg/ml Ampul
1053 Siklosporin inj 50 mg/ml Ampul
1054 Siklosporin kaps 100 mg Kaps
1055 Siklosporin kaps lunak 25 mg Kaps
1056 Siklosporin Kaps lunak 50 mg Kapsul
1057 Sildenafil Tab 20 mg Tab
1058 Silodosin tab 4 mg Tab
1059 Silostazol kaps SR 100 mg Kaps
1060 Silostazol tab 100 mg Tab
1061 Simeprevir tab 150 mg Tablet
1062 Simvastatin tab sal 10 mg Tab sal
1063 Simvastatin tab sal 20 mg Tab sal
1064 Simvastatin tab sal selaput 40 mg Tab sal
1065 Siprofloksasin inf 2 mg/ml Botol
1066 Siprofloksasin tab scored 500 mg Tab
1067 Siprofloksasin tetes mata 3 mg/ml Botol
1068 Sisplatin serb inj 10 mg Vial
1069 Sisplatin serb inj 50 mg Vial
1070 Sitarabin inj 50 mg Vial
1071 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial
1072 Sofosbuvir tab sal selaput 400 mg Tablet
1073 Somatostatin serb Inj 3000 mcg/mL Vial
1074 Spiramisin tab 250 mg Tab
1075 Spiramisin tab 500 mg Tab
1076 Spironolakton tab 100 mg Tab
1077 Spironolakton tab 25 mg Tab
1078 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
1079 Stavudin tab 30 mg Tab
1080 Streptokinase serb inj 1,5 juta UI/vial Vial
1081 Streptomisin serb inj 1.000 mg/vial Vial
1082 Sufentanil inj 5 mcg/ml (i.v.) Ampul
1083 Sugammadeks inj 100 mg/ml Vial
1084 Sukralfat susp 500 mg/5 ml Botol
1085 Sukralfat tab 500 mg Tab
1086 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial
1087 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial
1088 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial
1089 Sulfadiazin tab 500 mg Tablet
1090 Sulfasalazin kapl sal enterik 500 mg Kaps salut
1091 Sulfur colloid 4,5 mg gelatin/reaction vial Vial
1092 Surfaktan susp 25 mg/ml (intratrakeal) Botol
1093 Surgical ginggival pack Tube
1094 Takrolimus kaps 0,5 mg Kaps
1095 Takrolimus kaps 1 mg Kaps
1096 Takrolimus kaps lepas lambat 0,5 mg Kaps
1097 Takrolimus kaps lepas lambat 1 mg Kaps
1098 Tamoksifen tab 10 mg Tablet
1099 Tamoksifen tab 20 mg Tab
1100 Tamsulosin tab 0,2 mg Tab
1101 Tamsulosin tab SR 0,4 mg Tab
1102 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set
1103 Telbivudin tab 600 mg Tab
1104 Telmisartan tab 40 mg Tab
1105 Telmisartan tab 80 mg Tab
1106 Temozolamid kaps 100 mg Kaps
1107 Temozolamid kaps 20 mg Kaps
1108 Tenofovir tab 300 mg Tab
1109 Teofilin tab 150 mg Tab
1110 Teofilin tab SR 300 mg Tab
1111 Terazosin hcl tab 1 mg Tab
1112 Terazosin hcl tab 2 mg Tab
1113 Terbinafrin tab 250 mg Tablet
1114 Terbutalin cairan ih 2,5 mg/ml Botol
1115 Terbutalin inj 0,5 mg/ml Vial
1116 Terbutalin serb ih 0,50 mg/dose Vial
1117 Terbutalin sir 1,5 mg/5 ml Botol
1118 Terbutalin tab 2,5 mg Tab
1119 Testosteron inj 250 mg/ml (vial 1 ml) Vial
1120 Testosteron Inj 250 mg/ml (vial 4 ml) Vial
1121 Testosteron kaps lunak 40 mg Kaps
1122 Testoteron kombinasi : benserazin 25 mg +levodopa 100 mg Kaps
1123 Tetanus toxoid inj Ampul
1124 Tetrakain tts mata 0,5% Botol
1125 Tetrasiklin kaps 250 mg Kaps
1126 Tetrasiklin kaps 500 mg Kaps
1127 Tetrasiklin Salep Mata 1% Tube
1128 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set
1129 Tiamazol tab 10 mg Tab
1130 Tiamazol tab 5 mg Tab
1131 Tiamin (vitamin B1) tab 50 mg Tab
1132 Tikagrelor tab 90 mg Tab
1133 Timolol tts mata 0,25% Botol
1134 Timolol tts mata 0,5% Botol
1135 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul
1136 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul
1137 Tiotropium respimat ih 5 mcg/semprot Botol
1138 Tiotropium respimat ih 5 mcg/semprot Handihaler
1139 Tiotropium serb ih 18 mcg + handihaller Botol
1140 Tiotropium serb ih 18 mcg, refill Botol
1141 Tobramisin tetes mata 0,3% Botol
1142 Topiramat tab 100 mg Tab
1143 Topiramat tab 25 mg Tab
1144 Topiramat tab 50 mg Tab
1145 Trastuzumab serb inj 440 mg/vial Vial
1146 Travoprost tts mata 0,004% Botol
1147 Triamsinolon asetonid nasal spray 55 mcg/puf Botol
1148 Triamsinolon inj 10 mg/ml Ampul
1149 Triamsinolon inj 40 mg/ml Ampul
1150 Trifluoperazin tab sal 5 mg Tab sal
1151 Triheksifenidil tab 2 mg Tab
1152 Tropikamid tts mata 0,5% Botol
1153 Tropikamid tts mata 1% Botol
1154 Tuberkulin protein purified derivative 1:10 (i.k) Ampul
1155 Urea krim 10 % Tube
1156 Vaksin BCG inj (i.k) Vial
1157 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
1158 Vaksin campak inj (s.k.) Vial
1159 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml Vial
(i.m)
1160 Vaksin Influenza Vial
1161 Vaksin Japanese Enchepalitis (J.E) Vial
1162 Vaksin jerap difteri tetanus (DT) Vial
1163 Vaksin jerap difteri tetanus (Td) Vial
1164 Vaksin kombinasi DPT-HB-Hib Vial
1165 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
1166 Vaksin Meningitis Meningokokus Vial
1167 Vaksin polio IPV inj 0,5 ml Vial
1168 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
1169 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
1170 Vaksin Yellow Fever Vial
1171 Valasiklovir tab 500 mg Tab
1172 Valgansiklovir tab sal 450 mg Tab sal
1173 Valproat sir 250 mg/5 ml Botol
1174 Valproat tab sal 250 mg Tab sal
1175 Valproat tab sal 500 mg Tab sal
1176 Valproat tab sal enterik 200 mg Tab
1177 Valproat tab SR 250 mg Tab
1178 Valproat tab SR 500 mg Tab
1179 Valsartan tab 160 mg Tab
1180 Valsartan tab 80 mg Tab
1181 Vankomisin serb inj 500 mg/vial Vial
1182 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial
1183 Verapamil inj 2,5 mg/ml Vial
1184 Verapamil tab 240 mg Tab
1185 Verapamil tab 80 mg Tab
1186 Vidagliptin tab 50 mg Tab
1187 Vinblastin inj 1 mg/ml Ampul
1188 Vinkristin inj 1 mg/ml (vial 1 mL) Vial
1189 Vinkristin inj 1 mg/ml (vial 2 mL) Vial
1190 Vinorelbin inj 10 mg/ml, kemasan 1 ml Vial
1191 Vinorelbin inj 10 mg/ml, kemasan 5 ml Vial
1192 Vitamin B kompleks Tab
1193 Warfarin tab 1 mg Tab
1194 Warfarin tab 2 mg Tab
1195 Zidovudin kaps 100 mg Kaps
1196 Zinc drops 10 mg/ml Botol
1197 Zinc serb 10 mg Sachet
1198 Zinc sir 10 mg/ml Botol
1199 Zinc sir 20 mg/5 ml Botol
1200 Zinc tab disp 20 mg Tab
 AMA 2018 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 2018
KECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2020 BERDASA
N KERJA DAN DIBERI STEMPEL
S/KOLOM PADA FORMAT

RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2020

RENCANA RENCANA REALISASI PENGADAAN TAHUN KETERANGAN

PENGADAAN PENGADAAN 2018
TAHUN 2020 TAHUN 2019

(a) (b) (c) (d)

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1000 15000 0
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100 300 50
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650000 65000 500000
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15000 12000 15000
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1000 15000 300
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 500 500 240
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12000 12000 1000
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15000 10000 10000
15000 10000 15000
15000 10000 15000
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500 20000 500
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1000 1500 0
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5000 50000 5000
200 1000 100
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500 1500 500
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50 100 50
50 100 50
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50 100 0

100 1000 0

0 0 0
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300 500 300
300 600 300
3000 1000 3000
15000 15000 15000
0 0 0
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0 0 0
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5000 5000 0
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50 5000 42
50 5000 24
1000 5000 1000
5000 6000 1000
0 100 0
50000 35000 20000
50000 12000 30000
25000 24000 0
10 15 0
10 30 0
 0 0 0
5000 240 0
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2000 2400 0
5000 6000 0
5000 6000 0
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100 1200 100
0 0 0
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15000 18000 10000
75000 72000 70000
0 0 0
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5000 7200 0
5000 9600 3000
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48000 48000 48000
48000 48000 48000
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50 240 0
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500 3600 350
500 3600 350
100 1800 100
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2500 24000 2500
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1000 6000 1000
8000 96000 8000
 50 240 0
50 120 0
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3000 6000 0
3000 12000 3000
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1000 0 0
20 0 0
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10000 12000 5000
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100 600 100
100 600 100
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100 360 0
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0 0 0
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0 0 0

0 0 0

0 0 0
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0 0 0

0 0 0

100 1200 0
1000 3600 0
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5000 3600 5000
1000000 108000 500000
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95000 84000 95000
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1000 1800 1000
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1000 24000 1000
25000 36000 5000
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25000 24000 20000
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25000 36000 5000
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0 0 0
500 1440 200
500 1440 400
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500 480 0
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50 480 0
50 4800 0
1000 6000 0
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50 100 50
50 200 50
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5000 6000 0
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15000 150000 15000

0 0 0
1000 12000 0
6000 6000 5000
35000 36000 0
 0 0 0
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1000 2400 500
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3000 36000 3000
35000 108000 35000
3000 72000 3000
500 2400 0
12000 12000 12000
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5000 72000 5000
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5000 60000 5000
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2000 4800 1000
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0 0 0
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500 2400 50
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48000 48000 48000
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12000 120000 10000
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300 600 0
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50000 72000 50000
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5000 7200 5000
10000 120000 0
6000 12000 6000
6000 12000 1000
2000 6000 2000
0 0 0
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0 0 0
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3000 6000 2000
2500 3600 2000
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0 0 0
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0 0 0
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3000 6000 1200
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100 960 0
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0 600 0
36000 36000 36000
36000 36000 0
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3000 1800 3000
0 1200 0
 1000 1800 0
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3000 3600 0
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100 720 0
5000 48000 5000
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700 1200 200
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50000 60000 5000
35000 36000 25000
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150000 120000 150000
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5000 36000 1000
5000 48000 1000
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 500 2400 0
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72000 72000 5000
84000 84000 5000
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72000 72000 15000
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50000 72000 30000
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50 360 0
35000 36000 35000
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3000 60000 3000
100 240 0
1000 2400 0
500 2400 0
 0 2400 0
50 180 0

50 180 0

0 0 0
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50000 72000 20000
0 0 0
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25 48 24
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1000 6000 500
5000 72000 5000
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 0 0 0
5000 12000 2000
50000 84000 0
5000 96000 5000
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 50 180 0
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45000 48000 20000
1000 2400 0
1000 2400 5000
0 0 0
1000 600 200
1000 1800 0
1000 2400 0
500 1200 0
2000 6000 1000
L / VIAL / TUBE / SACCHET / PUFF

DAKAN TAHUN 2020 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2020