1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
2 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 5 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote ER 250 mg tablet Tablet Tablet 300 Tablet Rp. 2.793 PT. Abbot PT. APL
2 Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Arixtra inj 2,5 mg / 0,5 ml Dus, 2 pfs 0,5 ml pfs 80 pfs 241,667 PT. Glaxo Wellcome PT. APL
2 Ventolin Nebules Dus, 4x5 Btl Plastik Btl Plastik 2,5 ml 800 Btl Plastik 6,600 PT. Glaxo Wellcome PT. APL
3 Ventolin Inhaler Dus Botol 200 Dosis 5 Botol 63,750 PT. Glaxo Wellcome PT. APL
4 Seretide Inhaler 50 mcg Dus Botol 120 Dosis 3 Botol 90,667 PT. Glaxo Wellcome PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 10 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote ER 500 mg tablet Tablet Tablet 200 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 80/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 3 Turbuhaler Rp. 110.500 PT. Astra Zeneca PT. APL
@ 60 dosis
2 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 8 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote 250 mg tablet Tablet Tablet Salut 2000 Tablet Rp. 1.680 PT. Abbot PT. APL
2 Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Combiphar PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 60 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
2 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 20 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote 250 mg tablet Tablet Tablet Salut 3000 Tablet Rp. 1.680 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
2 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 84 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 450 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
1
2
3
4
Formulir 2
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 300 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 25 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote 250 mg tablet Tablet Tablet Salut 5000 Tablet Rp. 1.680 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 56 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Flixotide Dus, 2 Flow wrap Nebules 50 nebules Rp. 12.917 PT. Glaxo PT. APL
@ 5 nebules
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 300 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 25 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote 250 mg tablet Tablet Tablet Salut 5000 Tablet Rp. 1.680 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 56 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Flixotide Dus, 2 Flow wrap Nebules 50 nebules Rp. 12.917 PT. Glaxo PT. APL
@ 5 nebules
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 120 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 56 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 60 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 280 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 10 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote ER 500 mg tablet Tablet Tablet 200 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
1
2
3
5
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 60 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 280 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 10 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
Depakote ER 500 mg tablet Tablet Tablet 200 Tablet Rp. 5.450 PT. Abbot PT. APL
Depakote ER 250 mg tablet Tablet Tablet 300 Tablet Rp. 2.793 PT. Abbot PT. APL
Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
Depakote 250 mg tablet Tablet Tablet Salut 2000 Tablet Rp. 1.680 PT. Abbot PT. APL
Gresik, 16 September 2015
Pejabat Pembuat Komitmen
Pada Satuan Kerja RSUD Ibnu Sina Kab Gresik
( drg. JOELYATI )
Nip. 19620731 199012 2 001
1
Formulir 2
1 Arixtra inj 2,5 mg/0,5 ml Dus, 2 pfs@ 0,5 ml pfs 50 pfs Rp. 241.667 PT. Glaxo Wellcome PT. APL Rp. 12.083.350
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 300 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
2 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 30 Turbuhaler Rp. 117.600 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Depakote tab 250 mg Tablet Salut Tablet Salut 1.000 tablet Rp. 1.680 PT. Abbot PT. APL
2 Depakote ER 500 mg tablet Tablet Tablet 300 Tablet Rp. 5.450 PT. Abbot PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Arixtra inj 2,5 mg / 0,5 ml Dus, 2 pfs 0,5 ml pfs 30 pfs 241,667 PT. Glaxo Wellcome PT. APL
2 Ventolin Inhaler Dus Botol 200 Dosis 20 Botol 63,750 PT. Glaxo Wellcome PT. APL
3 Seretide Inhaler 50 mcg Dus Botol 120 Dosis 5 Botol 90,667 PT. Glaxo Wellcome PT. APL
4 Seretide Diskus 250 mcg Dus Foil Strip @ 60 3 Box 113,333 PT. Glaxo Wellcome PT. APL
dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 140 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
2 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Xalatan 0,005 % Dus Botol @ 2,5 ml 10 Rp. 127.000 PT. Pfizer Indonesia
Formulir 2
1 Seroquel XR 200 mg Dus, 1 Blister tablet 250 tablet Rp. 17.391 PT. Astra Zeneca PT. Parit Padang
@ 10 tablet Global
Formulir 2
1 Harnal D 0,2 mg tab Box / 2 Blister @ Tablet 140 tablet Rp. 5800 PT. Astelas PT. APL
14 tablet
2 Dorner tablet 20 mcg Box / 3 Blister @ Tablet 150 tablet Rp. 3600 PT. Astelas PT. APL
10 tablet
Formulir 2
1 Xalatan 0,005 % Dus Botol @ 2,5 ml 10 Rp. 127.000 PT. Pfizer Indonesia
Formulir 2
1 Arixtra inj 2,5 mg/0,5 ml Dus, 2 pfs@ 0,5 ml pfs 100 pfs Rp. 241.667 PT. Glaxo Wellcome PT. APL
2 Tracrium inj Box @ 5 ampul ampul 50 ampul Rp.99.999 PT. Glaxo Wellcome PT. APL
Formulir 2
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 Respules 100 Respules Rp. 8.900 PT. Astra Zeneca PT. APL
Respules
( drg. JOELYATI )
Nip. 19620731 199012 2 001
8
9
10
11
Formulir 2
1 Adalat Oros 30 mg tabl. Box @ 30 tablet Tablet 7500 Tablet Rp. 3.650 PT. Bayer PT. Parit Padang Global
2 Xarelto Box @ 10 tablet Tablet 50 Tablet Rp. 24.675 PT. Bayer PT. Parit Padang Global
( drg. JOELYATI )
DAFTAR PENGADAAN OBAT BERDASARKAN E-CATALOG OBAT
1 Adalat Oros 30 mg tabl. Box @ 30 tablet Tablet 4500 Tablet Rp. 3.650 PT. Bayer PT. Parit Padang Global
2 Primolut N 5 mg tablet Box @ 30 tablet Tablet 900 Tablet Rp. 2.618 PT. Bayer PT. Parit Padang Global
3 Xarelto Box @ 10 tablet Tablet 100 Tablet Rp. 24.675 PT. Bayer PT. Parit Padang Global
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Xalatan 0,005 % Dus Botol @ 2,5 ml 5 Rp. 121.500 PT. Pfizer Indonesia
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 40 Turbuhaler Rp. 134.500 PT. Astra Zeneca PT. APL
@ 120 dosis
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Cetadop 40 mg inj Box @ 5 ampul ampul 100 ampul Rp. 7.480 PT. Ethica PT. Parit Padang Global
2 Ondansetron 4 mg inj Box @ 5 ampul ampul 500 ampul Rp. 1.650 PT. Ethica PT. Parit Padang Global
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Ventolin Inhaler Dus Botol 200 dosis 50 botol Rp. 63.750 PT. Glaxo Wellcome PT. APL
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Adalat Oros 30 mg tablet Box @ 30 tablet tablet 4500 tablet Rp. 3.830 PT. Bayer PT. Parit Padang Global
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Ventolin Inhaler Dus Botol 200 dosis 100 botol Rp. 63.750 PT. Glaxo Wellcome PT. APL Rp. 6.375.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Ventolin Inhaler Dus Botol 200 dosis 100 botol Rp. 63.750 PT. Glaxo Wellcome PT. APL Rp. 6.375.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Symbicort Turbuhaler 160/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 60 Turbuhaler Rp. 134.500 PT. Astra Zeneca PT. APL Rp. 8.070.000
@ 120 dosis
2 Symbicort Turbuhaler 80/4,5 mcg Dus, 1 Turbuhaler Turbuhaler 3 Turbuhaler Rp. 121.000 PT. Astra Zeneca PT. APL Rp. 363.000
@ 60 dosis
3 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 respules 400 respules Rp. 9.725 PT. Astra Zeneca PT. APL Rp. 3.890.000
respules
4 Seroquel XR 200 mg Dus, 1 Blister tablet 400 tablet Rp. 19.000 PT. Astra Zeneca PT. APL Rp. 7.600.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
DAFTAR PENGADAAN OBAT BERDASARKAN E-CATALOG OBAT
1 Ventolin Inhaler Dus Botol 200 dosis 100 botol Rp. 63.750 PT. Glaxo Wellcome PT. APL Rp. 6.375.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
DAFTAR PENGADAAN OBAT BERDASARKAN E-CATALOG OBAT
1 Pulmicort Respules 0,25 mg/ml Dus, 4 Pak @ 5 respules 500 respules Rp. 9.725 PT. Astra Zeneca PT. APL Rp. 4.862.500
respules
( drg. JOELYATI )
VOLUME E-CATALOG OBAT
NAMA OBAT, BENTUK SEDIAAN,
NO KEMASAN SATUAN KEBUTUHAN HARGA SATUAN JUMLAH RUPIAH
PENYEDIA DISTRIBUTOR
KEKUATAN (SATUAN) (Rupiah)
1 Ventolin nebule Box Box 20 nebule 800 nebule Rp. 4.000 PT. Glaxo Wellcome PT. APL Rp. 3.200.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
VOLUME E-CATALOG OBAT
NAMA OBAT, BENTUK SEDIAAN,
NO KEMASAN SATUAN KEBUTUHAN HARGA SATUAN JUMLAH RUPIAH
PENYEDIA DISTRIBUTOR
KEKUATAN (SATUAN) (Rupiah)
1 Ventolin nebule Box @ 20 nebule Nebule 800 nebule Rp. 4.000 PT. Glaxo Wellcome PT. APL Rp. 3.200.000
2 Ventolin spray Fles Fles 30 fles Rp. 40.000 PT. Glaxo Wellcome PT. APL Rp. 1.200.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Ventolin nebule Box @ 20 nebule Nebule 600 nebule Rp. 4.000 PT. Glaxo Wellcome PT. APL Rp. 2.400.000
( drg. JOELYATI )
Nip. 19620731 199012 2 001
Formulir 2
1 Apidra solostar inj. Box @ 5 syringe Syringe 20 syringe Rp 87,000 PT. Aventis PT. APL Rp 1,740,000
2 Lantus inj. Box @ 5 syringe Syringe 20 syringe Rp 83,950 PT. Aventis PT. APL Rp 1,679,000
Total Rp 3,419,000
, 22 Februari 2019
Apoteker Pengelola Apotek