II.

OBAT DAN BHP JAMKESMAS

Harga Satuan
No. Nama Obat Stuan
(Rp.)
1 2 3 4
1 1 CC DISPOSIBLE SYR PCS 1,700
2 10 CC DISPO PCS 2,100
3 20 CC DISP PCS 13,000
4 3 CC DISP PCS 1,200
5 5 cc disp PCS 1,600
6 50 CC DISP(L.PINGGIR) UNIT 49,000
7 50 CC DISP(L.TENGAH) PCS 46,200
8 ABBOCAT 26 PCS 42,300
9 ABBOCATH 26 PCS 37,700
10 ABBOCATH N0.16 PCS 38,100
11 ABBOCATH N0.18 PCS 30,800
12 ABBOCATH N0.20 PCS 29,500
13 ABBOCATH N0.22 T PCS 30,800
14 ABBOCATH N0.24 PCS 42,300
15 ACETOSAL 100 TAB TAB 100
16 ACID SALICIL powder grm 300
17 ACTAZOLAM 0.5 TAB TAB 900
18 ACTRAPID NOVOLET AMP 150,600
19 ACYCLOVIR 200 TAB TAB 400
20 ACYCLOVIR 200 TAB TAB 700
21 ACYCLOVIR 400MG TAB TAB 900
22 ACYCLOVIR CREAM TUBE 4,700
23 ADEPS LANAE GR 600
24 ALBOTHYL 10 CC FLS 41,900
25 ALBUMAN 100 ML FLS 1,400,100
26 ALBUMAN 50 ML FLS 644,100
27 ALBUMIN 100 CC FLS 1,400,100
28 ALBUMIN 50 CC FLS 701,400
29 ALCO DROP FLS 57,300
30 ALCO PLUS SYR FLS 38,500
31 ALINAMIN F INJ AMP 19,300
32 ALLOPURINOL 100 MG TAB TABL 200
33 ALLYLESTRENOL TAB TAB 2,600
34 ALPENTIN 300MG TAB TAB 4,700
35 ALPRAZOLAM 0.25 TAB 700
36 ALPRAZOLAM 0.5 TAB 900
37 AMBROXOL SYR FLS 5,200
38 AMBROXOL TAB TAB 200
39 AMCOR 5MG TAB TAB 1,600
40 AMDIXAL 5 TAB TAB 3,800
41 AMIKASIN 250 MG VIAL 98,500
42 AMIKASIN 500 MG VIAL 171,200
43 AMINOFLUID 1 LITER INF VIAL 234,700
44 AMINOFLUID INF 500 ML FLS 140,100
45 AMINOFUSIN HEPAR FLS 260,100
46 AMINOFUSIN PAED INF FLS 116,300
47 AMINOLEBAN INF FLS 234,700
48 AMINOPHILIN INJ 24 MG AMP 4,700
49 AMINOPHILIN TAB TABL 200
50 AMINOSTERIL 6% inf FLS 102,700

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 1 2 3 4
51 AMIPAREN INF FLS 129,900
52 AMITRIPHILIN HCL 25 MG TAB 200
53 AMLODIPIN 10 TAB TAB 2,600
54 AMLODIPIN 10MG/50 TAB 2,800
55 AMLODIPIN 5 TAB'30 TAB 1,400
56 AMLODIPIN 5 TAB'50 TAB 1,600
57 AMLODIPINE 10 @100 TAB 2,600
58 AMOXAN I GR INJ VIAL 32,100
59 AMOXICILLIN 125 MG SYR FLS 5,800
60 AMOXICILLIN 500 MG TB TABL 600
61 AMPICILLIN 1 GR INJ VIAL 5,000
62 AMPICILLIN 500 MG TAB TABL 1,000
63 ANEMOLAT/FOLIC ACID TAB 300
64 ANTALGIN 500 MG TAB 200
65 ANTALGIN INJ 10 ML AMP 600
66 ANTALGIN INJ 2 ML AMP 700
67 ANTASIDA DOEN SYR FLS 6,000
68 ANTASIDA DOEN TAB TAB 100
69 ANTIHAEMOROID SUPP SUPP 3,100
70 APIALYS SYR PCS 39,300
71 APPALENS 18.5 PCS 145,800
72 APPAVISC PFS 3 ML PCS 136,100
73 APTOR TAB TAB 200
74 ARIXTRA 2.5MG INJ VIAL 538,400
75 AS TRANEKSAMAT 250INJ/5 AMP 9,900
76 ASABIUM TAB 1,400
77 ASAM MEF. 500 MG TAB 300
78 ASAM TRANEXAMAT 250 INJ AMP 5,000
79 ASAM TRANEXAMAT 500 INJ AMP 9,000
80 ASAM TRANEXAMAT 500 TAB TAB 1,700
81 ASERING INF FLS 21,000
82 ASERING INFUS FLA 21,000
83 ASTIKA TAB TAB 200
84 ATARAX 0,5 TAB 800
85 ATORVASTATIN 20 TAB TAB 6,800
86 ATRACURIUM HAMELN FLS 12,000
87 ATRAUCAN PCS 167,700
88 ATS 1500 IU AMP 142,600
89 ATS 1500 PLUS DISP 1CC VIAL 76,100
90 ATS 20000 IU VIAL 940,700
91 BACTECYN 0.75 INJ VIAL 111,300
92 BARITOP INJ VIAL 272,100
93 BD NEOFLON 26 PCS 48,600
94 BEDAK SALICYL FLS 1,800
95 BEROTEC SOL INH FLS 81,700
96 BETAHISTIN MESILAT 6MG TAB 1,400
97 BETASIN CR TUBE 35,900
98 BISOPROLOL 5MG TAB 3,600
99 BISOVEL 5 TAB TABL 2,700
100 BLOOD SET INF PCS 39,300
101 BLOOD SET OGS PCS 24,800
102 BLUE MONOLON 3-0 PCS 77,000
103 BLUE MONOLON 4-0 PCS 82,200
104 BLUE RHEXIS PCS 51,300
105 BONGROS FLS 3,422,500

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 1 2 3 4
106 BOTOL 100 ML FLS 3,400
107 BOTOL 100 ML FLS 3,400
108 BOTOL 30 ML PCS 2,100
109 BOTOL 50 FLS 2,300
110 BOTOL 60 CC BTL 2,600
111 BOTOL PLASTIK 200' PCS 4,800
112 BOTOL TETES 15 CC BTL 1,800
113 BROADCED INJ 1GR VIAL 236,200
114 BURNAZIN CREAM 35GR TUB 59,300
115 C.ASTENOF MND ED STRP 26,900
116 C.ASTHENOF ED FLS 31,700
117 C.AUGENTONIC ED 15 FLS 45,300
118 C.CARPIN 2 % ED FLS 32,500
119 C.CATARLEN ED FLS 46,300
120 C.CONVER ED FLS 25,600
121 C.FENICOL EO FLS 32,900
122 C.FLOXA MND ED STRP 35,100
123 C.LYTER ED FLS 33,900
124 C.LYTER MND ED PCS 5,100
125 C.MYCOS ED FLS 39,100
126 C.MYCOS EO FLS 34,500
127 C.MYDRIATYL ED FLS 62,400
128 C.PANTOCAIN ED FLS 22,700
129 C.POLYGRAN ED FLS 47,100
130 C.TIMOL 0,25% ED BTL 60,000
131 C.TIMOL 0.5 ED FLS 94,000
132 C.TOBRO ED FLS 40,800
133 C.TOBROSAN ED FLS 69,900
134 C.ULCORI MND ED STRP 33,500
135 C.VASACON A ED FLS 38,300
136 C.VASACON A MND ED STRP 25,300
137 C.VASACON ED FLS 27,800
138 C.VASACON MND ED STRP 23,700
139 C.XITROL ED FLS 46,300
140 C.XITROL EO FLS 50,400
141 C.XITROL MND ED STRP 32,100
142 Ca .LACTAT TAB TAB 100
143 CA.GLUKONAS AMPU 12,200
144 Ca.LACTAT TAB 100
145 CAIRAN 2A INF FLS 16,000
146 CAIRAN 4 ;1 INF FLS 16,000
147 CALCII LACTATE TAB TAB 100
148 CALOS TAB 800
149 CAMPHORA KG 251,500
150 CANDERSARTAN 8 MG TAB 6,800
151 CAPSUL 00 PCS 100
152 CAPSUL KOSONG NO.3 CAPS 100
153 CAPSUL NO. 0 CAP 100
154 CAPSUL NO. 1 CAP 100
155 CAPSUL NO. 2 CAP 100
156 CAPTOPRIL 12,5 MG TAB 100
157 CAPTOPRIL 12.5 [50] TAB 100
158 CAPTOPRIL 25 MG TAB TAB 200
159 CAPTOPRIL 25 TAB/50 TAB 200
160 CARBACARE PCS 94,100

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 1 2 3 4
161 CARBACHOL PCS 94,100
162 CARBAMAZEPIN TAB 400
163 CARBAMAZEPIN TAB TAB 400
164 CARDIOMIN CAPS CAPS 3,400
165 CARDISMO TAB TAB 4,200
166 CATGUT CHROMIC 2-0 TAPPER PCS 68,400
167 CATHETER NO.28 (TORASIC) PCS 136,900
168 CATHETER NO.32 (TORASIC) PCS 136,900
169 CEALB 100ML FLS 1,365,200
170 CEALB 50ML FLS 644,100
171 CEDOCARD 10 TAB TAB 2,100
172 CEDOCARD 5 TAB TAB 1,300
173 CEDOCARD INJ AMP 99,800
174 CEFADROXIL 250 CAP CAPS 700
175 CEFADROXIL 500 CAPS/50 CAPS 1,300
176 CEFADROXIL 500 MG CAP 1,300
177 CEFADROXIL SYR FLS 12,700
178 CEFIXIME 100 CAP CAP 3,700
179 CEFIXIME 100/30 TAB 3,700
180 CEFIXIME SYR FLS 47,100
181 CEFOPERAZON INJ VIAL 171,100
182 CEFOTAXIM 1 GR INJ @1 VIAL 10,800
183 CEFTAZIDIM IG INJ'1 VIAL 52,700
184 CEFTAZIDIME INJ VIAL 65,000
185 CEFTIZOXIM IG INJ VIAL 171,100
186 CEFTRIAXON INJ '2 VIAL VIAL 13,400
187 CEFTRIAXONE 1 GR INJ VIAL 13,400
188 CERCUL INJ/5 AMP 23,300
189 CEROPID I G INJ VIAL 207,100
190 CERPLAST AERO 50X50 PCS 69,100
191 CERPLAST AEROFILM 45X150 PCS 130,100
192 CERPLAST BASIC 100X150 PCS 111,300
193 CERPLAST BASIC 45X150 PCS 116,300
194 CERPLAST CAVITY 100X100 PCS 101,800
195 CETIRIZIN 10MG TAB TAB 500
196 CETIRIZIN TAB'30 TAB 500
197 CHLORAMEX INJ VIAL 15,400
198 CHLORAMPENICOL CAPS'250 cap 300
199 CHLORAMPHENICOL 250 MG CAPS 300
200 CHLORAMPHENICOL SALEPMATA TUBE 2,400
201 CHLORAMPHENICOL SYR FLS 6,200
202 CHLORAMPHENICOL TETES T. FLS 2,600
203 CHLORAPHENICOL TM FLS 3,900
204 CIMETIDIN 200 MG TABL 200
205 CIPROFLOXACIN 500 MG TAB 400
206 CIPROFLOXACIN 500 TAB'50 TAB 400
207 CIPROFLOXACIN INF FLS 106,400
208 CITHICOLIN 500 INJ AMP 47,900
209 CITICHOLIN 250 INJ '10 AMP 23,300
210 CITICHOLIN 250 INJ'5 AMP 25,700
211 CITICHOLIN 500 MG TAB TAB 11,400
212 CITROSOL TAB TAB 12,000
213 CIVELL INF FLS 93,400
214 CLINDAMICIN 150 CAP TAB 800
215 CLINDAMYCIN 300 @30 TAB 1,400

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 1 2 3 4
216 CLINDAMYCINE 150 CAP/100 CAP 800
217 CLINDAMYCINE 300 TAB 1,100
218 CLINDAMYCINE 300 CAP/100 CAP 1,100
219 CLOBAZAM 10 MG TAB TAB 1,400
220 CLONIDIN TAB TAB 300
221 CLOPIDOGREL TAB TAB 15,400
222 CLOPINE 25 TAB TAB 4,600
223 CLOPISAN TAB TAB 13,200
224 CLOZARIL 25MG TAB 4,900
225 CO AMOXICLAV 625 TAB TAB 7,900
226 CODEIN 10 MG TAB 700
227 CODEIN 20 MG TB TAB 1,300
228 COLISTINE 1.5 UG TAB TAB 8,700
229 COLOSTOM BAG PCS 4,200
230 COMAFUSIN HEPAR FLS 270,300
231 COMBIVENT UDV AMP 13,900
232 COMBO PACK 18 PCS 52,700
233 COMBO PACK 20 PCS 49,000
234 COMBO PACK 22 PCS 44,500
235 COMBO PACK 24 PCS 50,800
236 CONCOR 2.5MG TAB TAB 3,200
237 COPPER T LIBI PCS 65,000
238 COPPER T LIMAS PCS 59,900
239 COROLENE 3/0 CUTING PCS 154,000
240 CORTIDEX INJ AMP 8,900
241 COTRIMOXAZOLE 480 MG TB TAB 300
242 COTRIMOXAZOLE SYR FLS 6,100
243 CPZ 100 MG TAB 200
244 CPZ 25 MG TABL 40
245 CRESENT PCS 94,100
246 CRIPSA TAB TAB 19,400
247 CTM (CHLORPHENIRAMIN) 4MG TABL 20
248 CURCUMA PLUS SYR FLS 13,000
249 CURCUMA TAB LOS/500 TAB 900
250 CURCUMA TAB STRP TAB 1,000
251 CURVIT SYR FLS 22,300
252 CYTOSTOL TAB TAB 13,700
253 DACLON 2/0 C PCS 77,000
254 DACLON 3/0 C PCS 77,000
255 DACLON 4/0 C PCS 75,600
256 DACLON 5/0 PCS 75,600
257 DACLON 6/0 PCS 75,600
258 DAFILON 2/0 PCS 117,000
259 DAFILON 3/0 PCS 89,600
260 DAFILON 4/0 PCS 104,300
261 DAFILON 5/0 PCS 98,800
262 DAKTARIN ORAL GEL TUBE 75,800
263 DARYANT-TULLE PCS 24,400
264 DEHAF SACH SACH 9,700
265 DEPAKENE SYR FLS 118,700
266 DEPAKENE SYR 40ML FLS 89,000
267 DEPAKOTE 250 TAB TAB 6,800
268 DEPAKOTE ER 250 TAB TAB 4,600
269 DEPAKOTE ER 500 TAB TAB 8,900
270 DEXAMETASON TAB TAB 100

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 1 2 3 4
271 DEXAMETHASON TAB TAB 100
272 DEXAMETHASONE 0,5 MG INJ AMP 3,100
273 DEXOCORT CR TUBE 33,100
274 DEXON 6/0 C PCS 220,400
275 DEXON 6-0 TAP PCS 231,000
276 DEXTROMETHORPHAN 60 ML SY FLS 4,500
277 DEXTROP TAB '100 TAB TAB 100
278 DEXTROP TAB 15 MG TAB 100
279 DEXTROSE 10 % inf FLS 8,900
280 DEXTROSE 40 % VIAL 3,200
281 DEXTROSE 5 % OTSUKA FLS 8,300
282 DIALAC SACH SACH 7,200
283 DIAZEPAM 2 MG TAB 50
284 DIAZEPAM 2 MG INJ AMPU 3,700
285 DIAZEPAM 5 MG TAB TAB 100
286 DIAZEPAM 5MG/250 TAB 100
287 DIAZEPAM 5MG/INJ TAB 3,700
288 DICLOFAM 25 TAB 300
289 DIGOXIN TAB TABL 200
290 DILANTIN CAP CAP 4,600
291 DILTIAZEM 30 TAB 200
292 DIMEDAZOL INF FLS 30,700
293 DISPO.ELEKTRODE UNIT 8,700
294 DIUVAR INJ AMP 13,700
295 DIVASK 5 MG TAB 1,400
296 DOBUJECT 250/5ML INJ AMP 58,200
297 DOBUTAMINE INJ TAB 51,200
298 DOBUTEL INJ VIAL 49,800
299 DOKSISILIN 100 MG TAB 300
300 DOLAC 30 INJ AMP 12,300
301 DOMPERIDON TAB/30 TAB 700
302 DOMPERIDON TAB/50 TAB 600
303 DOMPERIDONE TAB 600
304 DOPAMET TAB TAB 1,600
305 DOXACIN CAPS CAPS 400
306 DPT INJ AMP 12,000
307 DULCOLAX 10 SUPP SUP 21,800
308 DULCOLAX 5 mg SUP SUP 16,200
309 DULCOLAX TAB TAB 1,300
310 DUMOZOL INF FLS 30,800
311 ELASTIK BIDAI PTH 3' ROLL 34,300
312 ELASTIK BIDAI PUTIH 4' ROLL 35,900
313 ELOX 5 gr cream TUB 35,900
314 EPHEDRIN 25 MG INJ AMP 18,100
315 EPHEDRIN 25 MG TB TAB 100
316 EPIDOSIN INJ AMP 28,300
317 EPREX 2000 UI PCS 261,300
318 ERITROMYCIN 200 MG SYR FLS 10,100
319 ERYSANBE 500 MG TAB TAB 4,300
320 ERYTROMYCIN 250 CAP CAPS 700
321 ETHAMBUTOL 500 MG TABL 900
322 ETHIGENT INJ AMP 4,100
323 ETT 3,0 PCS 37,700
324 ETT 3.5 PCS 37,700
325 ETT 6.5 PCS 37,700

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 9

 1 2 3 4
326 ETT 7 PCS 37,700
327 ETT 7.5 PCS 37,700
328 ETT NO 6 PCS 37,700
329 EUTHYROX 100 TAB TAB 2,200
330 EUTHYROX 50 TAB TAB 1,400
331 EXJADE PB TAB 250 MG TAB 55,300
332 FARGOXIN TAB TAB 50
333 FARMADOL INF FLS 85,600
334 FARMALAT TAB 10 MG TAB 100
335 FARSIX INJ AMP 2,200
336 FARSOBID INJ VIAL 85,600
337 FARSORBID TAB TAB 300
338 FEEDING N0.10 PCS 22,400
339 FEEDING N0.5 PCS 27,700
340 FEEDING N0.6 PCS 22,600
341 FEEDING N0.8 PCS 27,700
342 FEEDING N0.8 PANJANG PCS 27,700
343 FEEDING NO.3,5 PCS 27,700
344 FEEDING NO.5 (PANJANG) PCS 25,900
345 FEEDING TUBE 6 PANJANG PCS 22,600
346 FENOL GLISEROL 10% FLS 1,600
347 FERRIPROX FCT 500 TAB 39,300
348 FERRO SULFAT TAB 100
349 FIMAHES INF FLS 84,000
350 FIMALBUMIN INF 100 FLS 1,213,400
351 FITOMENADION TAB TAB 40
352 FLAMAR 25 TAB 1,100
353 FLAMAR 50 TAB 2,400
354 FLAMICORT 10 MG IAD INJ VIAL 150,600
355 FLUCONAZOL INF VIAL 179,700
356 FLUCONAZOL TAB TAB 34,300
357 FM CREPE 3' ROLL 62,400
358 FM CREPE 4INC ROLL 74,800
359 FM CREPE 6INC ROLL 104,100
360 FOLAVIT TAB TAB 800
361 FOLIC ACID TAB TAB 100
362 FOLLY CATH 10 PCS 13,200
363 FOLLY CATH 12 PCS 13,200
364 FOLLY CATH 14 PCS 13,200
365 FOLLY CATH 16 PCS 13,200
366 FOLLY CATH 18 PCS 13,200
367 FOLLY CATH 20 PCS 13,200
368 FOLLY CATH 22 PCS 13,200
369 FOLLY CATH 24 PCS 13,200
370 FOLLY CATH 8 PCS 13,200
371 FORASMA SYR FLS 32,500
372 FORASMA TAB TAB 1,200
373 FORBETES 500 TAB TAB 1,300
374 FORBETES 850 MG TAB 1,400
375 FORNEURO TAB TAB 5,000
376 FORTAGYL INF 100 FLS 29,100
377 FOSMYCIM 2 VIAL 234,300
378 FREEDOM 20 PCS 94,100
379 FREEDOM 19 PCS 94,100
380 FREEDOM 19.5 PCS 94,100

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 10

 1 2 3 4
381 FUROSEMIDE 40MG TAB/100 TAB 200
382 FURROCEMIDE 40 MG TABL 100
383 FURROCEMIDE INJ 10 MG AMP 3,200
384 GASTRUL TAB TAB 16,200
385 GELOFUSAL INF FLS 137,700
386 GELOFUSIN INF FLS 130,800
387 GEMFIBROZIL 300 CAP 400
388 GENTAMYCIN 0.1%CR TUB 2,900
389 GENTAMYCIN INJ AMP 5,700
390 GHIMAS JODOFORM UNIT 278,100
391 GLAUCON TAB 7,500
392 GLIBENKLAMID TAB TAB 100
393 GLICERIL GUACOLAT TAB 40
394 GLIMEPIRIDE 1MG TAB 1,100
395 GLIMEPIRIDE 2MG TAB 2,300
396 GLIQUIDON TAB TAB 900
397 GLOCOPHAGE TAB 500MG TAB 1,600
398 GLUCOBAY 50 TAB TAB 2,600
399 GLUCODEX TAB TAB 500
400 GLUCOSAMIN 250 TAB TAB 1,300
401 GLUCOSAMIN 500 TAB TAB 2,500
402 GLUDEPATIC 500 TAB TAB 700
403 GLUKOLOS TAB TAB 2,200
404 GLUMIN 500 TAB PCS 1,400
405 GLURENORM TAB 1,700
406 GLYBOTIC 250 INJ VIAL 93,000
407 GLYBOTIC 500MG INJ PCS 181,100
408 GOTROPIL 3 G INJ AMP 30,800
409 GRANEM 1 G INJ VIAL 308,000
410 GYPSONA 4 ' ROLL 65,000
411 GYPSONA 6 INC ROLL 82,200
412 H2O2 3 % FLS 4,200
413 HAEMOSTOP 250 MG INJ AMP 6,000
414 HAES STERIL 6% INFUS BTL 80,100
415 HALOPERIDOL 0,5 MG TABL 100
416 HALOPERIDOL 1,5 MG TABL 100
417 HALOPERIDOL 5 MG TAB TAB 200
418 HCT (HYDROCLORTIAZIDE) TABL 100
419 HCT 25 TAB 20
420 HEMAPO 3000 IU INJ VIAL 269,100
421 HEMOHES 6% INF FLS 77,000
422 HESTAR INF FLS 83,800
423 HEXYMER 2 TAB TAB 400
424 HISTAPAN TAB TAB 800
425 HPMC VISCO AEROVISC PCS 108,900
426 HUMULIN N INJ VIAL 150,600
427 HUMULIN R 100 IU INJ VIAL 150,600
428 HYDROCORTISON 1% CR TUBE 2,700
429 HYDROCORTISON 2.5%CR 5GR TUBE 4,700
430 HYDROQUIN MG 2
431 HYPAFIX 5cmX5m ROLL 49,700
432 HYSTOLAN TAB TAB 4,700
433 HYTRIN 2 TAB TAB 15,800
434 HYTRIN I MG TAB TAB 5,200
435 HYTROZ 1MG TAB 4,600

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436 HYTROZ 2MG TAB 8,100
437 I.SALMICOL 0.5 % FLS 6,400
438 I.SALMICOL 1% FLS 8,600
439 IBU PROFEN 200 MG TAB 200
440 IBU PROFEN 400 MG TAB TAB 300
441 IBUPROFEN SYR FLS 5,500
442 IKALEP 250MG TAB 5,800
443 IKAMICETIN EO TUBE 5,400
444 IKAMICETIN SK TUBE 9,400
445 IMPUGAN INJ AMP 4,000
446 INDOP INJ VIAL 51,300
447 INDUXIN INJ AMP 3,400
448 INERSON CR TUBE 43,900
449 INFUS.SET/MICRO DRIP PCS 6,200
450 INFUSION SET PCS 5,500
451 INHA 400 TAB TAB 900
452 INMATROL ED TUBE 35,000
453 INOTROP INJEKSI VIAL 169,400
454 INPEPSA 100ML FLS 75,200
455 INSULATARD NOVOLET AMP 134,800
456 INTERHISTIN TAB TAB 900
457 INTRADOL 50MG/ML INJ AMP 9,900
458 INVICLOT INJ VIAL 97,500
459 INVITEC TAB TAB 10,100
460 IRONYL TAB TAB 2,300
461 ISONIAZIDE 100 MG TABL 100
462 ISONIAZIDE 300 MG TAB 100
463 ISOSORBIDE DINITRAT 5MG TAB 100
464 IV 18 TROGE UNIT 11,600
465 IV 20 TROGE UNIT 11,600
466 IV 24 TROGE UNIT 11,600
467 IV AESCOMED 20 PCS 12,100
468 IV AXIMED 18 PCS 12,000
469 IV AXIMED 20 PCS 20,500
470 IV AXIMED 24 PCS 12,000
471 IV AXIMED 26 PCS 17,100
472 IV CANULA 16 PCS 19,900
473 IV CANULA 18 PCS 23,100
474 IV CANULA 20 PCS 12,100
475 IV CANULA 22 PCS 22,300
476 IV CANULA 24 PCS 26,500
477 IV CANULA 26 PCS 22,600
478 IV INFLO 22 PCS 12,100
479 IV INFLO 24 PCS 12,100
480 IV TROGE 26 PCS 12,000
481 JELCO 18 PCS 21,400
482 JELCO 20 PCS 12,100
483 JELCO 22 PCS 12,100
484 JELCO 24 PCS 12,100
485 KA EN IB INF FLS 23,200
486 KAEN 3A INF FLS 23,200
487 KAEN 4A INF FLS 24,300
488 KAEN 4B INF FLS 23,200
489 KA-EN MG 3 INFUS FLS 19,900
490 KALII CHLORID POW GRAM 1,600

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 1 2 3 4
491 KALMECO 500 CAPS TAB 3,000
492 KALMETHASON INJ AMP 3,900
493 KALMOXILIN IG INJ VIAL 39,300
494 KALNEX INJ AMP 12,800
495 KALTROPEN SUPP SUP 7,000
496 KALXETIN 10 MG CAP CAP 5,500
497 KASA STERIL BOX 4,700
498 KCL INJ VIAL 3,300
499 KCL INJ 25 ML VIAL 2,000
500 KERATOM PCS 94,100
501 KETOKONAZOL 200MG TAB TAB 600
502 KETOKONAZOL CREAM TUB 10,900
503 KETOPROFEN 100 TAB TAB 1,900
504 KETOPROFEN 50 TAB TAB 1,100
505 KETOPROFEN INJ AMP 8,100
506 KETOROLAC 30 INJ/6'VIAL AMP 20,800
507 KETOROLAC 30 INJ'10 AMP 20,800
508 KETOROLAC INJ 30MG AMP 23,100
509 KETOROLAC INJ/12 AMP 20,800
510 KETOROLAC TAB/30 TAB 3,900
511 KIDMIN INF FLS 71,800
512 KOATE DVI 280 IU VIAL 2,006,900
513 KONDOM CATHETER UNIT 12,200
514 KSR TAB TAB 4,100
515 LACOLDIN SYR PCS 21,400
516 LACTOR 30MG INJ AMP 20,700
517 LACTULA 100 SYR FLS 84,700
518 LACTULAC 60 SYR FLS 56,500
519 LACTULAX 120ML FLS 87,300
520 LAMINARIA STIF PCS 145,400
521 LANCE TIP PCS 94,100
522 LANSOPRAZOL 30/20 TAB 2,100
523 LANSOPRAZOLE 30MG TAB 2,500
524 LAPIBAL 500 CAPS CAPS 2,600
525 LASMALIN SYR FLS 32,500
526 LATROPIL SYR FLS 58,200
527 LAXADIN SYR FLS 40,300
528 L-BIO SACH SACH 6,000
529 LETONAL 100 MG TAB TAB 2,900
530 LETONAL 25MG TAB TAB 900
531 LEUKOCRAPE 6" ROLL 97,500
532 LEUKOCREPE 3 " ROLL 45,700
533 LEUKOCREPE 4" ROLL 64,700
534 LEUKODUR 3" ROLL 24,800
535 LEVOFLOXACIN 500/30 TAB 1,800
536 LEVOFLOXACIN INF FLS 136,900
537 LEVOFLOXACIN TAB TAB 1,900
538 LIDOCAIN 2% INJ AMP 1,700
539 LISINOPRIL 5 MG TAB TAB 600
540 LODOMER 2 TAB 1,700
541 LOMATULE PCS 19,500
542 LORATADINE TAB 500
543 LORINID MITE TAB/50 TAB 1,800
544 LOTASBAT CR TUBE 46,200
545 LOTIO KUMERFELDI 100CC FLS 46,200

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 1 2 3 4
546 MAAG SLANG 12 PCS 28,000
547 MAAG SLANG 14 PCS 28,000
548 MAAG SLANG 16 PCS 28,000
549 MAAG SLANG 18 PCS 28,000
550 MAAG SLANG N0.20 PCS 5,400
551 MAGN.SULFAT 40% AMP 6,600
552 MAGN.SULP 20 % 25 ML AMP 4,200
553 MAINTATE 2.5 TAB TAB 3,100
554 MALTOFER CHEW TAB TAB 3,600
555 MANITOL INF FLS 107,100
556 MECOBALAMIN 500 CAPS CAPS 1,200
557 MECOBALAMIN INJ AMP 13,700
558 MEDIAMER B6 TAB TAB 3,300
559 MEGABAL CAPS CAPS 2,300
560 MELOXICAM 15 TAB 1,900
561 MELOXICAM 15/30 TAB 1,900
562 MELOXICAM 15MG/20 TAB 1,900
563 MELOXICAM 7.5 TAB TAB 1,000
564 MELOXICAM 7.5 TAB/30 tab 1,000
565 MELOXICAM 7.5MG/20 TAB 1,000
566 MENTHOL CRYSTAL GRAM 1,900
567 MEROPENEM 0.5 GR VIAL 171,100
568 MEROPENEM INJ VIAL 308,000
569 MERTIGO SR TAB TAB 7,300
570 MERTIGO TAB TAB 3,900
571 MESTINON TAB TAB 11,100
572 METFORMIN 500 TAB 300
573 METHOTREXAT 50 INJ VIAL 60,200
574 METHYLERGOMETRIN INJ AMP 2,200
575 METHYLPREDNISOLON 16MG TAB 2,100
576 METHYLPREDNISOLON 4MG TAB 700
577 METHYLPREDNSLN 125 MG INJ VIAL 55,200
578 METIL ERGOMETRIN TAB TAB 200
579 METILPREDNISOLON 8 TAB TAB 900
580 METOCLOPRAMID INJ AMP 1,400
581 METOCLOPRAMIDE 10MG TAB 100
582 METRONIDAZOLE 500 MG TABL 300
583 METRONIDAZOLE GNK INF FLS 31,200
584 MEYLON INJ VIAL 12,800
585 MgSO4 powder kg 25,700
586 MICONAZOLE CR TUBE 4,700
587 MICROBAR POWDER 500 GRAM PCS 123,700
588 MICRODRIP BURET PCS 113,900
589 MIKAJECT 250MG INJ VIAL 89,800
590 MIKAJECT 500MG INJ VIAL 155,800
591 MIKASIN 250 INJ VIAL 101,100
592 MIKASIN 500 INJ VIAL 166,400
593 MIXTARD NOVOLET PEN 150,600
594 MOLOCO B12 TAB TAB 4,000
595 MONOFIT 3-0 CUTING PCS 128,300
596 MOXIC F TAB TAB 1,100
597 MQA PCS 38,900
598 MUCUS EXTRACTOR UNIT 20,800
599 MUSIN TAB TAB 500
600 MYCODERM CR TUBE 4,500

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 14

 1 2 3 4
601 MYCODERM TAB TAB 800
602 MYOMERGIN INJ AMP 2,700
603 NA DICLOFENAC 25MG TAB 300
604 NA DICLOFENAC 50 TAB 300
605 NACL 0,9 % 500 CC FLS 8,600
606 NACL 100 ML BTL 13,000
607 NACL I000 ML INF FLS 16,700
608 NAIRET SYR FLS 30,800
609 NAIRET TAB TAB 1,300
610 NASAL OXIGEN DEWASA SET 24,600
611 NASAL OXYGEN CHILD PCS 24,600
612 NASAL OXYGEN MASKER PCS 42,700
613 NATRIUM BIC. 500 MG TAB 30
614 NEEDLE 23 PCS 800
615 NEEDLE 25 PCS 1,200
616 NEEDLE NO.26 UNIT 1,200
617 NEEDLE NOVOFINE PCS 3,400
618 NELATON CATET.12 PCS 12,800
619 NELATON CATET.16 PCS 25,900
620 NELATON CATET.18 PCS 25,900
621 NELATON CATET.20 PCS 5,200
622 NELATON CATH NO.14 PCS 25,900
623 NELATON CATHETER N0.8 PCS 10,400
624 NELATON CATHETER NO.10 PCS 11,100
625 NEO DIAFORM TAB TAB 200
626 NEO-K INJ AMP 18,000
627 NERILON CR 10G TUBE 44,900
628 NEULIN INJ 500MG AMP 51,600
629 NEURODEX TAB TAB 400
630 NEUROSANBE INJ AMP 6,400
631 NEUROSANBE TAB TAB 1,400
632 NEUROTAM 3 G INJ AMP 74,400
633 NEW DIATAB TAB TAB 700
634 NIACEF GELL TUBE 32,100
635 NILADACIN 300 CAPS CAPS 1,400
636 NIMOTOP TAB TAB 11,000
637 NIPEDIPIN TAB TAB 200
638 NODIRIL 1 TAB TAB 2,100
639 NODIRIL 2 TAB TAB 4,700
640 NONEMI TAB TAB 1,300
641 NOPERTEN 5MG TAB 600
642 NORELUT TAB 4,200
643 NORIT TAB TABL 40
644 NOVAMET 500 INF(METRO) FLS 30,800
645 NOVELMYCIN 2 G INJ VIAL 222,400
646 NOVERTI TAB TAB 700
647 NOVOMIX 30 FLEXPEN VIAL 249,000
648 NOVORAPID FLEXPEN VIAL 158,700
649 NYLON 3/0 PCS 85,900
650 NYLON 4/0 C PCS 115,900
651 NYLON 5/0 PCS 68,300
652 NYMIKO DROP PCS 43,900
653 NYSTATIN TAB VAG SUP 400
654 OBH SYR 100 ML FLS 2,800
655 OBH SYR 200 ML FLS 3,900

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 15

 1 2 3 4
656 OCTALBIN 100 CC INJ FLS 2,566,900
657 OCTALBIN 50 cc inf FLS 466,700
658 OFLOXACIN 200 TAB TAB 900
659 OFLOXACIN 400 MG TAB TAB 1,300
660 OL.OLIVARUM CC 300
661 OMEPRAZOL 20MG CAP CAP 600
662 OMEPRAZOLE CAP'7 FLS 1,200
663 OMEPRAZOLE INJ VIAL 104,700
664 OMNIPAQUE 300MG INJ 25ml FLS 181,000
665 OMNIPAQUE 300MG INJ@50ML FLS 355,900
666 OMZ INJ VIAL 103,500
667 ONDANSETRON 4MG INJ/10 AMP 8,600
668 ONDANSETRON 8MG INJ/10 AMP 12,400
669 ONDASETRON 4 INJ AMP 9,400
670 ONDASETRON 4 TAB TAB 2,400
671 ONDASETRON 8 INJ AMP 12,400
672 ONDASETRON 8 TAB TAB 8,600
673 OPICEF SYR FLS 11,700
674 OPILAX 120 SYR FLS 82,200
675 OPILAX 60 SYR FLS 54,800
676 OPISTAN 500 TAB TAB 200
677 ORALIT SACH 600
678 ORASIC CAP TAB 600
679 ORASIC INJ AMP 10,800
680 OTOPAIN TK FLS 52,600
681 OTORYL 25 TAB TAB 100
682 OTSUCAT 22 PCS 12,100
683 OTSUCATH 18 PCS 17,400
684 OTSUCATH 20 PCS 12,100
685 OTSUCATH 24 PCS 12,100
686 OTTOGENTA CR TUBE 10,200
687 OTTOPAN DROP FLS 16,400
688 OTTOPAN TAB TAB 100
689 OTTOPRIM SYR FLS 4,700
690 OTTOPRIM TAB TAB 200
691 OXYTETRACYCLIN 1% SM TUBE 3,300
692 OZID INJ VIAL 105,700
693 PAKET LENSA 1 + MQ PCS 633,200
694 PAKET LENSA 2 PKT 590,400
695 PALMICOL SYR FLS 5,900
696 PAN AMIN G INF FLS 47,700
697 PARACETAMOL @100 TAB 200
698 PARACETAMOL 500 MG TAB 200
699 PARACETAMOL DROP FLS 8,200
700 PARACETAMOL INF FLS 77,000
701 PARACETAMOL SYR FLS 3,600
702 PEDAB TAB TAB 1,000
703 PEHACAIN INJ VIAL 4,900
704 PERFUSOR WHITE PCS 41,100
705 PERPHENAZINE 4 MG TAB 100
706 PETHIDIN 50 MG INJ AMPU 22,900
707 PHADILON 125 INJ VIAL 50,100
708 PHENOBARBITAL 30 MG TAB 100
709 PHENOBARBITAL INJ AMP 1,000
710 PHENTAL INJ AMP 12,800

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 16

 1 2 3 4
711 PHENYTOIN CAP CAPS 300
712 PIPET DROP PCS 2,200
713 PIRACETAM 1200 TAB TAB 2,000
714 PIRACETAM 1200/50 TAB 2,100
715 PIRACETAM 12G INF FLS 119,700
716 PIRACETAM 3 G INJ AMP 26,600
717 PIRACETAM 3 GRAM@10 AMP 26,600
718 PIRACETAM 800 TAB TAB 1,300
719 PIRALEN INJ AMP 4,700
720 PIRALEN TAB TAB 100
721 PIRANTEL PAMOAT 125 TAB 300
722 PIROXICAM 10 MG CAPS 100
723 PIROXICAM 10/120 TAB 100
724 PIROXICAM 20 MG CAPS 200
725 PITOGIN INJ AMP 4,100
726 PK POWDER POT 4,200
727 PLACTA 75 tab TAB 8,200
728 POLIBAN 3INC ROLL 23,600
729 POLIBAN 4INC ROLL 28,400
730 POLIBAN 6INC ROLL 43,100
731 POLIDEMISIN ED FLS 35,200
732 POLIGYP 3INC ROLL 33,800
733 POLIGYP 4' ROLL 47,900
734 POLIGYP 6' ROLL 63,400
735 POLYESTER 1 T PCS 86,300
736 POLYPROLPYLENE 2/0 C PCS 106,900
737 POLYPROPILENE 2/0 T PCS 121,000
738 POLYPROPILENE 3/0 T PCS 105,800
739 POLYPROPILENE 4/0 T PCS 133,800
740 POLYPROPILENE 5/0 C PCS 286,200
741 POLYPROPILENE 5/0 T PCS 112,200
742 POLYPROPILENE 6/0 T PCS 286,200
743 POSPARGIN INJ AMP 2,400
744 POSTOFIX PCS 46,200
745 POT KOSMETIK 50 PCS 7,700
746 POT PLASTIK 100 G PCS 1,800
747 POT PLASTIK 100 GR PCS 3,700
748 POT PLASTIK 15 PCS 400
749 POT PLASTIK 20' PCS 400
750 POT PLASTIK 30 PCS 1,000
751 POT PLASTIK 50 PCS 1,200
752 POVIDON IODINE 60ML FLS 5,200
753 PPC INJ VIAL 16,800
754 PPD 2 TU INJ DOSI 119,400
755 PREDNISONE 5 MG TAB 100
756 PREMICRON 1 PCS 139,100
757 PROFIKA SUPP SUP 6,800
758 PROFUNGAL 200 TAB 1,100
759 PRONALGES SUPP SUPP 7,000
760 PROPANOLOL 10 MG TAB TAB 100
761 PROPANOLOL 40 MG @ 100 TAB 100
762 PROPYLTHIOURACILE 100 MG TAB 400
763 PROSTIGMIN INJ AMP 21,100
764 PROSURE BANANA LIQ FLS 59,900
765 PUMPITOR INJ VIAL 104,700

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 17

 1 2 3 4
766 PYRANTEL TAB TAB 300
767 PYRAZINAMIDE 500 MG TAB TABL 400
768 PYRIDOXIN TAB TAB 50
769 Q'TEN 100 TAB TAB 14,100
770 QUICKY SUCTION NO 14 PCS 328,600
771 RANITIDIN 150 MG TAB TABL 300
772 RANITIDIN INJ AMP 10,200
773 RANITIDIN INJ (10) AMP 4,000
774 RANITIDIN INJ/25 AMP 3,900
775 RANITIDIN TAB'30 TAB 300
776 RATAN INJ/RANITIDIN AMP 4,000
777 RENABETIC TAB TAB 200
778 RENADINAC 25MG TAB TAB 100
779 RENADINAC 50 TAB TAB 200
780 RENXAMIN INF FLS 74,800
781 RESERPIN TAB TAB 100
782 RESTOR TAB TAB 600
783 RIFAMPICIN 300 MG CAPS 800
784 RIFAMPICIN 450 MG KAPL 1,000
785 RIFAMPICIN 600 MG TABL 1,400
786 RINGEL LACTATE FLS 8,700
787 RISPERIDON 2MG TAB TAB 3,700
788 RIVANOL 200CC FLS 2,000
789 RIZODAL 2 TAB TAB 3,900
790 ROLAC 30 INJ AMP 23,100
791 SAGESTAM CR TUBE 16,700
792 SAGESTAM ED FLS 29,300
793 SALBUTAMOL 2MG TAB 100
794 SALBUTAMOL 4MG TAB 100
795 SALEP 2-4 FLS 1,200
796 SANAZET TAB TAB 1,800
797 SANBE TEARS ED FLS 25,600
798 SANMETIDIN TAB TAB 2,200
799 SANTIBI 500 TAB TAB 1,300
800 SAPOPIRIDIS 100GR BUAH 12,800
801 SCABIMITE 30 g cr TUBE 77,000
802 SCOPAMIN tab TAB 1,900
803 SCPOPAMIN PLUS TAB 2,900
804 SEROQUEL XR TAB TAB 57,000
805 SERUM A.B.U 5 ML VIAL 638,200
806 SILAX INJ AMP 6,000
807 SIMVASTATIN 10 CAP/30 TAB 800
808 SIMVASTATIN 10 MG TAB TAB 800
809 SIMVASTATIN 20 TAB TAB 1,600
810 SIZORIL 5 TAB TAB 6,200
811 SKINTRACTION ANAK KIT 141,700
812 SKINTRACTION DWS KIT 183,700
813 SMECTA SACH SACH 4,100
814 SOFRA-TULLE PCS 20,500
815 SOFTBAN 6' ROLL 56,300
816 SOLAC 120ML SYR FLS 84,700
817 SOTATIC INJ AMP 6,800
818 SPINAL NEEDLE 18 PCS 35,200
819 SPINAL NEEDLE N0. 20 PCS 25,700
820 SPINOCAIN 25 PCS 49,600

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 18

 1 2 3 4
821 SPINOCAIN 26 PCS 49,600
822 SPIRONOLACTON 100 TAB TAB 1,700
823 SPIRONOLACTONE 25 TAB TAB 500
824 SPONGE PCS 42,700
825 STERIMAR ADULT FLS 146,200
826 STERIMAR BABY FLS 174,400
827 STESOLID 10 MG SUPPO RECT 55,500
828 STESOLID 10 ML INJ AMP 6,200
829 STESOLID 5 MG SUPPO RECT 22,600
830 STOLAX SUPP 10 MG SUP 8,700
831 STREPTOMYCIN INJ 1 GR VIAL 7,900
832 SUCTION CATETER 10 PCS 20,500
833 SUCTION CATETER 12 PCS 20,500
834 SUCTION CATHETER N0.14 PCS 20,500
835 SURGICRIL 0 C PCS 102,700
836 SURGICRIL 1 CUTING PCS 116,300
837 SURGICRIL 1 TAPER PSG 141,200
838 SURGICRIL 3/0 C PCS 121,500
839 SURGICRIL 3/0 T PCS 105,300
840 SURGICRYL 2/0 C PCS 108,400
841 SURGICRYL 2/0 T PCS 102,700
842 SURGICRYL 3/0 C MONO PCS 125,400
843 SURGICRYL 4/0 C MONO PCS 121,200
844 SURGICRYL 4/0 T PCS 97,000
845 SURGICRYL 4/O C PCS 124,300
846 SURGICRYL 5/0 C PCS 108,400
847 SURGICRYL O T PCS 102,700
848 SURGION 1 TAPER PCS 148,800
849 SURGION 3/0 C PCS 129,900
850 SURGIVENT 1 TAPPER PCS 68,400
851 SURGIVENT 3-0 CUTTING PCS 68,400
852 TARIVID TK FLS 106,100
853 TENSOCREP 4 ' ROLL 108,100
854 TENSOCREP 6' ROLL 141,900
855 TENSOCREPE 3' ROLL 47,700
856 TETAGAM INJ VIAL 282,300
857 TETRACYCLIN 250 MG CAPS 200
858 TETRACYCLIN 500 TAB 400
859 TEVOX INF FLS 82,200
860 THIAMPENICOL 500 CAP CAP 900
861 THYAMYCIN F SYR FLS 73,200
862 THYAMYCIN SYR FLS 42,700
863 THYROZOL 10MG TAB 2,100
864 THYROZOL 5MG TAB TAB 1,400
865 TIARYT TAB 2,400
866 TOMBAK SURGE EDGE PCS 93,400
867 TOPCORT CR TUBE 29,800
868 TORAMIN 10 INJ AMP 14,600
869 TORAMIN 30 INJ AMP 23,100
870 TRACHEAL CANUL FORTEX 7 PCS 1,647,100
871 TRAMADOL 50 CAP CAP 500
872 TRAMADOL INJ AMP 10,800
873 TRAMADOL INJ '5 AMP 9,900
874 TRAMADOL INJ/10 AMP 9,900
875 TRIAMCORT CR TUBE 71,800

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 19

 1 2 3 4
876 TRIAXITROL ED FLS 7,000
877 TRIFLUOPREAZIN TAB 800
878 TRIHEXYPHENIDIL 2 MG TABL 100
879 TRIOFUSIN INF FLS 111,300
880 TRIWAY STOPCOCK PCS 22,300
881 TROGYL 500 TAB TAB 300
882 TROGYL SYR FLS 59,900
883 TUTOPUSIN INF FLS 72,800
884 ULCERANIN INJ AMP 3,000
885 ULCERANIN TAB TAB 300
886 ULSIDEX TAB TAB 500
887 ULSIKUR INJ AMP 6,100
888 UMBILICAL CLEMP PCS 3,600
889 URDAHEX CAPS CAPS 13,100
890 URINE BAG UNI 6,800
891 URINTER CAP TAB 3,200
892 UROTRACTIN CAPS CAPS 4,000
893 VACLO 75 TAB TAB 14,000
894 VALISANBE 5 TAB TAB 3,900
895 VALSARTAN 80 TAB TAB 6,200
896 VELCOX 15MG TAB TAB 1,200
897 VELCOX 7.5MG TAB TAB 1,600
898 VICRYL 8/0 T PCS 442,800
899 VISCOLONE PCS 94,100
900 VIT B COMPLEX TAB 40
901 VIT B.1 TAB FLS 100
902 VIT C 50 MG TAB TABL 42
903 VIT A 6000 SI TAB FLS 200
904 VIT B12 TAB TAB 20
905 VIT C 100 TAB 30
906 VIT K INJ 1 CC AMP 2,700
907 VIT K tab TAB 100
908 VIT K TAB/500 TAB 100
909 VOLUVEN 500ML INF FLS 82,800
910 VOMCERAN 4MG/2ML AMP 6,500
911 WIDAHES FLS 81,200
912 WIDAHES 130 INF FLS 81,200
913 WING N0.23 PCS 13,700
914 WING N0.25 PCS 13,700
915 WING N0.27 PCS 15,000
916 ZINC 20 TAB 700
917 ZINCARE TAB TAB 3,000
918 ZOFREDAL 2 TAB TAB 3,700
919 ZYPRAZ 0,5 MG TAB 800

Standar Satuan Harga Belanja Barang Tahun 2018 VII - 20