RAB DAK 2019 PBE Kemenkes

RENCANA ANGGARAN BIAYA (RAB)
KEGIATAN PENGADAAN ALAT KESEHATAN

MELALUI APBN TAHUN ANGGARAN 2019
Kementerian Negara/Lembaga : Kementerian Kesehatan RI

Unit Eselon I : Direktorat Jenderal Pelayanan Kesehatan
Program : Pembinaan Pelayanan Kesehatan
Unit Eselon II/Satker : Rumah Sakit Umum Daerah Kota Mataram
Kegiatan : Pengadaan Alat Kesehatan APBN Tahun Anggaran 2019
Bidang Pelayanan Rujukan
Indikator Kinerja Kegiatan : Terpenuhinya Kebutuhan Alat Kesehatan Rumah Sakit Tipe
di Rumah Sakit Umum Daerah Kota Mataram
Keluaran (output) : Terealisasinya Sarana, Prasarana dan Alat Kesehatan Standa
Volume : 381
Satuan Ukur : Unit & Paket
KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN HARGA SATUAN

1 2 3 4 5
1 Sarana
A. Bangunan Rawat Inap I, II, dan III 1 Paket 75,000,000,000
2 Alat Kesehatan
A. Alat Kesehatan Rawat Inap
Alat Kesehatan Rawat I, II & III
Bed patient Electric 20 UT 110,629,080
SP5 EX Syringe Pump 20 UT 15,900,000
VP5 EX Infusion Pump 20 UT 17,280,000
Electrocardiograph (ECG) 6 dan12 channel 4 UT 51,096,068
Bed Side Cabinet 20 UT 4,475,000
Box Bayi 12 UT 7,357,490
Tiang Infus Hook 5 20 UT 2,230,000
B. IGD
Alat Kesehatan IGD
Giraffe Incubator Standard 2 UT 420,599,872
BeneView T6 Patient Monitor 10 UT 118,950,100
MINDRAY ICU Pendant Hyport 8000 14 UT 246,916,225
SP5 EX Syringe Pump 10 UT 15,900,000
VP5 EX Infusion Pump 10 UT 17,280,000
Vasculuminator 2 UT 157,775,612
Ventilator mobile C1 Hamilton 4 UT 515,334,960
C. Alat Kesehatan Rawat Jalan

Alat Kesehatan Poliklinik Sp. Mata
Autorefraktometer 2 UT 156,349,000
Bingkai Uji Coba Trial Lens(Trial Frame) 2 UT 2,663,750
Trial Lens 2 UT 18,232,500
Streak Retinoscope 2 UT 9,076,500
Opthalmoscope indirek 2 UT 55,272,500
Opthalmoscope direk 2 UT 5,567,750
Hand Held Fundus 2 UT 90,414,000
Slit Lamp 2 UT 106,512,000
Sterilizer Statim 5000s 2 UT 93,946,250
Non Contact Tonometer 2 UT 201,700,000
Alat Kesehatan Poliklinik Sp. THT
Lampu Kepala 1 UT 3,535,000
Spekulum Hidung 10 UT 4,519,000
Spekulum Telinga 9 UT 827,000
Sudip/Penekan Lidah/Tongue depressor 10 UT 2,234,596
ENT Treatment Set 1 UT 1,081,093,530
Alat Kesehatan Poliklinik Sp. Syaraf
EMG/Electro Myo Graph 1 UT 757,500,000
EEG with FULL HD 1 UT 522,500,000
Alat Kesehatan Poliklinik Sp. Gigi
Dental Unit DA130 1 UT 270,737,000
D. RADIOLOGI
Alat Radiologi
Ct-Scan Scenaria 64/128 Slice 1 UT 12,219,548,000
CR 1 UT 631,883,066
DR( Digital Radiologi) 1 UT 1,948,677,480
C-Arm 1 UT 1,727,399,988
ESWL Siemens 1 UT 4,573,637,500
Cathlab Angiography 1 UT 1,416,427,047
E. LABORATORIUM
Alat Laboratorium
Alat Laboratorium Sp. Patologi Anatomi
Automatic Tissue Processing 1 UT 879,856,200
Cryostat 1 UT 734,701,200
Fully motorize rotary microtome 1 UT 381,220,800
Manual Microtome 1 UT 261,220,800
Rectangular Flattening table 1 UT 21,992,000
F. Ruang Operasi
Alat Ruang Operasi
Lamp Ceiling Mounted/lampu operasi 2 UT 443,831,614
Table Electrohydraulic/meja operasi 2 UT 1,277,511,109
Laparoscopy include Broncoscopy 1 UT 1,793,351,760
Orthopedi Spine 1 UT 460,200,000
ORTHOPAEDIC SURGERY 1 UT 1,051,432,000
Aesculap Hernia and Appendix For Children 1 UT 80,167,000
MEDIZINTECHNIK ENT Set 1 UT 103,663,231
Wire Instrument 1 UT 118,140,937
LCP Large Fragment Set 1 UT 448,358,482
LCP Small Fragment Set 1 UT 650,133,498
Aesculap Hernia and Appendix Set I 1 UT 83,606,000
Urology Set 1 UT 138,676,404
Aesculap Laparatomy Set 1 UT 210,797,000
Basic Obgyn Operating Instrument Set 1 UT 146,200,000
ORTHOPEDIC BASIC INSTRUMENT SET 1 UT 71,966,300
Mayor Orthopedic instrument Set 1 UT 44,131,800
Aesculap Oral Surgery Set 1 UT 18,875,000
Aesculap Dental Instruments Set 1 UT 82,114,000
Aesculap Sinus Set 1 UT 111,980,000
Thoracotomy (Lung) Children And Baby 1 UT 330,729,000
G. Ruang IC (Intensive Care)

MINDRAY ICU Pendant Hyport 8000 20 UT 246,916,225
Hemodialisa - HD Dialog+ BBraun 2 UT 360,000,000
COVIDIEN Puritan Bennett 840 Ventilator 4 UT 960,475,390
Set Bubble CPAP with Air-O2 Mixer 11 UT 91,736,900
Giraffe Incubator Standard 3 UT 420,599,872
Dual T Piece INSP+EXP 2 UT 204,387,750
Infant Warmer Mod. LERI C88 2 UT 196,622,889
Phototherapy Apparatus 5 UT 64,474,491
BeneView T6 Patient Monitor 10 UT 118,950,100
H. Alat Pengelolaan Makanan dan Gizi

FOOD TROLLEY 10 UT 17,215,100
Table Stainless Steel 4 UT 29,825,504
I. Alat CSSD
TROLLEY CLEANER 4 UT 8,600,500
Rak Instrument Steril almari 10 UT 32,995,875
LAUNDRY TROLLEY 5 UT 5,826,300
INSTRUMENT TROLLEY 5 UT 5,826,300
LINEN HAMPER CARRIAGE 8 UT 9,841,600
Table Stainless Steel 6 UT 29,825,504
J. Alat Kalibrasi dan Alat Pemeliharaan(IPSRS)
Vital Sign Simulators 1 138,696,000
Performance Analysers 1 289,736,000
T O TAL 381 Unit/Paket
Mataram, 06 Februar
Direktur,
Rumah Sakit Umum Daera
dr. H. L. Herman Mahapu

NIP. 19681110200112
AN BIAYA (RAB)
N ALAT KESEHATAN
N ANGGARAN 2019
n Alat Kesehatan APBN Tahun Anggaran 2019
nya Kebutuhan Alat Kesehatan Rumah Sakit Tipe B
inya Sarana, Prasarana dan Alat Kesehatan Standar Tipe B di RSUD Kota Mataram
TOTAL HARGA KETERANGAN

6 7
75,000,000,000 Lelang
3,302,955,752
2,212,581,600 E-Catalog
318,000,000 E-Catalog
345,600,000 E-Catalog
204,384,272 E-Catalog
89,500,000 E-Catalog
8,604,987,502
841,199,744 E-Catalog
1,189,501,000 E-Catalog
3,456,827,150 E-Catalog
159,000,000 E-Catalog
172,800,000 E-Catalog
315,551,224 E-Catalog
408,768,544 E-Catalog
2,061,339,840 E-Catalog
4,189,812,990
1,479,468,500
312,698,000 E-Catalog
5,327,500 E-Catalog
110,545,000 E-Catalog
180,828,000 E-Catalog
213,024,000 E-Catalog
187,892,500 E-Catalog
403,400,000 E-Catalog
1,159,607,490
3,535,000 E-Catalog
7,443,000 E-Catalog
1,081,093,530 E-Catalog
1,280,000,000
757,500,000 E-Catalog
522,500,000 E-Catalog
270,737,000
270,737,000 E-Catalog
22,517,573,081
12,219,548,000 E-Catalog
631,883,066 E-Catalog
1,948,677,480 E-Catalog
1,727,399,988 E-Catalog
4,573,637,500 E-Catalog
1,416,427,047 E-Catalog
2,278,991,000
879,856,200 E-Catalog
734,701,200 E-Catalog
381,220,800 E-Catalog
261,220,800 E-Catalog
9,387,207,858
887,663,228 E-Catalog
2,555,022,218 E-Catalog
1,793,351,760 E-Catalog
460,200,000 E-Catalog
1,051,432,000 E-Catalog
103,663,231 E-Catalog
118,140,937 E-Catalog
448,358,482 E-Catalog
650,133,498 E-Catalog
138,676,404 E-Catalog
210,797,000 E-Catalog
146,200,000 E-Catalog
111,980,000 E-Catalog
330,729,000 E-Catalog
14,289,410,581
4,938,324,500 E-Catalog
720,000,000 E-Catalog
3,841,901,560 E-Catalog
1,009,105,900 E-Catalog
204,384,272 E-Catalog
1,261,799,616 E-Catalog
408,775,500 E-Catalog
393,245,778 E-Catalog
322,372,455 E-Catalog
1,189,501,000 E-Catalog
291,453,016
172,151,000 E-Catalog
119,302,016 E-Catalog
680,309,574
329,958,750 E-Catalog
178,953,024 E-Catalog
428,432,000
138,696,000 E-Catalog
289,736,000 E-Catalog
140,971,133,354
Mataram, 06 Februari 2018
Direktur,
Rumah Sakit Umum Daerah Kota Mataram
dr. H. L. Herman Mahaputra, M. Kes

NIP. 196811102001121003

Indikator Kinerja Kegiatan : Terpenuhinya Kebutuhan Alat Kesehatan Rumah Saki
Keluaran (output) : Terealisasinya Alat Kesehatan Standar Tipe B di RSU
Volume : 816
Satuan Ukur : Unit
KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN HARGA SATUAN

1 2 3 4 5
A. RAWAT JALAN
Alat Kesehatan Rawat Jalan
EKG 12 Channel BTL-08 LC 4 UT 85,000,000
Hecting Set 5 UT 7,705,039
Echocardiograph 1 UT 1,752,261,851
Tensimeter Aneroid 10 UT 2,219,349
Chamber Audiometry 1 UT 62,486,000
Slit Lamp 1 UT 115,500,000
Snellen Projektor 1 UT 3,949,000
Trial Lens Set 1 UT 18,000,000
Trial Frame 1 UT 2,600,000
Lensmeter 1 UT 33,000,000
Tonometer 1 UT 100,000,000
Streak Retinoscope 1 UT 9,000,000
Direct Ophthalmoscope 1 UT 5,500,000
Dental Unit 1 UT 124,785,003
B. IGD
Alat Kesehatan IGD
Ventilator Transport T1 7 UT 412,989,500
Infant radiant warmer 4 UT 121,547,585
Syringe Pump 20 UT 34,000,000
Suction Pump 20 UT 16,572,919
Infusion Pump 20 UT 34,000,000
Nebulaizer 10 UT 12,364,654
X-Ray Viewer 2 UT 1,848,000
Baby Incubator Transport 2 UT 199,621,800
Patient Monitor 5 UT 139,570,800
Defibrillator 2 UT 113,251,444
Transport Strecher 4 UT 13,651,025
Tiang Infus 20 UT 1,554,000
Bed Patient Electric 10 UT 71,200,000
C. RADIOLOGI
Alat Radiologi
USG 3D/4D ORCHEO LITE 1 UT 610,000,000
Ct-Scan Scenaria 64/128 Slice 1 UT 11,805,077,856
Digital Radiologi 1 UT 1,893,286,000
CR 1 UT 627,805,200
X-Ray Mobile 1 UT 2,378,826,450
C-Arm 1 UT 1,118,847,000
Cathlab Optima 1 UT 8,541,417,316
D. RAWAT INAP
Alat Rawat Inap
Suction Pump 10 UT 16,572,919
Syring Pump 50 UT 34,000,000
Bed Patient 50 UT 10,213,041
Matras 60 UT 3,025,000
Meja Mayo 50 UT 2,823,500
Examination lamp 20 UT 2,072,000
patient monitor 20 UT 139,570,800
Kursi Roda 10 UT 2,707,500
Pulse Oximetry 20 UT 11,490,350
Defibrillator 2 UT 113,251,444
Tiang Infus 20 UT 1,554,000
Trolley Instrument 10 UT 4,526,300
Nebulizer 10 UT 12,364,654
Partus set 5 UT 23,510,000
Hecting Set 10 UT 4,478,397
E. RUANG OPERASI
Alat Ruang Operasi
Laringoscop bayi 2 UT 4,761,000
Laringoscop Dewasa 2 UT 4,761,000
Lampu Operasi 5 UT 411,000,000
Meja Operasi 5 UT 296,000,000
Mesin Anestesi 5 UT 528,865,856
Pendant 5 UT 251,993,700
surgery mayor set 1 UT 52,531,000
Jackson reese 4 UT 4,575,000
Alat Peco/Mesin Fecoemulsifikasi 1 UT 346,500,000
Laparoscopy include Broncoscopy 1 UT 1,758,188,000
autoclave 1 UT 219,405,902
Orthopedi Spine 1 UT 438,200,000
Laparoscopy Obgyn 1 UT 1,687,234,000
ORTHOPAEDIC SURGERY 1 UT 1,050,000,000
F. RUANG IC(Intensive Care)

Alat ICCU & Intermediate
Bed Patient Electric 10 UT 49,951,000
Matras Dekubitus 5 UT 36,416,831
Infision Pump 10 UT 34,000,000
Ventilator 3 UT 929,000,000
Pendant 5 UT 226,000,000
Alat NICU
Infant radiant warmer 4 UT 121,547,586
Continuous positive airway pressure (CPAP) 4 UT 86,300,000
Baby Basket 10 UT 2,847,206
Incubator Infant 4 UT 34,026,000
Infision Pump 5 UT 34,000,000
Alat PICU
Ventilator Anak 5 UT 568,000,000
Pendant 5 UT 226,000,000
Alat Ruang ICU
ICU Bed Electric 2 UT 69,866,000
Pendant 5 UT 226,000,000
Ventilator 3 UT 929,000,000
G. LABORATORIUM
Alat Laboratorium
Imunology Analyzer 1 UT 837,458,000
Hematology Analyzer 1 UT 264,601,470
Blood Gas Analyzer 1 UT 220,000,000
Centrifuge 5 UT 39,520,000
Mikroskop 2 UT 114,800,000
Tissue Processor 1 UT 476,063,280
H. CSSD
Alat Instalasi CSSD
Trolley Linen Kotor 5 UT 4,526,300
Trolley Linen Bersih 5 UT 5,694,400
Sterilisator suhu tinggi 1 UT 1,067,536,000
Washing Machine 1 UT 238,000,000
I. REHAB MEDIK
Alat Rehab Medik
Microwave Diathermy 3 UT 103,969,000
Shortwave Diathermy 3 UT 110,000,000
Infrared Device 6 UT 5,307,429
Ultrasound Therapy 3 UT 42,497,345
Tens / Es Electrotheraphy 3 UT 81,502,058
T O TAL 816 Unit
Mataram, 01 Fe
Direktu
Rumah Sakit Umum
dr. H. L. Herman Ma
NIP. 196811102
NGGARAN BIAYA (RAB)
GADAAN ALAT KESEHATAN
N TAHUN ANGGARAN 2019
Pengadaan Alat Kesehatan APBN Tahun Anggaran 2019
Terpenuhinya Kebutuhan Alat Kesehatan Rumah Sakit Tipe B
Terealisasinya Alat Kesehatan Standar Tipe B di RSUD Kota Mataram
TOTAL HARGA KETERANGAN

6 7
2,627,800,539
340,000,000 E-Catalog
1,752,261,851 E-Catalog
115,500,000 E-Catalog
3,949,000 E-Catalog
2,600,000 E-Catalog
100,000,000 E-Catalog
9,000,000 E-Catalog
5,500,000 E-Catalog
124,785,003 E-Catalog
7,764,395,838
2,890,926,500 E-Catalog
486,190,340 E-Catalog
680,000,000 E-Catalog
331,458,380 E-Catalog
680,000,000 E-Catalog
425,000,000 E-Catalog
123,646,540 E-Catalog
3,696,000 E-Catalog
399,243,600 E-Catalog
697,854,000 E-Catalog
226,502,888 E-Catalog
712,000,000 E-Catalog
26,975,259,822
610,000,000 E-Catalog
11,805,077,856 E-Catalog
1,893,286,000 E-Catalog
627,805,200 E-Catalog
2,378,826,450 E-Catalog
1,118,847,000 E-Catalog
8,541,417,316 E-Catalog
9,086,911,118
850,000,000 E-Catalog
165,729,190 E-Catalog
1,700,000,000 E-Catalog
1,700,000,000 E-Catalog
510,652,050 E-Catalog
181,500,000 E-Catalog
141,175,000 E-Catalog
2,791,416,000 E-Catalog
229,807,000 E-Catalog
226,502,888 E-Catalog
123,646,540 E-Catalog
114,903,500 E-Catalog
117,550,000 E-Catalog
13,040,191,032
9,522,000 E-Catalog
9,522,000 E-Catalog
2,055,000,000 E-Catalog
1,480,000,000 E-Catalog
2,644,329,280 E-Catalog
1,259,968,500 E-Catalog
346,500,000 E-Catalog
1,758,188,000 E-Catalog
219,405,902 E-Catalog
438,200,000 E-Catalog
1,687,234,000 E-Catalog
1,050,000,000 E-Catalog
17,523,996,159
499,510,000 E-Catalog
182,084,155 E-Catalog
340,000,000 E-Catalog
340,000,000 E-Catalog
697,854,000 E-Catalog
2,787,000,000 E-Catalog
1,130,000,000 E-Catalog
486,190,344 E-Catalog
345,200,000 E-Catalog
136,104,000 E-Catalog
170,000,000 E-Catalog
170,000,000 E-Catalog
170,000,000 E-Catalog
170,000,000 E-Catalog
2,840,000,000 E-Catalog
1,130,000,000 E-Catalog
697,854,000 E-Catalog
170,000,000 E-Catalog
139,732,000 E-Catalog
976,995,600 E-Catalog
1,130,000,000 E-Catalog
2,787,000,000 E-Catalog
2,225,322,750
837,458,000 E-Catalog
264,601,470 E-Catalog
220,000,000 E-Catalog
197,600,000 E-Catalog
229,600,000 E-Catalog
476,063,280 E-Catalog
1,356,639,500
1,067,536,000 E-Catalog
238,000,000 E-Catalog
1,045,749,783
311,907,000 E-Catalog
330,000,000 E-Catalog
127,492,035 E-Catalog
244,506,174 E-Catalog
81,646,266,541
Direktur,

NIP. 196811102001121003

Indikator Kinerja Kegiatan : Terpenuhinya Kebutuhan Alat Kesehatan Rumah Sakit
Keluaran (output) : Terealisasinya Sarana, Prasarana dan Alat Kesehatan S

Volume : 381
Satuan Ukur : Unit & Paket
KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN

1 2 3 4
1 Sarana
A. Bangunan Rawat Inap I, II, dan III 1 Paket
2 Alat Kesehatan
A. Alat Kesehatan Rawat Inap
Alat Kesehatan Rawat I, II & III
Bed patient Electric 20 UT
SP5 EX Syringe Pump 20 UT
VP5 EX Infusion Pump 20 UT
Electrocardiograph (ECG) 6 dan12 channel 4 UT
Bed Side Cabinet 20 UT
Box Bayi 12 UT
Tiang Infus Hook 5 20 UT
B. IGD
Alat Kesehatan IGD
Giraffe Incubator Standard 2 UT
BeneView T6 Patient Monitor 10 UT
MINDRAY ICU Pendant Hyport 8000 14 UT
SP5 EX Syringe Pump 10 UT
VP5 EX Infusion Pump 10 UT
Vasculuminator Vena Set 2 UT
Ventilator mobile C1 Hamilton 4 UT
C. Alat Kesehatan Rawat Jalan
Alat Kesehatan Rawat Jalan (Umum)

Aesculap Dental Instruments Set 1 UT
EEG with FULL HD 1 UT
Dental Unit DA130 1 UT
Sterilizer Statim 5000s 2 UT
Alat Kesehatan Poliklinik Sp. Mata
Autorefraktometer 2 UT
Bingkai Uji Coba Trial Lens(Trial Frame) 2 UT
Trial Lens 2 UT
Streak Retinoscope 2 UT
Opthalmoscope indirek 2 UT
Opthalmoscope direk 2 UT
Hand Held Fundus 2 UT
Slit Lamp 2 UT
Non Contact Tonometer 2 UT
Alat Kesehatan Poliklinik Sp. THT
Lampu Kepala 1 UT
Spekulum Hidung 10 UT
Spekulum Telinga 9 UT
Sudip/Penekan Lidah/Tongue depressor 10 UT
ENT Treatment Set 1 UT
Aesculap Sinus Set 1 UT
Alat Kesehatan Poliklinik Sp. Syaraf
EMG/Electro Myo Graph 1 UT
Alat Poliklinik Sp. Kebidanan dan Kandungan
Basic Obgyn Operating Instrument Set 1 UT
D. RADIOLOGI
Alat Radiologi
Ct-Scan Scenaria 64/128 Slice 1 UT
CR 1 UT
DR( Digital Radiologi) 1 UT
C-Arm 1 UT
Cathlab Angiography 1 UT
E. LABORATORIUM
Alat Laboratorium
Alat Laboratorium Sp. Patologi Anatomi
Automatic Tissue Processing 1 UT
Cryostat 1 UT
Fully motorize rotary microtome 1 UT
Manual Microtome 1 UT
Rectangular Flattening table 1 UT
F. Ruang Operasi
Alat Ruang Operasi
Lamp Ceiling Mounted/lampu operasi 2 UT
Table Electrohydraulic/meja operasi 2 UT
ESWL Siemens 1 UT
Laparoscopy include Broncoscopy/urology 1 UT
Orthopedi Instrument Spine 1 UT
General ORTHOPAEDIC SURGERY 1 UT
Aesculap Intubation For Children 1 UT
MEDIZINTECHNIK ENT Surgical Set 1 UT
Wire Remove Instrument 1 UT
LCP Large Fragment Set 1 UT
LCP Small Fragment Set 1 UT
Aesculap Intubation Dewasa 1 UT
Laparascopy urology 1 UT
Aesculap Laparatomy 1 UT
ORTHOPEDIC BOR INSTRUMENT SET 1 UT
Mayor Surgery Orthopedic 1 UT
Aesculap minor Oral Surgery Set 1 UT
Thoracotomy (Lung) Children And Baby 1 UT
G. Ruang IC (Intensive Care)

MINDRAY ICU Pendant Hyport 8000 20 UT
Hemodialisa - HD Dialog+ BBraun 2 UT
COVIDIEN Puritan Bennett 840 Ventilator 4 UT
Set Bubble CPAP with Air-O2 Mixer 11 UT
Giraffe baby Incubator Standard 3 UT
Dual CRRT T Piece INSP+EXP 2 UT
Infant Warmer Mod. LERI C88 2 UT
Phototherapy Apparatus 5 UT
BeneView T6 Patient Monitor 10 UT
H. Alat Pengelolaan Makanan dan Gizi

FOOD TROLLEY 10 UT
Table Stainless Steel 4 UT
I. Alat CSSD
TROLLEY biasa CLEANER 4 UT
Rak Instrument Steril almari 4 susun 10 UT
LAUNDRY TROLLEY tertutup 10 UT
Hermaic trolley LINEN HAMPER CARRIAGE 8 UT
Table setting Stainless Steel 6 UT
J. Alat Kalibrasi dan Alat Pemeliharaan(IPSRS)

Vital Sign Simulators 1 UT
Performance Analysers 1 UT
T O TAL 381 Unit/Paket
Rumah Sakit Umum

(RAB)
SEHATAN
RAN 2019
Pelayanan Kesehatan
n Kesehatan
Daerah Kota Mataram
ehatan APBN Tahun Anggaran 2019
uhan Alat Kesehatan Rumah Sakit Tipe B

m Daerah Kota Mataram
a, Prasarana dan Alat Kesehatan Standar Tipe B di RSUD Kota Mataram
HARGA SATUAN TOTAL HARGA KETERANGAN

5 6 7
75,000,000,000 75,000,000,000 Lelang
3,302,955,752
110,629,080 2,212,581,600 E-Catalog

15,900,000 318,000,000 E-Catalog
17,280,000 345,600,000 E-Catalog
51,096,068 204,384,272 E-Catalog
4,475,000 89,500,000 E-Catalog
7,357,490 88,289,880 E-Catalog
2,230,000 44,600,000 E-Catalog
8,604,987,502
420,599,872 841,199,744 E-Catalog

118,950,100 1,189,501,000 E-Catalog
246,916,225 3,456,827,150 E-Catalog
15,900,000 159,000,000 E-Catalog
17,280,000 172,800,000 E-Catalog
157,775,612 315,551,224 E-Catalog
51,096,068 408,768,544 E-Catalog
515,334,960 2,061,339,840 E-Catalog
4,530,106,990
1,063,243,500
82,114,000 82,114,000 E-Catalog
522,500,000 522,500,000 E-Catalog
270,737,000 270,737,000 E-Catalog
93,946,250 187,892,500 E-Catalog
1,291,576,000
156,349,000 312,698,000 E-Catalog
2,663,750 5,327,500 E-Catalog
18,232,500 36,465,000 E-Catalog
9,076,500 18,153,000 E-Catalog
55,272,500 110,545,000 E-Catalog
5,567,750 11,135,500 E-Catalog
90,414,000 180,828,000 E-Catalog
106,512,000 213,024,000 E-Catalog
201,700,000 403,400,000 E-Catalog
1,271,587,490
3,535,000 3,535,000 E-Catalog
4,519,000 45,190,000 E-Catalog
827,000 7,443,000 E-Catalog
2,234,596 22,345,960 E-Catalog
1,081,093,530 1,081,093,530 E-Catalog
111,980,000 111,980,000 E-Catalog
757,500,000
757,500,000 757,500,000 E-Catalog
146,200,000
146,200,000 146,200,000 E-Catalog
17,943,935,581
12,219,548,000 12,219,548,000 E-Catalog

631,883,066 631,883,066 E-Catalog
1,948,677,480 1,948,677,480 E-Catalog
1,727,399,988 1,727,399,988 E-Catalog
1,416,427,047 1,416,427,047 E-Catalog
2,278,991,000
879,856,200 879,856,200 E-Catalog

734,701,200 734,701,200 E-Catalog
381,220,800 381,220,800 E-Catalog
261,220,800 261,220,800 E-Catalog
21,992,000 21,992,000 E-Catalog
13,620,551,358
443,831,614 887,663,228 E-Catalog
1,277,511,109 2,555,022,218 E-Catalog
4,573,637,500 4,573,637,500 E-Catalog
1,793,351,760 1,793,351,760 E-Catalog
460,200,000 460,200,000 E-Catalog
1,051,432,000 1,051,432,000 E-Catalog
80,167,000 80,167,000 E-Catalog
103,663,231 103,663,231 E-Catalog
118,140,937 118,140,937 E-Catalog
448,358,482 448,358,482 E-Catalog
650,133,498 650,133,498 E-Catalog
83,606,000 83,606,000 E-Catalog
138,676,404 138,676,404 E-Catalog
210,797,000 210,797,000 E-Catalog
71,966,300 71,966,300 E-Catalog
44,131,800 44,131,800 E-Catalog
18,875,000 18,875,000 E-Catalog
330,729,000 330,729,000 E-Catalog
14,289,410,581
246,916,225 4,938,324,500 E-Catalog
360,000,000 720,000,000 E-Catalog
960,475,390 3,841,901,560 E-Catalog
91,736,900 1,009,105,900 E-Catalog
51,096,068 204,384,272 E-Catalog
420,599,872 1,261,799,616 E-Catalog
204,387,750 408,775,500 E-Catalog
196,622,889 393,245,778 E-Catalog
64,474,491 322,372,455 E-Catalog
118,950,100 1,189,501,000 E-Catalog
291,453,016
17,215,100 172,151,000 E-Catalog
29,825,504 119,302,016 E-Catalog
680,309,574
8,600,500 34,402,000 E-Catalog
32,995,875 329,958,750 E-Catalog
5,826,300 58,263,000 E-Catalog
9,841,600 78,732,800 E-Catalog
29,825,504 178,953,024 E-Catalog
428,432,000
138,696,000 138,696,000 E-Catalog
289,736,000 289,736,000 E-Catalog
140,971,133,354
Direktur,

NIP. 196811102001121003
KEGIATAN PENGADAAN SARANA, PRASARANA, DAN ALAT KESEHATAN MELALUI DANA ALOKASI KHUSUS (D
TAHUN ANGGARAN 2019
Kementerian Negara/ Lembaga : Kementerian Kesehatan

Uit Esselon II/ Satker : Direktorat Jenderal Pelayanan Kesehatan/ RSUD Kota Mataram
Kegiatan : Pengadaan Peningkatan Sarana, Prasarana dan Alat Kesehatan
Sasaran Kegiatan : RSUD Yang Memenuhi Standar Sarana, Prasarana Dan Alat Kesehatan Rumah Sakit Tipe B
Indikator Kinerja Kegiatan : Rumah Sakit Yang Memenuhi Standar Tipe B
Keluaran (Output) Kegiatan : Peningkatan Sarana, Prasarana Dan Alat Kesehatan Di Rumah Sakit
Indikator Keluaran (Output) Keg. : Pengadaan Sarana, Prasarana Dan Alat Kesehatan Sesuai Standar Di Rumah Sakit
Volume : 773 Unit (Alat Kesehatan)
Satuan Ukur : Unit
Alokasi Dana : Rp 95,100,559,319
Rincian
Jenis Perhitungan
Volume
Kode Output, Sub Output, Komponen
Uraian Sub Output Uraian Suboutput/ Komponen/ Subkomponen/ Akun/ Detil Sub
Komponen dan Sub Komponen (Utama/
Output Satuan Jumlah
Pendukung)
1 2 3 4 5 6 7
I ALAT KESEHATAN ALAT KESEHATAN RAWAT JALAN Utama

Alat Kesehatan Rawat Jalan
Aesculap Dental Instrument set unit 3
EEG Full HD unit 2
SCHILLER ECG Electrodecardiograph Unit 5
Biosanitizer Automate aHP Unit 21
Sterilizer Satim 5000s Unit 2
Dental UNIT DA130 Unit 2
Poli Sp. Mata
Autorefraktometer Unit 2
Bingkai Uji Coba Trial Lens(Trial Frame) Unit 2
Trial Lens Unit 2
Phacoemulsification Machine / CV 9000 Unit 1
Streak Retinoscope Unit 2
Opthalmoscope indirek Unit 2
Opthalmoscope direk Unit 2
Hand Held Fundus Unit 2
Slit Lamp Unit 2
Non Contact Tonometer Unit 2
Poli Sp. THT
Lampu Kepala Unit 2

Spekulum Hidung Unit 10
Spekulum Telinga Unit 9
Sudip/Penekan Lidah/Tongue depressor Unit 10
ENT Treatment Set Unit 1
Aesculap Sinus Set Unit 2
Poli Sp. Syaraf
EMG/Electro Myo Graph Unit 1

Poli Sp. Kebidanan dan Kandungan
Basic Obgyn Operating Instrument set Unit 4
ALAT KESEHATAN RAWAT INAP KELAS I, II dan III Utama

Alat Kesehatan Rawat Inap Kelas I, II dan III
Bed patient Electric Unit 42

SP5 EX Syringe Pump Unit 54
Decubitus Mattress - Linet Virtuosso Unit 6
VP5 EX Infusion Pump Unit 54
SCHILLER ECG Electrode /EKG Unit 10
Bed Side Cabinet Unit 42
Box Bayi Unit 36
Tiang Infus Hook 5 Unit 42
ALAT KESEHATAN IGD Utama

Alat Kesehatan Instalasi Gawat Darurat (IGD)
Giraffe Incubator Standard Unit 5

Easymove (Pemindah Pasien) Unit 8
Video-Rhino-Laryngoscope w. Monitor Unit 1
MACINTOSH Laryngoscope Blade Unit 4
BeneView T6 Patient Monitor Unit 21
CENTRAL MONITOR PIIC IX Unit 2
BeneHeart D6 Defibrillator Unit 10
MINDRAY ICU Pendant Hyport 8000 Unit 14
SP5 EX Syringe Pump Unit 42
VP5 EX Infusion Pump Unit 42
Vasculuminator Vena Set Unit 2
Ventilator mobile C1 Hamilton Unit 6
ALAT RUANG OPERASI Utama
Lamp Ceiling Mounted/lampu operasi unit 2
Table Electrohydraulic/meja operasi unit 2
ESWL Siemens unit 1
Laparoscopy include Broncoscopy/urology unit 1
Orthopedi Instrument Spine unit 1
General ORTHOPAEDIC SURGERY unit 1
Aesculap Intubation For Children unit 1
MEDIZINTECHNIK ENT Surgical Set unit 1
Wire Remove Instrument unit 1
LCP Large Fragment Set unit 1
LCP Small Fragment Set unit 1
Aesculap Intubation Dewasa unit 1
Laparascopy urology unit 1
Aesculap Laparatomy unit 1
ORTHOPEDIC BOR INSTRUMENT SET unit 1
Mayor Surgery Orthopedic unit 1
Aesculap minor Oral Surgery Set unit 1
Thoracotomy (Lung) Children And Baby unit 1
ALAT KESEHATAN INTENSIVE CARE UNIT (ICU) Utama
MINDRAY ICU Pendant Hyport 8000 unit 20

Hemodialisa - HD Dialog+ BBraun unit 2
CENTRAL MONITOR PIIC IX Unit 5
Decubitus Mattress - Linet Virtuosso Unit 10
CPAP Emergency Kit Unit 5
Blanket WARM AIR Unit 20
Ventilator mobile C1 Hamilton Unit 6
SUCTION PUMP - VACUSON 60 Unit 4
COVIDIEN Puritan Bennett 840 Ventilator unit 4
Set Bubble CPAP with Air-O2 Mixer unit 11
Giraffe baby Incubator Standard unit 3
Dual CRRT T Piece INSP+EXP unit 2
Infant Warmer Mod. LERI C88 unit 2
Phototherapy Apparatus unit 5
BeneView T6 Patient Monitor unit 10
ALAT PENGOLAHAN MAKANAN DAN GIZI Utama
FOOD TROLLEY unit 15
RADIOLOGI Utama
Ct-Scan Scenaria 64/128 Slice unit 1
Panoramic Digital OC 200D Unit 1
CR unit 1
DR( Digital Radiologi) unit 1
C-Arm unit 1
Cathlab Angiography unit 1
LABORATORIUM Utama
Automatic Tissue Processing unit 1

Cryostat unit 1
Fully motorize rotary microtome unit 1
Manual Microtome unit 1
Rectangular Flattening table unit 1
Central Sterile Service Department (CSSD) Utama
TROLLEY biasa CLEANER unit 4

Rak Instrument Steril almari 4 susun unit 10
LAUNDRY TROLLEY tertutup unit 10
Hermaic trolley LINEN HAMPER CARRIAGE unit 8
Table setting Stainless Steel unit 6
Alat Pemulasaran Jenazah Utama

Autopsy Table Unit 1
Alat Instalasi Pemeliharaan Sarana Rumah Sakit (IPSRS) Utama
Vital Sign Simulators unit 1

Phototherapy Radiometer DALE40 unit 1
Gas Flow Analyzer VT305 unit 1
Defibrillator Analyzer IMPULSE 7000DP unit 1
Performance Analysers unit 1
Sub Total I Unit 773

TOTAL
Mengetahui,
WALIKOTA MATARAM
H. AHYAR ABDUH
ANA ALOKASI KHUSUS (DAK)
Harga Satuan Total Referensi Harga Lokasi
8 9 10 11
8,854,186,990 RSUD Kota Mataram

4,470,708,500
82,114,000 246,342,000 e-catalog
522,500,000 1,045,000,000 e-catalog
70,000,000 350,000,000 e-catalog
100,000,000 2,100,000,000 e-catalog
93,946,250 187,892,500 e-catalog
270,737,000 541,474,000 e-catalog
1,654,076,000
156,349,000 312,698,000 e-catalog
2,663,750 5,327,500 e-catalog
18,232,500 36,465,000 e-catalog
362,500,000 362,500,000 e-catalog
9,076,500 18,153,000 e-catalog
55,272,500 110,545,000 e-catalog
5,567,750 11,135,500 e-catalog
90,414,000 180,828,000 e-catalog
106,512,000 213,024,000 e-catalog
201,700,000 403,400,000 e-catalog
1,387,102,490
3,535,000 7,070,000 e-catalog
4,519,000 45,190,000 e-catalog
827,000 7,443,000 e-catalog
2,234,596 22,345,960 e-catalog
1,081,093,530 1,081,093,530 e-catalog
111,980,000 223,960,000 e-catalog
757,500,000
757,500,000 757,500,000 e-catalog
584,800,000
146,200,000 584,800,000 e-catalog
110,629,080 4,646,421,360 e-catalog

15,900,000 858,600,000 e-catalog
143,844,073 863,064,438 e-catalog
17,280,000 933,120,000 e-catalog
70,000,000 700,000,000 e-catalog
4,475,000 187,950,000 e-catalog
7,357,490 264,869,640 e-catalog
2,230,000 93,660,000 e-catalog
420,599,872 2,102,999,360 e-catalog

21,103,725 168,829,800 e-catalog
350,839,684 350,839,684 e-catalog
4,863,532 19,454,128 e-catalog
118,950,100 2,497,952,100 e-catalog
274,867,187 549,734,374 e-catalog
118,501,444 1,185,014,440 e-catalog
246,916,225 3,456,827,150 e-catalog
15,900,000 667,800,000 e-catalog
17,280,000 725,760,000 e-catalog
157,775,612 315,551,224 e-catalog
70,000,000 700,000,000 e-catalog
515,334,960 3,092,009,760 e-catalog
443,831,614 887,663,228 e-catalog
1,277,511,109 2,555,022,218 e-catalog
4,573,637,500 4,573,637,500 e-catalog
1,793,351,760 1,793,351,760 e-catalog
4,863,532 24,317,660 e-catalog
460,200,000 460,200,000 e-catalog
350,839,684 350,839,684 e-catalog
1,051,432,000 1,051,432,000 e-catalog
80,167,000 80,167,000 e-catalog
103,663,231 103,663,231 e-catalog
118,140,937 118,140,937 e-catalog
448,358,482 448,358,482 e-catalog
650,133,498 650,133,498 e-catalog
83,606,000 83,606,000 e-catalog
138,676,404 138,676,404 e-catalog
210,797,000 210,797,000 e-catalog
71,966,300 71,966,300 e-catalog
44,131,800 44,131,800 e-catalog
18,875,000 18,875,000 e-catalog
330,729,000 330,729,000 e-catalog

246,916,225 4,938,324,500 e-catalog
360,000,000 720,000,000 e-catalog
4,863,532 29,181,192 e-catalog
274,867,187 1,374,335,935 e-catalog
350,839,684 350,839,684 e-catalog
143,844,073 1,438,440,730 e-catalog
12,375,240 61,876,200 e-catalog
62,171,000 1,243,420,000 e-catalog
515,334,960 3,092,009,760 e-catalog
110,000,926 440,003,704 e-catalog
960,475,390 3,841,901,560 e-catalog
91,736,900 1,009,105,900 e-catalog
70,000,000 350,000,000 e-catalog
420,599,872 1,261,799,616 e-catalog
204,387,750 408,775,500 e-catalog
196,622,889 393,245,778 e-catalog
64,474,491 322,372,455 e-catalog
118,950,100 1,189,501,000 e-catalog
258,226,500 RSUD Kota Mataram

17,215,100 258,226,500 e-catalog

12,219,548,000 12,219,548,000 e-catalog
1,011,500,000 1,011,500,000 e-catalog
631,883,066 631,883,066 e-catalog
1,948,677,480 1,948,677,480 e-catalog
1,727,399,988 1,727,399,988 e-catalog
1,416,427,047 1,416,427,047 e-catalog

879,856,200 879,856,200 e-catalog
734,701,200 734,701,200 e-catalog
100,000,000 700,000,000 e-catalog
381,220,800 381,220,800 e-catalog
261,220,800 261,220,800 e-catalog
21,992,000 21,992,000 e-catalog

8,600,500 34,402,000 e-catalog
32,995,875 329,958,750 e-catalog
100,000,000 200,000,000 e-catalog
5,826,300 58,263,000 e-catalog
9,841,600 78,732,800 e-catalog
29,825,504 178,953,024 e-catalog

1,509,397,000 1,509,397,000 e-catalog

138,696,000 138,696,000 e-catalog
41,429,000 41,429,000 e-catalog
145,818,000 145,818,000 e-catalog
107,034,000 107,034,000 e-catalog
100,000,000 100,000,000 e-catalog
289,736,000 289,736,000 e-catalog
95,100,559,319
95,100,559,319

Direktur,
NIP. 196811102001121003

RAB DAK 2019 PBE Kemenkes

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RENCANA ANGGARAN BIAYA (RAB)

KEGIATAN PENGADAAN ALAT KESEHATAN

Kementerian Negara/Lembaga : Kementerian Kesehatan RI

KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN HARGA SATUAN

C. Alat Kesehatan Rawat Jalan

G. Ruang IC (Intensive Care)

H. Alat Pengelolaan Makanan dan Gizi

T O TAL 381 Unit/Paket

dr. H. L. Herman Mahapu

n Alat Kesehatan APBN Tahun Anggaran 2019

nya Kebutuhan Alat Kesehatan Rumah Sakit Tipe B

TOTAL HARGA KETERANGAN

Mataram, 06 Februari 2018

dr. H. L. Herman Mahaputra, M. Kes

Kementerian Negara/Lembaga : Kementerian Kesehatan RI

KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN HARGA SATUAN

F. RUANG IC(Intensive Care)

T O TAL 816 Unit

Pengadaan Alat Kesehatan APBN Tahun Anggaran 2019

Terpenuhinya Kebutuhan Alat Kesehatan Rumah Sakit Tipe B

Terealisasinya Alat Kesehatan Standar Tipe B di RSUD Kota Mataram

TOTAL HARGA KETERANGAN

Mataram, 01 Februari 2017

dr. H. L. Herman Mahaputra, M. Kes

Kementerian Negara/Lembaga : Kementerian Kesehatan RI

Keluaran (output) : Terealisasinya Sarana, Prasarana dan Alat Kesehatan S

KODE RINCIAN ALAT KESEHATAN VOLUME SATUAN

C. Alat Kesehatan Rawat Jalan

Alat Kesehatan Rawat Jalan (Umum)

G. Ruang IC (Intensive Care)

H. Alat Pengelolaan Makanan dan Gizi

J. Alat Kalibrasi dan Alat Pemeliharaan(IPSRS)

T O TAL 381 Unit/Paket

Rumah Sakit Umum

uhan Alat Kesehatan Rumah Sakit Tipe B

a, Prasarana dan Alat Kesehatan Standar Tipe B di RSUD Kota Mataram

HARGA SATUAN TOTAL HARGA KETERANGAN

75,000,000,000 75,000,000,000 Lelang

110,629,080 2,212,581,600 E-Catalog

420,599,872 841,199,744 E-Catalog

12,219,548,000 12,219,548,000 E-Catalog

879,856,200 879,856,200 E-Catalog

Mataram, 06 Februari 2018

dr. H. L. Herman Mahaputra, M. Kes

Kementerian Negara/ Lembaga : Kementerian Kesehatan

Satuan Ukur : Unit

Alokasi Dana : Rp 95,100,559,319

I ALAT KESEHATAN ALAT KESEHATAN RAWAT JALAN Utama

Poli Sp. Mata

Poli Sp. THT

Lampu Kepala Unit 2

Poli Sp. Syaraf

EMG/Electro Myo Graph Unit 1

ALAT KESEHATAN RAWAT INAP KELAS I, II dan III Utama

Bed patient Electric Unit 42

ALAT KESEHATAN IGD Utama

Giraffe Incubator Standard Unit 5

ALAT KESEHATAN INTENSIVE CARE UNIT (ICU) Utama

MINDRAY ICU Pendant Hyport 8000 unit 20

ALAT PENGOLAHAN MAKANAN DAN GIZI Utama

FOOD TROLLEY unit 15

Automatic Tissue Processing unit 1

Central Sterile Service Department (CSSD) Utama