1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida tablet 200 mg) n/a PT.

Kimia Farma 1 blister@24 tablet

2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera PT. SmithKline Dus, 3 Blister @ 10 kapsul
3 Air untuk irigasi lar infus 1000 ml WIDA WI UNICAP PT. Widatra Bhakti Btl @ 1000 ml
4 Akarbose tablet/kaplet 100 mg n/a PT. Dexa Medica Dus, 10 strip @10tablet
5 Akarbose tablet/kaplet 50 mg n/a PT. Dexa Medica Dus, 10 strip @10tablet
6 Albendazol suspensi 200 mg/5 ml n/a PT. Indofarma Dus, 10 dus @ 1 botol @ 10
7 Albendazol tablet/kapsul/kaplet 400 mg n/a PT. Holi Pharma Dus, 5 strip @ 6 tablet
8 Albumin serum normal (human albumin) injeksi 20%, 100 ml Zenalb PT. Ikapharmindo Vial 100 ml
9 Albumin serum normal (human albumin) injeksi 20%, 50 ml Zenalb PT. Ikapharmindo Vial 50 ml
10 Albumin serum normal (human albumin) injeksi 25%, 20 ml PLASBUMIN 25% 20 ML PT. Dipa Pharmalab botol @ 20 ml
11 Albumin serum normal (human albumin) injeksi 25%, 50 ml PLASBUMIN 25% 50 ML PT. Dipa Pharmalab botol @ 50 ml
12 Albumin serum normal (human albumin) injeksi 5% 250 ml PLASBUMIN 5% 250 ML PT. Dipa Pharmalab botol @ 250 ml
13 Albumin serum normal (human albumin) injeksi 5% 50 ml PLASBUMIN 5% 50 ML PT. Dipa Pharmalab botol @ 50 ml
14 Alopurinol tablet/kapsul/kaplet 100 mg n/a PT. Pertiwi Agung Box, 10 strips @ 10 tablets
15 Alopurinol tablet/kapsul/kaplet 300 mg n/a PT. Bernofarm Dus, 10 blister @ 10 tablet
16 Alprazolam tablet/kapsul/kaplet 0,25 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
17 Alprazolam tablet/kapsul/kaplet 0,5 mg n/a PT. Kimia Farma Ktk 10x10 tablet
18 Alprazolam tablet/kapsul/kaplet 1 mg n/a PT. Kimia Farma Ktk 10x10 tablet
19 Alteplase injeksi 50 mg/vial Actilyse PT. Boehringer Dus, 1 vial@50mg + 1 vial p
20 Amfoterisin B salep mata 1% Fungicide PT. Cendo tube 3.5 gr
21 Amikasin injeksi 250 mg/ml Glybotic 250 mg /ml PT. Sanbe Farma Vial 2 ml
22 Aminofilin injeksi 24 mg/ml n/a PT. Lucas Djaja dus 30 ampul @10 ml
23 Aminofilin tablet scored 200 mg n/a PT. Erela Botol @100 Tablet
24 Aminofilin tablet/kapsul/kaplet 150 mg n/a PT. Erela Btl @ 100 tablet
25 Amiodaron injeksi 150 mg/3 ml Cordarone PT. Aventis Pharma Dus, 6 ampul @ 3 ml
26 Amiodaron tablet/kaplet 200 mg Kendaron Tablet PT. Darya Varia strip
27 Amitriptilin tablet salut 25 mg (HCl) n/a PT. Indofarma Dus, 10 strip @ 10 tss
28 Amlodipin tablet 10 mg n/a PT. Pertiwi Agung Box, 3 strips @ 10 tablets
29 Amlodipin tablet 5 mg n/a PT. Pertiwi Agung Box, 3 strips @ 10 tablets
30 Amoksisilin kapsul/kaplet 250 mg n/a PT. Novapharin dus 10 X 10'S
31 Amoksisilin kapsul/kaplet/tablet scored 500 mg n/a PT. Mersifarma KOTAK @ 10 x 10 TAB
32 Amoksisilin sirup kering forte 250 mg/5 ml n/a PT. Holi Pharma Dus, Botol 60 ml
33 Amoksisilin sirup kering 125 mg/ 5 ml n/a PT. Novapharin btl @ 60 ml
34 Ampisilin serbuk injeksi i.v. 1000 mg/vial n/a PT. Bernofarm Dus, 10 vial @ 1 g
Analog insulin long acting inj 100 UI/ml, vial/cartridge disposible/penfill Lantus Solostar 100IU/ml 5pens PT. Aventis Pharma
35 dus, 5 solostar pen @ 3ml
cartridge (Insulin glargine 100 IU/ml) x3ml
Analog insulin mix acting inj 100 UI/ml, Analog insulin mix acting inj 100 UI/ml Novomix Flexpen
36 PT. Ferron Injeksi 100 IU/ml, Flexpen dis
(Premix 30% Insulin Aspart + 70% Protaminated Insulin Aspart (Analogue))
Analog insulin mix insulininj 100 UI/ml, vial/cartridge disposible/penfill
37 cartridge (25% insulin lispro, 75% insulin lispro protamine suspension, (rDNA)) Humalog Mix 25 PT. Bayer Indonesia Penfill cartridge

Analog insulin rapid acting inj 100 UI/ml, vial/cartridge disposible/penfill

38 Novorapid Vial PT. Ferron Dus, vial 10 ml
cartridge (Insulin Aspart (Analogue))
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge disposible/penfill
39 Novorapid Flexpen PT. Ferron Injeksi 100 IU/ml, Flexpen dis
cartridge (Insulin Aspart (Analogue))
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge disposible/penfill Apidra Solostar 100IU/ml 5pens PT. Aventis Pharma
40 dus, 5 solostar pen @ 3ml
cartridge (Insulin glulisine 100 IU/ml) x3ml
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge disposible/penfill
41 Humalog PT. Bayer Indonesia Penfill cartridge
cartridge (Insulin lispro (rDNA origin))
42 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg PT. Astra Dus, 2 blister @ 14 Tablet
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg
43 n/a PT. Erela Dus, 10 Strip @ 10 Tablet
Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml
44 n/a PT. Erela Botol @ 60 ml
Magnesium Hidroksida 200 mg/5 ml
45 Anti Bakteri DOEN salep komb: Basitrasin 500 IU/g Polimiksin 10.000 IU/g n/a PT. Indofarma Dus, 25 tube @ 5 g
46 Antimalaria DOEN kombinasi : Pirimetamin 25 mg Sulfadoksin 500 mg n/a PT. Kimia Farma ktk 10 x 10 tablet
47 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a PT. Kimia Farma Btl 100 tablet
48 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levodopa 100 mg Levopar Tablet PT. Meprofarm Dus, 5 strip @ 10 tablet
49 Artemether injeksi 80 mg/ml Artem PT. Kimia Farma Dus 6 amp @ 1ml
50 Asam Asetilsalisilat (asetosal) tablet 100 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's
51 Asam Asetilsalisilat (asetosal) tablet/kaplet/kapsul 80 mg Miniaspi 80 PT. Mersifarma KOTAK @ 10 x 10 TAB
52 Asam Askorbat (Vitamin C) tablet 250 mg n/a PT. Kimia Farma ktk 10x10 tablet
53 Asam Askorbat (Vitamin C) tablet 50 mg n/a PT. Kimia Farma Dus 10 strip x 10 tab
54 Asam Folat tablet/kapsul/kaplet 0,4 mg Starfolat PT. Dexa Medica Dus, 10 strip @10 tablet
55 Asam Folat tablet/kapsul/kaplet 1 mg n/a PT. Marin Liza Farmasi Botol @ 100 tablet
56 Asam Ibandronat injeksi 6mg/6ml Bondronat PT. Boehringer Boks, 1 ampul
57 Asam Mefenamat kapsul/kaplet 500 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kaptab s
58 Asam pipemidat kapsul 400 mg Urotractin 400 mg PT. Sanbe Farma Strip
59 Asam traneksamat injeksi 100 mg/ml n/a PT. Hexpharm Dus, 10 ampul @ 5 ml
60 Asam traneksamat injeksi 50 mg/ml n/a PT. Bernofarm Dus, 10 ampul @ 5 ml
61 Asam zoledronat injeksi 4mg/5mL ZOMETA PT. Novartis Dus, 1 vial plastik @ 5ml
62 Asiklovir salep mata 3% Temiral Eye Oint PT. Sanbe Farma Tube 3,5 gram
63 Asiklovir tablet/kapsul/kaplet 200 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet
64 Asiklovir tablet/kapsul/kaplet 400 mg n/a PT. Sampharindo Dus, 5 strip @ 10 tablet
65 Asparaginase serbuk injeksi 10.000 UI/vial Leunase PT. Widatra Bhakti 10.000 UI/Vial
66 Atapulgit tablet 600 mg Pularex PT. Zenith Dus 5 strip @ 10 tablet
67 Atenolol tablet/kapsul/kaplet 100 mg Betablok PT Kalbe Farma strip
68 Atrakurium injeksi 25 mg/2,5 ml Tracrium PT. Glaxo Dus, 5 ampul @ 2.5 ml
69 Atropin Sulfat tablet 0,5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
70 Atropin Sulfat tetes mata 0,5% Cendo Tropin 0,5% PT. Cendo Botol 5ml
71 Atropin Sulfat tetes mata 1% Cendo Tropin 1% PT. Cendo Botol 5ml
72 Azitromisin sir kering 200 mg/ 5 mL n/a PT. Soho botol @ 60 ml
73 Azitromisin tablet 500 mg n/a PT. Kimia Farma ktk 2x10 tablet
74 Azitromisin tablet 250 mg n/a PT. Soho Strip
75 Bedak salisil serbuk 2% n/a PT. Rama Dus @ 50 gram
76 Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a PT. Phapros, Tbk Ds 10 vial x 1,2 Jt IU
77 Benzatin Benzil Penisilin 2,4 juta IU/vial n/a PT. Phapros, Tbk 10 vial @ 2.400.000 IU
78 Beractant injeksi / suspensi 25 mg/mL Survanta PT. Abbott Indonesia Vial
79 Beraprost sodium tablet 20 mcg Dorner 20 µg PT. Combiphar Box/ 3 blister @ 10 Tablet
80 Betametason krim 0,1% (sebagai Valerat) n/a PT. Kimia Farma Tube 5 gr
81 Betametason tetes mata 1 mg/ml Betam Ophtal ED PT. Sanbe Farma botol @ 5 ml
Bevasizumab injeksi 25 mg/ml (Skema Risk Sharing sesuai Kepmenkes RI
82 Avastin PT. Boehringer Dus, 1 vial @ 4 ml
Nomor HK.02.02/Menkes/223/2014)
83 Bikalutamid tablet salut 150 mg Casodex 150 mg PT. Astra Dus, 2 blister @ 14 Tablet
84 Bikalutamid tablet salut 50 mg Casodex 50 mg PT. Astra Dus, 2 blister @ 14 Tablet
85 Bisakodil suppositoria 10 mg Stolax supp PT. Sanbe Farma Supp
86 Bisakodil suppositoria 5 mg Dulcolax Supp Infant PT. Boehringer 1 Box @ 6's
87 Bisoprolol tablet 2,5 mg Concor 2.5 PT. Merck Tbk Dus 10 blister @ 10 tablet
88 Bisoprolol tablet 5 mg n/a PT. Pratapa Nirmala Box 3 X 10 tab
89 Bleomisin serbuk injeksi 15 mg/ampul BLEOCIN PT Kalbe Farma Vial
90 Bromokriptin tablet 2,5 mg Cripsa tab PT. Caprifarmindo Box 3 x 10'S
91 Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler PT. Astra Dus, 1 Turbuhaler @ 100 dos
92 Budesonid inhaler 200 mcg/puff, 200 dosis Obucort Swinghaler PT Otsuka Indonesia Unit, 200 dosis
93 Budesonid respules / cairan inhaler 0,25mg/mL Pulmicort Respules PT. Astra Dus, 4 pak @ 5 respules @ 2
Symbicort Turbuhaler 160/4.5 PT. Astra
94 Budesonid-formoterol (fixed combination) inhaler 160/4,5 mcg Dus, 1 Turbuhaler @ 120 dos
mcg
95 Budesonid-formoterol (fixed combination) inhaler 80/4,5 mcg Symbicort 80/4.5 mcg PT. Astra Dus, 1 Turbuhaler @ 60 dosi
96 Bupivakain injeksi 0,50% (HCl) + glukosa 8% n/a PT. Dexa Medica Dus, 5 ampul @ 4 ml
97 Bupivakain injeksi 0,50% (P.V) Bunascan PT. Pratapa Nirmala ampul
98 Dabigatran eteksilat kapsul 75 mg Pradaxa PT. Boehringer Dus, 3 blister @ 10 kapsul
99 Dabigatran eteksilat kapsul 110 mg Pradaxa PT. Boehringer Dus, 3 blister @ 10 kapsul
100 Dakarbazin serbuk injeksi 200 mg/vial DBL Dacarbazine PT. Tempo vial @ 20 ml
101 Daunorubisin serbuk injeksi 20 mg/vial DAUNOCIN PT. Novell vial
102 Deferasiroks tablet disp/ eff 250 mg Exjade 250 mg Tab PT. Novartis Dus, 4 blister @ 7 tablet
103 Deferasiroks tablet disp/ eff 500 mg Exjade 500 mg Tab PT. Novartis Dus, 4 blister @ 7 tablet
104 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution PT. Sydna Farma Dus, Botol @ 500ml
105 Deferipron tablet 500 mg Ferriprox tablet PT. Sydna Farma Dus, Botol @ 100 tablet
106 Deferoksamin Mesilat serbuk injeksi 500 mg Desferal PT. Novartis Dus, 10 vial @ 500mg
107 Deksametason injeksi i.v./i.m. 5 mg/ml n/a PT. Indofarma Dus, 100 ampul @ 1 ml
108 Deksametason tablet 0,5 mg n/a Dus, 10 Strip@10 Tablet
109 Desogestrel tablet 75 mcg Cerazette PT. Merck Dus, 1 Blister @ 28 tablet
110 Desoksimetason krim 0,25% DEXIGEN PT. Ifars Dus, tube @ 5 g
111 Desoksimetason krim 0,25% n/a PT. Dexa Medica Kotak, tube @ 15 gram
112 Diazepam larutan rektal 5 mg/2,5 mL STESOLID PT. Actavis Dus, 5 alubag @ 1 tube @ 2,
113 Diazepam larutan rektal 10 mg/2,5 mL STESOLID PT. Actavis Dus, 5 alubag @ 1 tube @ 2,
114 Diazepam tablet 2 mg n/a PT. Kimia Farma Btl 100
115 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a PT. Phapros, Tbk Dus @ 30 Ampul
116 Digoksin injeksi 0,25 mg/ml Fargoxin inj PT. Pratapa Nirmala Box @ 5 ampul 2 mL
117 Digoksin tablet 0,25 mg n/a PT. Yarindo Box 10 X 10 Tab
118 Diltiazem HCl tablet 30 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
Herbesser Powder Injection
119 Diltiazem infus injeksi 50 mg PT. Tanabe Indonesia 10 vial @ 50mg
50mg
120 Diltiazem injeksi 25 mg/5 mL Farmabes Injeksi 25 mg PT. Pratapa Nirmala Vial 5 mL
121 Diltiazem Kapsul SR 100 mg Herbesser CD 100 PT. Tanabe Indonesia 3 blister @ 10 kapsul
122 Diltiazem Kapsul SR 200 mg Herbesser CD 200 PT. Tanabe Indonesia 3 blister @ 10 kapsul
123 Dimenhidrinat tablet 50 mg n/a PT. Kimia Farma Btl 100 tablet
124 Dinatrium edetat tetes mata 0,35% E.D.T.A PT. Cendo botol 15 ml
125 Dinatrium klodronat infus kons 60 mg/mL Bonefos Infus 60 mg / 5 ml PT. Bayer Indonesia ampul
126 Dobutamin injeksi 50 mg/mL DOBURAN PT. Dipa Pharmalab ampul @ 5 ml
127 Doksazosin mesilat tablet 1 mg Cardura 1mg PT. Pfizer Indonesia Dus, 5 blister @10's tab
128 Doksazosin mesilat tablet 2 mg Cardura 2mg PT. Pfizer Indonesia Dus, 5 blister @10's tab
129 Doksisiklin tablet/kapsul/kaplet 100 mg n/a PT. Yarindo Box @ 10 strip 10 kapsul
130 Doksorubisin serbuk injeksi i.v. 10 mg/vial Doxorubicin Actavis 10 mg PT. Actavis Dus, 1 vial @ 10 mg
131 Doksorubisin serbuk injeksi i.v. 50 mg/vial Doxorubicin Actavis 50 mg PT. Actavis Dus, 1 vial @ 50 mg
132 Domperidon suspensi/sirup 5 mg/5 ml n/a PT. Novapharin btl @ 60 ml
133 Domperidon tablet 10 mg n/a PT. Novapharin dus 10 X 10'S
134 Domperidon tetes 5 mg/mL n/a PT. Bernofarm Dus, botol @ 10 ml
135 Dopamin injeksi 40 mg/ml UDOPA PT. Dipa Pharmalab ampul @ 5 ml
136 Dosetaksel injeksi 20 mg/0,5 ml n/a PT. Sanbe Farma Dus, 1 vial @0,5 ml+ 1 vial p

137 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate calcium Renalscan KaeF PT. Kimia Farma Dus @ 5 vial
trisodium/mL
138 Dutasterid kaps lunak 0,5 mg Avodart PT. SmithKline Dus, Botol Plastik @ 30 Table
139 Efavirens tablet salut 600 mg n/a PT. Kimia Farma Botol 30 tab
140 Efedrin Inj 50 mg/ml n/a PT. Bernofarm Ampul @ 1 ml
141 Eksemestan tablet 25 mg Aromasin PT. Pfizer Indonesia Dus, 2 blister @ 15 tablet
142 Enoksaparin sodium inj 20 mg/0,2 mL Lovenox 2000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe @ 0,
143 Enoksaparin sodium inj 40 mg/0,4 mL Lovenox 4000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe @ 0,
144 Enoksaparin sodium inj 60 mg/0,6 mL Lovenox 6000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe @ 0,
145 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a PT. Phapros, Tbk Dus @ 30 Ampul
146 Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe PT Kalbe Farma Vial @ 25 ml
147 Epirubisin serb injeksi 10 mg/5 ml n/a PT. Sanbe Farma Dus, 1 vial @5 ml
148 Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI D-Vit FT PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet
149 Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml D-Vit Syrup PT. Gracia Pharmindo Dus, Botol Plastik @ 100 mL
150 Eritromisin kapsul/kaplet 250 mg n/a PT. Kimia Farma ktk 10 x 10 kapsul
151 Eritromisin kapsul/kaplet 500 mg n/a PT. Indofarma Dus, 10 blister @ 10 kss
152 Eritromisin sirup kering 200 mg/ 5 ml n/a PT. Phyto Botol @60 ml
153 Eritropoetin-alfa inj 10000 UI/mL Hemapo 10.000 IU PT Kalbe Farma vial/ampul (Prefilled Syringe)
154 Eritropoetin-alfa inj 2000 UI/mL Eprex 2000 PT. Soho Dus, 6 prefilled syrenge @ 0.
155 Eritropoetin-alfa inj 3000 UI/mL Hemapo 3000 PT Kalbe Farma Prefilled Syringe @ 1ml
156 Eritropoetin-beta inj 2000 UI/0,3 mL Recormon PT. Boehringer Boks, 6 ampul
157 Etambutol tablet 250 mg (HCl) n/a PT. Kimia Farma ktk 20 x 10 tablet
158 Etambutol tablet salut 500 mg (HCl) n/a PT. Indofarma Dus, 10 strip @ 10 tss
159 Etanol 70% cairan n/a PT. Novapharin btl @ 100 ml
160 Etinilestradiol tablet 0,05 mg Lynoral PT. Merck Dus, botol @ 100 tablet
161 Etonogestrel implan 68 mcg Implanon PT. Merck Dus, 1 blister @ 1 subdermal
162 Etoposid injeksi 20 mg/ml Posyd PT. Combiphar Vial 100mg/5ml
163 Eugenol cairan n/a PT. Kimia Farma Botol 10 ml
164 Everolimus tab 0,25 mg Certican 0,25 mg Tab PT. Novartis Dus, 6 blister @ 10 tablet
165 Everolimus tab 0,5 mg Certican 0,5 mg Tab PT. Novartis Dus, 6 blister @ 10 tablet

166 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi IX 25 Coffact 500 IU/20 ml PT. Graha Farma Dual, vial 500 IU
UI, faktor koagulasi X 14-35 UI
167 Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi Novoseven PT. Ferron KOTAK @ 1 VIAL SERBUK OBA
168 Faktor VIII (konsentrat) serb inj 230 -340 UI Haemoctin PT. Kimia Farma vial
169 Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5 mL Haemoctin PT. Kimia Farma vial
170 Faktor VIII (konsentrat) serb inj 480 - 600 UI KOATE DVI 500 IU PT. Dipa Pharmalab vial
171 Fenitoin injeksi 50 mg/ml n/a PT. Mersifarma KOTAK @ 10 ampul
172 Fenitoin kapsul/kaplet 100 mg n/a PT. Ikapharmindo Botol @ 100
173 Fenitoin Na Inj 100 mg/2 ml n/a PT. Mersifarma KOTAK @ 10 ampul
174 Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a PT. Phapros, Tbk Dus @ 30 Ampul
175 Fenofibrat kaps 100 mg n/a PT. Hexpharm Dus, 3 strip @ 10 kapsul
176 Fenofibrat kaps 300 mg n/a PT. Hexpharm Dus, 3 strip @ 10 kapsul
177 Fenoksimetil penisilin (penisilin V) tablet 250 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's
178 Fenoksimetil penisilin (penisilin V) tab 125 mg Fenocin PT. Actavis Dus 45 x 12 tab
179 Fenoksimetil penisilin (penisilin V)tablet 500 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's
180 Fenoterol HBr ih 100 mcg/puff Berotec MDI PT. Boehringer Box, canister 10mL
181 Fenoterol HBr inh solution 0,1% Berotec Solution PT. Boehringer Dus, Canister 200 dosis
182 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10 ml n/a PT. Kimia Farma Dus 5 ampul@ 10ml
183 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 2 ml n/a PT. Kimia Farma Dus 5 ampul@ 2ml
184 Fentanil patch 12,5 mcg/jam Durogesic 12,5 MU Matrix PT. Kimia Farma Dus @ 5 patch
185 Fentanil patch 25 mcg/jam Durogesic 25 MU Matrix PT. Kimia Farma Dus@ 5 patch
186 Fentanil patch 50 mcg/jam Durogesic 50 MU Matrix PT. Kimia Farma Dus@ 5 patch
187 Filgrastim inj 300 mcg/mL Leucogen PT Kalbe Farma pfs @ 0,5 ml
188 Finasterid tab 5 mg Prostacom PT. Combiphar Box, isi 3 Strip @ 10 tab
189 Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's
190 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml n/a PT. Phapros, Tbk dus @ 30 ampul
191 Fludarabin inj 50 mg Fludara IV LYO PT. Aventis Pharma Dus, 5 vial @ 50 mg
192 Fludarabin tab 10 mg Fludara Oral PT. Aventis Pharma Dus, 4 blister @ 5 tablet salu
193 Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi PT. Mersifarma Dus, 5 ampul @ 1ml
194 Flukonazol injeksi 2 mg/ml n/a PT. Natura Dus, 1 Botol @ 100 mL
195 Flukonazol tablet/kaplet/kapsul 50 mg Diflucan 50mg PT. Pfizer Indonesia Blister
196 Flukonazol tablet/kapsul 150 mg n/a PT. Kimia Farma ktk 1 x 10 kapsul
197 Fluoksetin tablet 10 mg Foransi 10 PT. Gracia Pharmindo strip
198 Fluoksetin tablet 20 mg NOPRES PT. Dexa Medica DUS, 30 TABLET
199 Fluorometolon tetes mata 0,1 % Ocuflam ED PT. Sanbe Farma botol @ 5 ml
200 Fluorourasil inj 250 mg/mL Curacil PT Kalbe Farma vial @ 1 ml
201 Fluorourasil inj 500 mg/ 5 mL Curacil PT Kalbe Farma vial @ 10 ml
202 Flusinolon asetonid krim 0,025% SYNARCUS PT. Ifars Dus, Tube 5 g
203 Flutikason furoat intranasal spray Avamys PT. Glaxo Dus, Botol 120 Dosis Spay
204 Flutikason propionat nebules 0,5 mg Flixotide Nbules PT. Glaxo Dus, 2 flow wrap@ 5 nebules
205 Fondaparinuks inj 2,5 mg/0,5 mL Arixtra PT. Glaxo Dus, 2 pfs 0.5 ml
206 Fraksi protein plasma lar inf 5% Plasmanate PT. Dipa Pharmalab dus, vial @ 250 ml
207 Furosemid injeksi i.v./i.m. 10 mg/ml n/a PT. Indofarma Dus, 25 ampul @ 2 ml
208 Furosemid tablet 40 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
209 Gadobutrol macrocyclic 5 mg Gadovist 5 mg PT. Bayer Indonesia Prefilled Syringe
210 Gadobutrol macrocyclic 7,5 mg Gadovist 7,5 mg PT. Bayer Indonesia Prefilled Syringe
211 Gadoksetat disodium 0,25 mmol gadoxetate disodium/mL Primovist PT. Bayer Indonesia Prefilled Syringe
212 Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene PT. Boehringer Boks, 1 ampul
213 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium klorida 0,30 g n/a PT. Phapros, Tbk Dus @ 100 Sachet
Trinatrium sitrat dihidrat 0,58 g Glukosa Anhidrat 2,70 g
214 Gefitinib tab 250 mg Iressa 250 mg PT. Astra Dus, 1 blister @ 10 tablet
215 Gemfibrozil kapsul/kaplet 300 mg n/a PT. Indofarma Dus, 10 blister @ 12 kapsul
216 Gemfibrozil tablet 600 mg n/a PT. Indofarma Dus, 10 blister @ 10 kaptab
217 Gemsitabin inj 1000 mg/vial Gemzar 1000 mg PT. Bayer Indonesia vial
218 Gemsitabin inj 200 mg/vial n/a PT. Sanbe Farma Dus, 1 vial @200 mg
219 Gentamisin injeksi 40 mg/ ml n/a PT. Indofarma Dus, 5 ampul @ 2 ml
220 Gentamisin salep mata 0,3% Genoint Salep Mata PT. Erela Tube @ 3,5 gr
221 Gentamisin tetes mata 0,3% n/a PT. Indofarma Dus, botol plastik 5 ml
222 Glibenklamid tablet 5 mg n/a PT. Indofarma Dus, 10 blister @ 10 kaptab
223 Gliklazid tab 80 mg GLUCODEX PT. Dexa Medica DUS, 100 TABLET
224 Gliklazid tab 30 mg Diamicron MR 30 PT. Pradja Pharin Dus, 6 strip @ 10 tablet lepa
225 Glikuidon tab 30 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
226 Glimepiride tablet 1 mg n/a PT. Kimia Farma ktk 5x10 tablet
227 Glimepiride tablet 2 mg n/a PT. Kimia Farma ktk 5x10 tablet
228 Glimepiride tablet 3 mg n/a PT. Kimia Farma ktk 5x10 tablet
229 Glimepiride tablet 4 mg n/a PT. Kimia Farma ktk 5x10 tablet
230 Glipizid tablet/kaplet/kapsul 10 mg Glucotrol 10 mg PT. Pfizer Indonesia Dus, botol@TAB 10MG 30
231 Glipizid tablet/kaplet/kapsul 5 mg Glucotrol 5 mg PT. Pfizer Indonesia Dus, botol@TAB 10MG 31
232 Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard PT. Kimia Farma Dus 10x10
233 Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte PT. Kimia Farma Dus 10x10
234 Gliseril trinitrat tab sublingual 0,5 mg Nitral PT. Actavis Btl @ 30 tablet
235 Gliserin lar 50% Gliserin lar 50% PT. Lucas Djaja Glycerin 100 ml
236 Glukosa larutan infus 10 % steril n/a PT. Widatra Bhakti botol @ 500 ml
237 Glukosa larutan infus 5 % steril n/a PT. Widatra Bhakti botol @ 500 ml
238 Goserelin asetat inj 10,8 mg/vial Zoladex 10,8 mg PT. Astra Dus, 1 syringe @ 10.8 mg
239 Goserelin asetat inj 3,6 mg Zoladex 3,6 mg PT. Astra Dus, 1 syringe @ 3.6 mg
240 Griseofulvin tablet 125 mg n/a PT. Phapros, Tbk Dus @ 10 X 10 's
241 Haloperidol inj 50 mg/mL Haldol Decanoas PT. Soho Dus 5 Ampul@1mL
242 Haloperidol injeksi i.m 5 mg/ml Lodomer Injeksi PT. Mersifarma KOTAK @ 12 ampul
243 Haloperidol tablet 0,5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet
244 Haloperidol tablet 5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet
245 Haloperidol tablet 1,5 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet
246 Haloperidol tablet 2 mg Lodomer 2 PT. Mersifarma KOTAK @ 10 x 10 TAB
247 Haloperidol tts 2 mg/mL LODOMER DROPS PT. Mersifarma BOTOL @ 15 ML
248 Halotan Inhalasi Halothane PT. Dexa Medica Botol
249 Heparin injeksi i.v./s.k. 5000 UI/ml Inviclot PT. Pratapa Nirmala vial
250 Hepatitis B imunoglobulin (human) Hyperhep B PT. Dipa Pharmalab Dus, 1 syringe @ 0.5 mL
251 Hidrokortison krim 1% n/a PT. Marin Liza Farmasi tube @ 5 ml
252 Hidrokortison krim 2,5 % n/a PT. Kimia Farma Tube 5 gr
253 Hidroksi Urea tablet/kaplet/kapsul 500 mg HYDROXYUREA MEDAC PT. Dipa Pharmalab vial
254 Hiosin butilbromid injeksi 20 mg/ml n/a PT. Otto box 5ampul @1 ml
255 Homatropin tetes mata 2% Homatro 2% PT. Cendo Botol 5ml

256 Human insulin intermediate acting inj 100 UI/ml, vial (Human Insulin Insulatard Vial PT. Ferron Dus, vial 10 ml
(Intermediate-Acting))

257 Human insulin intermediate acting inj 100 UI/ml, vial (Insulin human Basal) Humulin N Vial PT. Bayer Indonesia Dus, vial 10 ml

258 Human insulin intermediate acting inj 100 UI/ml, vial/cartridge n/a PT. Aventis Pharma Dus, 1 Vial @ 5 ml
disposible/penfill cartridge

259 Human insulin intermediate acting inj 100 UI/ml,penfill cartridge (Human Insulatard Penfill PT. Ferron Injeksi 100 IU/ml, penfill disp
Insulin (Intermediate-Acting))

260 Human insulin intermediate acting inj 100 UI/ml,penfill cartridge (Insulin Humulin N Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @
human Basal)

261 Human insulin intermediate acting inj 100 UI/ml,penfill cartridge (Insulin Sansulin N PT. Sanbe Farma penfillcartridge @ 3ml
human Basal)

262 Human insulin mix insulin inj 100 UI/ml, penfill cartridge (Human Insulin Mixtard Penfill PT. Ferron Injeksi 100 IU/ml, penfill disp
(Premix: 30% Soluble + 70 % NPH Insulin))

263 Human insulin mix insulin inj 100 UI/ml, penfill cartridge (Insulin human Comb) Humulin 30/70 Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @

264 Human insulin mix insulin inj 100 UI/ml, vial (Human Insulin (Premix: 30% Mixtard Vial PT. Ferron Dus, vial 10 ml
Soluble + 70 % NPH Insulin))

265 Human insulin mix insulin inj 100 UI/ml, vial (Insulin human Comb) Humulin 30/70 Vial PT. Bayer Indonesia Dus, vial 10 ml

266 Human insulin short acting inj 100 UI/ml, penfill cartridge (Human Insulin Actrapid Penfill PT. Ferron Injeksi 100 IU/ml, penfill disp
(Short Acting))
267 Human insulin short acting inj 100 UI/ml, penfill cartridge (Insulin human Rapd) Sansulin R PT. Sanbe Farma penfill cartridge @ 3ml

268 Human insulin short acting inj 100 UI/ml, penfill cartridge (Insulin human Rapd) Humulin R Cart PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @

269 Human insulin short acting inj 100 UI/ml, vial (Human Insulin (Short Acting)) Actrapid Vial PT. Ferron Dus, vial 10 ml

270 Human insulin short acting inj 100 UI/ml, vial (Insulin human Rapd) Humulin R Vial PT. Bayer Indonesia Dus, vial 10 ml

271 Human insulin short acting inj 100 UI/ml, vial/cartridge disposible/penfill n/a PT. Aventis Pharma Dus, 1 Vial @ 5 ml
cartridge
272 Human tetanus imunoglobulinn injeksi i.m. 250 UI Tetagam PT. Dexa Medica Prefilled syringe
273 Ibuprofen sirup 100 mg/5 ml n/a PT. Indofarma Dus, botol 60 ml
274 Ibuprofen suspensi 200 mg/5 ml n/a PT. Indofarma Dus, botol 60 ml
275 Ibuprofen tablet 200 mg n/a PT. Yarindo botol @ 100 tablet
276 Ibuprofen tablet 400 mg n/a PT. Novapharin dus 10 X 10'S
277 Ifosfamid serbuk injeksi 1000 mg/vial Holoxan injeksi 1000 PT. Mugi Laboratories Dus, 1 vial @ 1 g

278 Imanitib Mesilat tablet salut selaput 100 mg (Skema Risk Sharing sesuai Glivec PT. Novartis Dus, 6 blister @ 10 tablet sal
Kepmenkes RI Nomor HK.02.02/Menkes/223/2014)
279 Imidapril tab 10 mg Tanapress 10mg PT. Tanabe Indonesia 3 blister @ 10 tablet
280 Imidapril tab 5 mg Tanapress 5mg PT. Tanabe Indonesia 3 blister @ 10 tablet
281 Iopamidol 200-300 mg Iodium/mL (300mg @ vial 100ml) Iopamiro PT. Dipa Pharmalab Dus, botol @ 100 ml
282 Iopamidol 200-300 mg Iodium/mL (300mg @ vial 30ml) Iopamiro PT. Dipa Pharmalab Dus, vial @ 30 ml
283 Iopamidol 200-300 mg Iodium/mL (300mg @ vial 50ml) Iopamiro PT. Dipa Pharmalab Dus, vial @ 50 ml
284 Iopamidol 300-370 mg Iodium/mL (370mg @ vial 100ml) Iopamiro PT. Dipa Pharmalab Dus, botol @ 100 ml
285 Iopamidol 300-370 mg Iodium/mL (370mg @ vial 30ml) Iopamiro PT. Dipa Pharmalab Dus, vial @ 30 ml
286 Iopamidol 300-370 mg Iodium/mL (370mg @ vial 50ml) Iopamiro PT. Dipa Pharmalab Dus, vial @ 50 ml
287 Iopromide 300-370 mg Iodium/mL (300 mg / 100 ml) Ultravist 300/100 mg PT. Bayer Indonesia Botol
288 Iopromide 300-370 mg Iodium/mL (300 mg / 50 ml) Ultravist 300/50 mg PT. Bayer Indonesia Botol
289 Iopromide 300-370 mg Iodium/mL (370 mg / 100 ml) Ultravist 370/100 mg PT. Bayer Indonesia Botol
290 Iopromide 300-370 mg Iodium/mL (370 mg / 50 ml) Ultravist 370/50 mg PT. Bayer Indonesia Botol
291 Ipratropium bromida inhalasi 20 mcg/semprot Atrovent HFA PT. Boehringer Box, canister 10mL
Atrovent solution for inhalation PT. Boehringer
292 Ipratropium bromida nebulizer 0,025% Box, bottle 20mL
0.025%
293 Irbesartan tab 150 mg n/a PT. Indofarma Dus, 5 blister @ 10 kss
294 Irbesartan tab 300 mg n/a PT. Indofarma Dus, 5 blister @ 10 kss
295 Irinotekan inf 20 mg/ml n/a PT. Sanbe Farma Dus, 1 vial @2 ml
296 Isofluran inhalasi Terrell PT. Pratapa Nirmala Botol 100 mL
297 Isoniazid tablet/kapsul/kaplet 100 mg n/a PT. Phyto Botol 100 tablet
298 Isoniazid tablet/kapsul/kaplet 300 mg n/a PT. Phyto Botol 100 tablet
299 Isosorbid Dinitrat injeksi i.v 10 mg/10 ml Farsorbid inj PT. Pratapa Nirmala vial
300 Isosorbid Dinitrat tablet sublingual 5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
301 Isosorbid dinitrat tablet/kaplet/kapsul 10 mg Isonat PT. Kimia Farma Dus, 5 strip @ 10 tablet
302 Kalium aspartat tab 300 mg Kalipar PT. Tempo Strip
303 Kalium Klorida tablet 600 mg KSR PT. Merck Tbk Dus, 10 strip @ 10 tablet
304 Kalsium Folinat (Leukovorin Ca) inj 50 mg/ml DBL Leucovorin PT. Tempo Vial 50 mg/5 ml
305 Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Kalsium glukonat PT. Ethica Ampul
306 Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg n/a PT. Afifarma Dus,10 Strip @ 10 tablet
307 Kalsium polistirena sulfonat ktg 5 g KALQUEST PT. Novell kantong 5 g
308 Kanamisin inj 1000 mg/ vial n/a PT. Hexpharm vial
309 Kandesartan tab 16 mg n/a PT. Dexa Medica Dus, 3 Blister @ 10 tablet
310 Kandesartan tab 8 mg n/a PT. Dexa Medica Dus, 3 Blister @ 10 tablet
311 Kapesitabin tab 500 mg Xeloda PT. Boehringer Boks, 120 tablet
312 Kaptopril tablet 50 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
313 Kaptopril tablet scored 25 mg n/a PT. Errita Pharma Dus, 10 strip @10 tablet
314 Kaptopril tablet scored12,5 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet
Tegretol Syrup 100mg/5ml,
315 Karbamazepin sirup 100 mg/5 ml PT. Novartis Dus, botol @ 120 ml
120ml
316 Karbamazepin tablet 200 mg n/a PT. Indofarma Dus, 10 blister @ 10 tablet
317 Karbimazol tab 5 mg Neo-Mercazole PT. Nicholas Dus,botol 100 tablet
318 Karbogliserin tetes telinga 10% Karbogliserin tetes telinga 10% PT. Lucas Djaja Fenol 100 mg / 1 ml
319 Karboplatin 150 mg / 15 ml DBL Carboplatin 150 mg PT. Tempo vial @ 15 ml
320 Karboplatin 450 mg / 45 ml DBL Carboplatin 450 mg PT. Tempo vial @ 45 ml
321 Karvediol tablet/kaplet/kapsul 6,25 mg V - BLOC PT Kalbe Farma strip
322 Ketamin injeksi i.v. 100 mg/ml KTM PT. Guardian Vial @ 10 ml
323 Ketamin injeksi i.v. 50 mg/ml Ketamin Hameln PT. Combiphar Box, isi 1 vial @ 10 ml
324 Ketokonazol krim 2% n/a PT. Novell Box isi 1 Tube @ 15 g
325 Ketokonazol krim 2% n/a PT. Hexpharm tube 5 gr
326 Ketokonazol krim 2% n/a PT. Kimia Farma tube 10 gr
327 Ketokonazol scalp sol 2% Zoloral SS PT. Ikapharmindo Botol 80 ml
328 Ketokonazol tablet 200 mg n/a PT. Dexa Medica Dus, 5 Strip @ 10 tablet
329 Ketoprofen supositoria 100 mg Protofen Supp PT. Kimia Farma dus 2 's @ 10 supp
330 Ketorolac injeksi 30 mg/ml n/a PT. Phapros, Tbk Dus @ 12 Ampul
331 Klaritromisin tab 500 mg ORIXAL PT. Ifars Dus, 3 Strip @ 10 Kaplet salu
332 Klindamisin kapsul/kaplet 150 mg n/a PT. Indofarma Dus, 5 blister @ 10 kapsul
333 Klindamisin kapsul/kaplet 300 mg n/a PT. Indofarma Dus, 5 blister @ 10 kapsul
334 Klobazam tab 10 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
335 Klonidin injeksi i.v 0,15 mg/ml (HCL) (150) Catapres Injeksi PT. Boehringer Box, 10 ampoules @ 1mL
336 Klonidin tablet 0,15 mg n/a PT. Kimia Farma Ktk 10X10 TAB
337 Klopidogrel tab 75 mg n/a PT. Hexpharm Dus, 3 strip @ 10 tab
338 Kloramfenikol kapsul/kaplet 250 mg n/a PT. Kimia Farma ktk 10x10 tablet
339 Kloramfenikol salep mata 1 % n/a PT. Kimia Farma Tube 5 gr
340 Kloramfenikol serb inj 1000 mg/mL Colsancetine Injeksi PT. Sanbe Farma vial
341 Kloramfenikol suspensi 125 mg/ 5 ml n/a PT. Bernofarm Botol @ 60 ml
342 Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a PT. Phapros, Tbk Dus @ 30 Ampul
343 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a PT. Phapros, Tbk Dus @ 30 Ampul
344 Klorpromazin tablet salut 100 mg (HCl) n/a PT. Mersifarma Kotak @ 10 x 10 tab
345 Klorpromazin tablet salut 25 mg (HCl) n/a PT. Phapros, Tbk 10 X 10
346 Klozapin 100 mg n/a PT. Mersifarma KOTAK @ 5 x 10 TAB
347 Klozapin 25 mg n/a PT. Mersifarma KOTAK @ 5 x 10 TAB
348 Kodein tablet 10 mg n/a PT. Kimia Farma ktk 10x10 tablet
349 Kodein tablet 15 mg n/a PT. Kimia Farma ktk 10x10 tablet
350 Kodein tablet 20 mg n/a PT. Kimia Farma ktk 10x10 tablet
351 Kolekalsiferol (vitamin D3) kapsul lunak 0,25 mcg Ostriol PT. Pratapa Nirmala Btl @ 30 kapsul
352 Koloid HES BM 130 000 lar inf 6% Voluven PT. Fresenius Botol Plastik @ 500 ml
353 Kombinasi : Ipratropium bromida inhalasi 0,5 mg Salbutamol 2,5 mg Combivent UDV PT. Boehringer 1 dus @ 20 vial
354 Kombinasi suspensi : Parafin + gliserin + fenolftalein Laxadine Emulsi 60 ml PT. Galenium Botol @ 60 ml
355 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat 0,25 mg n/a PT. Erela Dus, 100 Sachet @ 30 Tablet
356 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat 0,25 mg n/a PT. Kimia Farma 1 sase @30 tablet

357 Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664 mg; Kalium klorida Cendo Lyteers PT. Cendo botol 15 ml
1,32 mg
358 Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem PT. Novartis Dus, 4 blister @ 6 tablet
359 Kombinasi: Levodopa 100 mg; Karbidopa 25 mg; Entekapon 200 mg Stalevo PT. Novartis Dus, botol plastik @ 30 table
360 Kombinasi: Lopinavir 200 mg; Ritonavir (LPV/r) 50 mg Aluvia PT. Abbott Indonesia botol @ 120 tablet
361 Kombinasi: Salmeterol 25 mcg; Flutikason propionat 50 mcg Seretide Inhaler 50 mcg PT. Glaxo Dus, Botol 120 Dosis
362 Kombinasi: Salmeterol 50 mcg; Flutikason propionat 100 mcg Seretide Diskus 100 mcg PT. Glaxo Dus, foil strip @ 60 dosis
363 Kombinasi: Salmeterol 50 mcg; Flutikason propionat 250 mcg Seretide Diskus 250 mcg PT. Glaxo Dus, foil strip @ 60 dosis
364 Kontrasepsi pil oral, kombinasi :* Levonorgestrel 150 mcg Etinilestradiol 30 mcg n/a PT. Kimia Farma Dus, 100 blister @ 28 tablet
365 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg n/a PT. Promedrahardjo Dus, 10 Strip@10 Tablet
Trimetoprim 80 mg
Kotrimoksazol
366 5 ml Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / n/a PT. Sampharindo Botol, 60 ml
367 Kuinin (Kina) tablet 200 mg n/a PT. Kimia Farma ktk 60 tablet
368 Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a PT. Kimia Farma ktk 100 amp @ 2 ml
369 Kuinin tablet 222 mg (H2SO4.7H2O) n/a PT. Kimia Farma ktk 10 x 10 tablet
370 Lamivudin tablet/kaplet/kapsu 100 mg Heplav PT. Kimia Farma Botol 30 tab
371 Lamivudine tablet 150 mg n/a PT. Kimia Farma Botol 60 tablet
372 Lansoprazol inj 30 mg/ml Prosogan Inj. PT. Takeda Indonesia Serbuk vial
373 Lanzoprazol kapsul/kaplet 30 mg n/a PT. Indofarma Dus, 2 strip @ 10 kapsul
374 Lapatinib tab 250 mg Tykerb PT. SmithKline Dus, 7 Blister @ 10 tablet
375 Larutan mengandung Asam Amino (Asam Amino 10%) Kalbamin PT. Finusolprima botol 500 ml

376 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Na+ 2 Amiparen PT Otsuka Indonesia Softbag 500 ML
mEq, Asetat 120 mEq)

377 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl- 52 Pan-amin G PT Otsuka Indonesia Softbag 500 ML
mEq)

378 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Aminofluid PT Otsuka Indonesia Double Chamber Softbag 10
elektrolit) 1000 ml

379 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Aminofluid PT Otsuka Indonesia Double Chamber Softbag 50
elektrolit) 500 ml

380 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, L- Aminofusin Hepar PT Kalbe Farma botol 500 mL
Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)
381 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Taurine 0,24 Aminosteril Infant 6% PT. Fresenius Botol Gelas 100 ml
gr/l)

382 Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Amino Nephrosteril PT. Fresenius Botol Gelas 250 ml
esensial: Asam Amino non esensial = 60 : 40)

383 Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N 11.53 g, Kidmin PT Otsuka Indonesia Softbag 200 ML
AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)

384 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Na+ 14 Aminoleban PT Otsuka Indonesia Softbag 500 ML
mEq, Cl 94 mEq)
385 Larutan mengandung Asam Amino (Asam amino 8%) Aminosteril N-Hepa PT. Fresenius Botol Gelas 500 ml

386 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 g/L) Eas Pfrimer PT. Finusolprima botol 250 ml

387 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Aspartate 10 Comafusin Hepar PT. Finusolprima botol 500 ml
gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)

Larutan mengandung Asam Amino (Kombinasi Asam aminno 50 g/L, Sorbitol 50

388 g/L, Xylitol 50 g/L, Asam Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L, Nikotinamida Aminofusin L600 PT Kalbe Farma botol 500 mL
(Niasinamida) 0.06 g/L, Piridoksin HCl (Vit B6) 0.04 g/L, Riboflavin Natrium
Fosfat 2.5 mg/L, elektrolit)

389 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, vitamin dan Aminofusin Paed PT Kalbe Farma botol 250 mL
elektrolit)

390 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 34gr, Glukosa: Kabiven 1440 ml PT. Fresenius Bag (3 Chamber) 1440 ml
97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal, Akses peripheral))

391 Larutan mengandung Asam Amino (Kombinasi Asam Amino: 45gr, Glukosa: Kabiven 1920 ml PT. Fresenius Bag (3 Chamber) 1920 ml
130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400 kkal, Akses peripheral))

392 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 gr + Combiflex Plus (790 kcal) PT. Phapros, Tbk Bag Double chamber (Dua c
Asam Amino 48 gr dgn akses sentral)

393 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 gr + Combiflex peri (480 kcal) PT. Phapros, Tbk Bag Double chamber (Dua c
Asam Amino 40 gr )
394 Larutan mengandung Elektrolit (Kalium Klorida) Otsu - KCl 7,46% PT Otsuka Indonesia Ampoel 25 ML

395 Larutan mengandung Elektrolit (Larutan Ringer Laktat) Wida RL PT. Widatra Bhakti Botol 1000 ml
396 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 Asering PT Otsuka Indonesia Plastic Bottle 500 ML
mEq)

397 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) KA EN 1B PT Otsuka Indonesia Plastic Bottle 500 ML

398 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Potassium Totilac PT Kalbe Farma flexybag 250 mL
Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Sodium

399 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Magnesium 1.0 Ringerfundin 500 mL PT. Phapros, Tbk LDPE (Low Density Poly Ethile
mmol/l, Chloride 118 mmol/l, Acetate 24 mmol/l, Malate 5.0 mmol/l)

400 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L Triofusin 1000 PT Kalbe Farma botol 500 mL
+ elektrolit)

401 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 g/ L) Triofusin 500 PT Kalbe Farma Flexy bag 500 mL

402 Larutan mengandung Karbohidrat (Maltose 100 gr) Martos PT Otsuka Indonesia Plastic Bottle 500 ML

Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g sodium

403 chloride, 0.15 g potassium chloride, 0.10 g calcium chloride dihydrate dan 1.55 Potacol inj PT Otsuka Indonesia Plastic Bottle 500 ML
g sodium lactate)

404 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Tutofusin OPS PT Kalbe Farma botol 500 mL
Sorbitol 50 gr/L)

405 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Glukosa Clinimix N9G20E PT Kalbe Farma Botol Plastik 1000 mL
100 gr/L, elektrolit)

406 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Glukosa 75 Clinimix N9G15E PT Kalbe Farma Botol Plastik 1000 mL
gr/L, elektrolit)

407 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 g, glucose 33 g, Triofusin E1000 PT Kalbe Farma botol 500 mL
Xylitol 30 g/ L)

408 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 Wida HSD PT. Widatra Bhakti Botol 500 ml
g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)

409 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Chloride Wida D5-NS PT. Widatra Bhakti Botol 500 ml
9 g, air untuk injeksi ad 1000 ml)

410 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 g) WIDA 2A PT. Widatra Bhakti Botol 500 ml

411 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 g) WIDA D5-1/4NS PT. Widatra Bhakti Botol 500 ml
412 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 g) WIDA D5-1/2NS PT. Widatra Bhakti Botol 500 ml

Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi infus

413 per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Futrolit PT. Sanbe Farma softbag 500ml
Sorbitol 50g)

414 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa 5%) Wida RD PT. Widatra Bhakti Botol 500 ml

415 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Glukosa KA ENMG 3 PT Otsuka Indonesia Plastic Bottle 500 ML
100 gr)

416 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat KA EN 3B PT Otsuka Indonesia Plastic Bottle 500 ML
2.24 gr, Dekstrosa 27 gr)

417 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 gr, KA EN 3A PT Otsuka Indonesia Plastic Bottle 500 ML
KCL 0.75 gr Dekstrosa 27 gr)
418 Larutan mengandung Lipid ( Infus Lipid Emulsi MCT/LCT 20% 100 ml) Lipofundin MCT/LCT 1% 100 PT. Phapros, Tbk 20%, Botol Kaca @100 ml, sin
419 Larutan mengandung Lipid (Emulsi lemak 20%) Intralipid PT. Fresenius Botol Gelas 100 ml
420 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml) Lipofundin MCT/LCT 1% 250 PT. Phapros, Tbk 20%, Botol Kaca @250 ml, sin

421 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Asam Nutriflex Lipid Special 1250 PT. Phapros, Tbk Bag, 3 chamber ( 3 kompart
Amino 71.8 gr + Lipid 50 gr dgn akses sentral)

422 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Asam Nutriflex Lipid Peri 1250 PT. Phapros, Tbk Bag, 3 chamber ( 3 kompart
Amino 40 gr + Lipid MCT/LCT 50 gr)

423 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Asam Nutriflex Lipid Special 625 PT. Phapros, Tbk Bag, 3 chamber ( 3 kompart
Amino 35.9 gr + Lipid 25 gr dgn akses sentral)

424 Larutan mengandung Lipid (Soybean Oil 200 g/L, Egg Lecithins 12 gr/L, Glycerol Ivelip PT Kalbe Farma Flexy bag 100 mL
Ph 25 gr/L, Sodium Oleate 0.3 gr/L)
425 Latanoprost tetes mata 0,01% Cendo Glaopen PT. Cendo strip 5 x 0.6 ml
426 Latanoprost tts mata 0,005% btl@2,5ml Xalatan 0,005% PT. Pfizer Indonesia dus, Botol @ 2,5 ml
427 Lenograstim inj 263 mcg/mL Granocyte 34 1vl HSA Free PT. Aventis Pharma Dus, 1 vial @ 263 mcg + 1 pre
428 Letrozol tablet/kaplet/kapsul 2,5 mg FEMARA PT. Novartis Dus, 3 blister @ 10 tablet
429 Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg PT. Takeda Indonesia Vial
430 Leuprorelin asetat inj depot 11,25 mg Tapros 3M PT. Takeda Indonesia Vial
431 Leuprorelin asetat inj depot 3,75 mg TAPROS 3.75 MG PT. Takeda Indonesia Vial
432 Levofloksasin inf 5 mg/mL n/a PT. Infion Box, 1 Botol @ 100 ml
433 Levofloksasin tablet 500 mg n/a PT. Promedrahardjo Dus, 5 Strip@10 Tablet
434 Levofloksasin tts mata 0,5% Optiflox PT. Erela Btl @ 5 ml
435 Levotiroksin tablet/kaplet/kapsul 100 mcg Euthyrox 100 PT. Merck Tbk Dus 4 blister @ 25 tablet
436 Lidokain injeksi 2% (HCL) n/a PT. Bernofarm Dus, 100 ampul @ 2 ml
437 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a PT. Indofarma Dus, 30 ampul @ 2 ml
438 Lidokain jeli 2% Xylocaine Jelly 2% PT. Astra Dus, 10 syringe @ 10 g
439 Lidokain semprot 10% Xylocaine Spray 10 mg/dosis PT. Astra Dus,Botol @ 50 ml (500 dosis
440 Lisinopril tablet 10 mg n/a PT. Novell Box ,3 Strip @ 10 tablet
441 Lisinopril tablet 5 mg n/a PT. Novell Box ,3 Strip @ 10 tablet
442 Litium karbonat tablet 200 mg Frimania 200 PT. Mersifarma KOTAK @ 10 x 10 TAB
443 Litium karbonat tablet 400 mg Frimania 400 PT. Mersifarma KOTAK @ 10 x 10 TAB
444 Loperamid tablet 2 mg n/a PT. Ifars Dus, 10 Strip @ 10 Tablet
445 Loratadin tablet 10 mg n/a PT. Promedrahardjo Dus, 5 Strip@10 Tablet
446 Lorazepam tablet 0,5 mg MERLOPAM 0,5 mg PT. Mersifarma KOTAK @ 10 x 10 TAB
447 Lorazepam tablet 2 mg Merlopam 2 PT. Mersifarma KOTAK @ 10 x 10 TAB
448 Low molecule feri sucrose inj amp 100 mg/5 mL DIALIFER PT. Novell ampul
449 Manitol n/a PT. Finusolprima botol 500 ml
450 Maprotilin HCl tab 25 mg Ludios PT. Soho Strip
451 Maprotilin HCl tab 50 mg Sandepril 50 PT. Mersifarma KOTAK @ 5 x 10 TAB
452 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/mL Bonescan KaeF PT. Kimia Farma Dus @ 5 vial
453 Mebendazol tablet 500 mg Vermox 500 PT. Taisho Dus,24 Catch @ 1 tablet
454 Medroksi Progesteron Asetat tablet/kaplet/kapsul 100 mg Provera 100mg PT. Pfizer Indonesia Dus, 10 blister @10 tablet
455 Melfalan tablet 2 mg Alkeran PT. Glaxo Box, Tablet 2 mg/25's
456 Meropenem inj 1 g n/a PT. Bernofarm Dus, 1 vial @ 1 g
457 Meropenem serb inj 500 mg/vial n/a PT. Bernofarm Dus, 1 vial @ 0,5 g
458 Mesna inj 100 mg/mL Uromitexan injeksi. PT. Mugi Laboratories Dus, 15 Ampul
459 Metadon sir 50mg/5ml n/a PT. Kimia Farma Botol 1000 ml
460 Metformin HCl tablet 500 mg n/a PT. Bernofarm Dus, 10 blister @ 10 tablet
461 Metformin HCl tablet 850 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kaptab
462 Metildopa tablet salut 250 mg DOPAMET PT. Actavis Dus, 10 Strip @ 10 tablet sal
463 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg n/a PT. Kimia Farma ktk 10 x 10 tablet salut
464 Metilergometrin Maleat injeksi 0,200 mg-1 ml n/a PT. Ethica ampul @ 1 ml
465 Metilfenidat kapsul LA 20 mg Ritalin LA PT. Novartis Dus, botol plastik @ 30 kaps
466 Metilfenidat tablet SR 10 mg RITALIN PT. Novartis Dus, 2 blister @ 15 tablet
467 Metilprednisolon inj 125 mg/2 mL n/a PT. Dexa Medica Dus, 1 Vial @125mg + 1 amp
468 Metilprednisolon inj 500 mg/8 mL n/a PT. Bernofarm Dus, 1 vial @ 500 mg
469 Metilprednisolon tablet 16 mg n/a PT. Mahakam Strip
470 Metilprednisolon tablet 4 mg n/a PT. Natura Dus, 10 Blister @ 10 Tablet
471 Metilprednisolon tablet 8 mg n/a PT. Dexa Medica Dus, 10 Blister @ 10 tablet
472 Metoklopramid drop botol 10 mL GAVISTAL drops PT. Meprofarm Dus, Botol 10 ml
473 Metoklopramide sirup 5 mg/ 5 ml LEXAPRAM SIRUP PT. Molex Ayus BOTOL 60 ML
474 Metoklopramide tablet 5 mg n/a PT. Kimia Farma ktk 10 x 10 tablet
475 Metotreksat serb inj 50 mg/2 mL Methotrexate Kalbe PT Kalbe Farma vial @ 2 ml
476 Metotreksat serbuk injeksi i.v/i.m./i.t. 5 mg METHOTREXATE EBEWE PT. Sandoz Box 10 ampul @ 1 ml
METHOTREXATE EBEWE 2.5
477 Metotreksat tablet/kaplet/kapsul 2,5 mg PT. Sandoz Box, bottle @ 50 tab
MG
478 Metronidazol infus 500 mg/100 ml n/a PT. Natura Dus, 1 Botol @ 100 ml
479 Metronidazol ovula 500 mg Vagizol PT. Kimia Farma dus 1 's @ 5 ovula
480 Metronidazol supositoria 500 mg Flagyl PT. Aventis Pharma Dus, 2 blister @ 5 suppositor
481 Metronidazol tablet 250 mg n/a PT. Phyto 10 strip @ 10 tab
482 Metronidazol tablet 500 mg n/a PT. Phyto 10 strip @ 10 tab
483 MIBG (meta-iodobenzylguanidine) Endoneuroscan KaeF 1 PT. Kimia Farma vial
484 MIBI (metoxy iso butyl iso nitril) 5-mL reaction vial Cardioscan KaeF PT. Kimia Farma Dus @ 5 vial
485 Midazolam injeksi i.v. 1 mg/ml Fortanest PT Kalbe Farma Box isi 5 ampul
486 Midazolam injeksi i.v. 5 mg/ml Dormicum PT. Boehringer Boks 5 amp
487 Mikafungin Na serb inj 50 mg Mycamine PT. Combiphar Dus,1 vial@50mg
488 Mikofenolat Mofetil 500 mg Cellcept PT. Boehringer Boks, 50 tablet
489 Mikonazol krim/salep 2 % (Nitrat) n/a PT. Kimia Farma Tube 10 gram
490 Mitomisin C (crystallin) serbuk inj 10 mg/vial Mitomycin C PT. Widatra Bhakti 10 mg /Vial
491 Modified fluid gelatine BM 30 000 lar inf 4% Gelofusine 4% PT. Phapros, Tbk Btl @ 500 ml
492 Moksifloksasin tetes mata 0,5% Vigamox PT. Tempo botol, tetes mata 3 ml
493 Mometason furoat krim 0,1% n/a PT. Guardian tube 10 gram
494 Morfin HCL inj 10 mg/ml n/a PT. Kimia Farma Dus 10 amp @ 1 ml
495 Morfin HCL tablet SR 10 mg MST Continus 10 mg PT. Mahakam Dus, 6 strip @ 10 tablet
496 Morfin HCL tablet SR 15 mg MST Continus 15 mg PT. Mahakam Dus, 6 strip @ 10 tablet
497 Morfin tablet 10 mg n/a PT. Kimia Farma Botol 30 tablet
498 N-asetil sistein inj. nebules 100 mg N-ace cairan inhalasi PT. Pratapa Nirmala Box @ 5 ampul
499 Nacl 0,9% n/a PT. Widatra Bhakti Botol 500 ml
500 Nadroparin inj 9500 Axa/mL syringe 0,3 mL Fraxiparine 0.3 ml PT. Glaxo Dus, 5 blister @ 2 pfs 0.3 ml
501 Nadroparin inj 9500 Axa/mL, syringe 0,4 mL Fraxiparine 0.4 ml PT. Glaxo Dus, 5 blister @ 2 pfs 0.4 ml
502 Nadroparin inj 9500 Axa/mL, syringe 0,6 mL Fraxiparine 0.6 ml PT. Glaxo Dus, 5 blister @ 2 pfs 0.6 ml
503 Nalokson injeksi 0,4 mg/ml Nokoba PT. Pratapa Nirmala Dus, 5 Ampul @ 2ml
504 Natrium Bikarbonat injeksi i.v 8,4% Meylon PT Otsuka Indonesia Ampoel 25 ML
505 Natrium Diklofenak tablet 50 mg n/a PT. Phapros, Tbk Dus @ 5 X 10 's
506 Natrium Diklofenak tablet 25 mg n/a PT. Phapros, Tbk Dus @ 5 X 10 's
507 Natrium fosfat lar oral 45 mL Fleet Phosphosoda PT. Combiphar Botol, 45 ml
508 Natrium fusidat salep 20 mg/g Fucilex Ointment PT. Molex Ayus Tube 5 gr
509 Neostigmin injeksi 0,5 mg/ml Neostigmin Hameln inj PT. Pharma Health Care Box, isi 5 ampul @ 1 ml
510 Nevirapin tablet 200 mg n/a PT. Kimia Farma btl 60 tablet
511 Nifedipin tab 20 mg, slow release; oros Adalat Oros 20 mg PT. Bayer Indonesia blister
512 Nifedipin tab 30 mg, oros Adalat Oros 30 mg PT. Bayer Indonesia blister
513 Nifedipin tablet/kapsul 10 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet sal
514 Nilotinib kapsul 200 mg (Skema Risk Sharing sesuai Kepmenkes RI Nomor Tasigna PT. Novartis Dus, 2 blister @ 14 kapsul
HK.02.02/Menkes/223/2014)
515 Nistatin tablet salut 500.000 IU/ g n/a PT. Phapros, Tbk Dus @ 10 X 10 's
516 Nistatin vaginal tablet 100.000 IU/ g n/a PT. Phapros, Tbk Dus @ 10 X 10 's
517 Norepinefrin injeksi 1 mg/ml Levosol PT. Kimia Farma Dus 5 amp @ 8 ml
518 Noretisteron tablet 5 mg Primolut N PT. Bayer Indonesia blister
519 Obat Antituberkulosis FDC Kategori 1 n/a PT. Kimia Farma Paket
520 Obat Antituberkulosis FDC Kategori 2 n/a PT. Indofarma Paket
521 Obat Antituberkulosis FDC Kategori Anak n/a PT. Phapros, Tbk Paket
522 Obat Antituberkulosis FDC Sisipan n/a PT. Indofarma Paket@84 tablet
523 Obat Antituberkulosis Kategori 1 dewasa n/a PT. Indofarma Dus, 1 dus @ 60 blister @ 8 t
524 Obat Antituberkulosis Kategori anak n/a PT. Indofarma Dus, 60 sachet tahap intensif
525 Octreotide Acetate0,05 - 6 mg/mL Octide PT. Pratapa Nirmala Box @ 5 ampul
526 Ofloksasin tets telinga 3% Tarivid Otic Solution PT Kalbe Farma Btl @ 5 ml
527 Ofloxacin tablet 200 mg n/a PT. Novell Box ,5 Strip @ 10 tablet
528 Ofloxacin tablet 400 mg n/a PT. Novell Box ,5 Strip @ 10 tablet
529 Oksaliplatin serbuk injeksi 100 mg / vial ELOXATIN PT. Aventis Pharma Dus, 1 vial @ 20 ml
530 Oksaliplatin serbuk injeksi 50 mg / vial ELOXATIN PT. Aventis Pharma Dus, 1 vial @ 10 ml
531 Oksimetazolin tetes hidung 0,025% Ilaidin Drops PT. Merck Tbk botol @ 10 ml
532 Oksitosin injeksi 10 IU/ml Oxytocin "S" PT. Ethica ampul @ 1 ml
533 Oktreotid 10 mg Sandostatin LAR PT. Novartis Dus, vial @ 355m + 1 prefille
534 Olanzapin inj 10 mg/vial Zyprexa IM PT. Bayer Indonesia Vial
535 Olanzapin kapl salut 5 mg Olandoz 5 PT. Sandoz 3 X 10 fcc
536 Olanzapin tab 10 mg Olandoz 10 PT. Sandoz 3 X 10 fcc
537 Olopatadin tts mata 0,1% Patanol PT. Tempo botol, tetes mata 5 ml
538 Omeprazol injeksi 40 mg/ 10 ml n/a PT. Natura Dus, 1 Vial @ 40 mg
539 Omeprazol kapsul/kaplet 20 mg n/a PT. Novapharin dus 10 X 3'S
540 ondansetron inj 4 mg/ 2 mL n/a PT. Indofarma Dus, 5 Ampul @ 2ml
541 Ondansetron tab 4 mg n/a PT. Yarindo Box 3 X 10 Tab
542 Ondansetron tablet 8 mg n/a PT. Yarindo Box 3 X 10 Tab
543 Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit Ultaclam, 1 unit n/a PT Kalbe Farma Transfer Set: Set; Ultaclam:
Tenckoff Catheter, Titanium Adaptor) Larutan Dialisa 1.5%: Dianeal
544 Paket CAPD Pergantian Transfer Set per 6 bulan n/a
Low Calcium with 1,5% PT Kalbe Farma Set
Dextrose; Larutan Dialisa 2.5%:
545 Paket CAPD Rutin 120 ( 4x ganti cairan perhari dengan komposisi Larutan Dianeal Low Calcium with 2,5% PT Kalbe Farma Larutan Dialisa 1.5 %: 2.000
Dialisa 1.5 %, Larutan Dialisa 2.5 %, Larutan Dialisa 4.25 %, Minicap) Dextrose; Larutan Dialisa
546 Paklitaksel inj 100 mg/vial 4.25%: Dianeal
SINDAXEL Low Calcium
100 MG/16,67 ML PT. Actavis Vial 6mg/ml (100mg/16.67ml
with 4.25% Dextrose
547 Paklitaksel inj 300 mg/vial SINDAXEL 260mg/43.33 ML PT. Actavis Vial 6mg/ml (260mg/43.33ml
548 Paklitaksel injeksi 30 mg/vial SINDAXEL 30 MG/5 ML PT. Actavis Vial 6mg/ml (30mg/5ml)
549 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) n/a PT. Indofarma Dus, 15 botol
550 Parasetamol sirup 120 mg / 5 ml n/a PT. Afifarma botol 60 ml
551 Parasetamol tablet 500 mg n/a PT. Promedrahardjo Dus, 10 Strip@10 Kaplet Salu
552 Parasetamol tetes 60 mg/0,6 mL NAPREX DROPS PT. Darya Varia botol @ 15 ml
553 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Pegasys PT. Boehringer Boks, 1 pfs
554 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Pegasys PT. Boehringer Boks, 1 pfs
555 Pegylated Interferon alfa-2b serb inj 100 mcg Pegintron Vial 100 Mcg PT. Merck Dus, 1 vial 100 mcg + 1 ampul
556 Pegylated Interferon alfa-2b serb inj 120 mcg Pegintron Pen 120 Mcg PT. Merck Dus, 1 prefilled syringe (ser
557 Pegylated Interferon alfa-2b serb inj 50 mcg Pegintron PT. Merck Dus, 1 vial 50 mcg + 1 ampul
558 Pegylated Interferon alfa-2b serb inj 80 mcg Pegintron Vial 80 Mcg PT. Merck Dus, 1 vial 80 mcg + 1 ampul
559 Perak sulfadiazin krim 1% BURNAZIN 35 GR PT. Darya Varia tube @ 35 gram
560 Perindoprilarginin tab 5 mg Bioprexum 5 mg PT. Pradja Pharin Dus, botol plastik @ 30 table
561 Permetrin krim 5% Scabimite Cream 10 PT. Galenium Tube @ 10 g
562 Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) n/a PT. Kimia Farma Ktk 10 ampx2ml
563 Pioglitazon tab 15 mg DECULIN 15 MG PT. Dexa Medica 30 TAB/BOX
564 Pioglitazon tab 30 mg DECULIN 30 MG PT. Dexa Medica 30 TAB/BOX
565 Pirantel suspensi 125 mg/5 ml n/a PT. Holi Pharma Botol 60 ml
566 Pirantel tablet score (base) 125 mg n/a PT. Holi Pharma Dus, 25 Blister @ 4 tablet
567 Pirazinamid tablet 500 mg n/a PT. Holi Pharma Dus 10 strip @ 10 tablet
568 Piridoksin (vitamin B6) inj 100 mg/mL n/a PT. Ikapharmindo Ampul 1 ml
569 Polikresulen cairan Aptil PT. Pratapa Nirmala Dus, Botol @ 10ml
570 Povidon Iodida larutan 10% 1000 ml n/a PT. Afifarma botol @ 1000 ml
571 Povidon Iodida larutan 10% 30 ml n/a PT. Afifarma botol @ 30 ml
572 Povidon Iodida larutan 10% 300 ml n/a PT. Afifarma botol @ 300 ml
573 Povidon Iodida larutan 10% 60 ml n/a PT. Kimia Farma btl 60 ml
574 Pramipeksol tab ER 0,375 mg Sifrol ER 0,375mg PT. Boehringer Dus, 3 alu blister @ 10 tablet
575 Pramipeksol tab ER 0,750 mg Sifrol ER 0,750mg PT. Boehringer Dus, 3 alu blister @ 10 tablet
576 Pravastatin tablet 20 mg n/a PT. Novell Box ,5 Strip @ 10 tablet
577 Prednison tablet/kapsul/kaplet 5 mg n/a PT. Holi Pharma Dus, 10 strip @ 10 tablet
578 Probenesid tablet/kapsul/kaplet 500 mg Probenid PT. Dexa Medica Dus, 10 strip @ 10 tablet
579 Prokain Benzilpenisilin serbuk injeksi 3 juta IU/vial n/a PT. Bernofarm Vial @ 3 juta IU
580 Propanolol tablet 10 mg ( HCl ) n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
581 Propiltiourasil tablet/kapsul/kaplet 100 mg n/a PT. Indofarma Botol @ 100 Tablet
582 Propofol injeksi i.v., bolus 1% Fresofol 1% MCT/LCT PT. Fresenius Ampul
583 Propranolol tablet 40 mg (HCl) n/a PT. Holi Pharma Dus, 10 strip @ 10 tablet
584 Quetiapin tab 200 mg Seroquel XR 200 mg PT. Astra Dus, 1 blister @ 10 tablet
585 Quetiapin tab 300 mg Seroquel XR 300 mg PT. Astra Dus, 1 blister @ 10 tablet
586 Quetiapin tab 400 mg Seroquel XR 400 mg PT. Astra Dus, 1 blister @ 10 tablet
587 Ramipril tablet 2,5 mg Cardace 2.5mg 6x10 s tablet PT. Pharma Health Care Dus, 6 blister @ 10 tablet
588 Ramipril tablet 5 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 kaptab
589 Ramipril tablet/kaplet/kapsul 10 mg n/a PT. Novell Dus, 10 strip @ 10 tablet
590 Ranitidin injeksi 25 mg/ml n/a PT. Natura Dus, 10 Ampul @ 2 ml
591 Ranitidin tablet 150 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet sal
592 Retinol (Vitamin A) 100.000 IU n/a PT. Kimia Farma Botol 50 kapsul lunak
593 Retinol (Vitamin A) 200.000 IU kapsul lunak n/a PT. Kimia Farma Botol 50 Kapsul
594 Rifampisin tablet/kapsul/kaplet 300 mg n/a PT. Indofarma Dus, 10 Strip @ 10 Kapsul
595 Ringer Laktat larutan infus n/a PT. Widatra Bhakti botol 500 ml
596 Risperidon tablet 1 mg n/a PT. Dexa Medica Dus, 5 Blister @ 10 tablet
597 Risperidon tablet 2 mg n/a PT. Mersifarma KOTAK @ 5 x 10 TAB
598 Risperidon tablet 3 mg n/a PT. Dexa Medica Dus, 5 Blister @ 10 tablet

599 Rituksimab injeksi 10 mg/ml (Skema Risk Sharing sesuai Kepmenkes RI Nomor Mabthera PT. Boehringer Dus, 1 vial @ 10 ml
HK.02.02/Menkes/223/2014)
600 Rivaroksaban tab 10 mg Xarelto 10 mg PT. Bayer Indonesia Blister
601 Rivaroksaban tab 15 mg Xarelto 15 mg PT. Bayer Indonesia Blister
602 Rivaroksaban tab 20 mg Xarelto 20 mg PT. Bayer Indonesia Blister
603 Ropinirol Tablet Salut 2 mg Requip PD 24 Hour 2 mg PT. Glaxo Dus, 7 blister @ 4 Tablet lep
604 Ropinirol Tablet Salut 4 mg Requip PD 24 Hour 4 mg PT. Glaxo Dus, 7 blister @ 4 Tablet lep
605 Ropinirol Tablet Salut 8 mg Requip PD 24 Hour 8 mg PT. Glaxo Dus, 7 blister @ 4 Tablet lep
606 Salbutamol cairan ih 0,1% Ventolin Nebules PT. Glaxo Dus, 4x5 Botol Plastik@2.5 m
607 Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler PT. Glaxo Dus, botol 200 dosis
608 Salbutamol serb inh 200 mcg/kaps Ventolin Rotacaps PT. Glaxo Dus, 10 Blister @ 10 Kapsul
609 Salbutamol serb inh 200 mcg/kaps + rotahaler Ventolin Rotahaler PT. Glaxo Dus, 1 Rotahaler
610 Salbutamol tablet 2 mg (sebagai Sulfat) n/a PT. Yarindo strip @ 10 tablet
611 Salbutamol tablet 4 mg (sebagai Sulfat) n/a PT. Kimia Farma ktk 10 x 10 tablet
612 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% n/a PT. Marin Liza Farmasi Pot @ 30 gram
613 Sefadroksil sirup kering 125 mg/5ml n/a PT. Holi Pharma Dus, Botol 60 ml
614 Sefadroksil kapsul/kaplet 250 mg n/a PT. Hexpharm strip
615 Sefadroksil kapsul/kaplet 500 mg n/a PT. Bernofarm Dus, 10 strip @ 10 kapsul
616 Sefadroksil sir kering 250 mg/5 mL n/a PT. Holi Pharma Dus, Botol 60 ml
617 Sefaleksin kapsul/kaplet 500 mg n/a PT. Ifars Dus, 5 Strip @ 10 Kapsul
618 Sefazolin serbuk injeksi 1 g/vial n/a PT. Dexa Medica Dus, 2 Vial @ 1 gram
619 Sefepim inj 1 g n/a PT. Yarindo Box 2 Vial @ 1000mg
620 Sefiksim kapsul/kaplet 100 mg n/a PT. Bernofarm Dus, 10 blister @ 10 kapsul
621 Sefiksim sirup kering 100 mg/ 5 ml n/a PT. Ifars Dus, Botol 30 ml
622 Sefoperazon inj 1 g n/a PT. Holi Pharma Dus, 2 vial @ 1 g
623 Sefotaksim injeksi 0,5 g n/a PT. Hexpharm vial
624 Sefotaksim injeksi 1 g n/a PT. Natura Dus, 10 Vial @ 1 g
625 Sefpodoksim proksetil tab 100 mg Banadoz 100 PT. Sandoz Dus, 3 blister @ 10 tablet
626 Seftazidim injeksi 1 g n/a PT. Dexa Medica Dus, 2 Vial @ 1 gram
627 Seftriakson serbuk injeksi 1 g/vial n/a PT. Natura Dus, 10 Vial @ 1 g
628 Sefuroksim tablet/kapsul/kaplet 250 mg Zinnat 250 mg PT. Glaxo Dus, 1 Blister @ 10 Tablet sa
629 Sefuroksim tab 500 mg Zinnat 500 PT. Glaxo Dus, 1 Blister @ 10 Tablet sa
630 Sertralin tab 50 mg Fatral PT. Pratapa Nirmala strip @ 10 tab
631 Setirizin sirup 5 mg/5 ml n/a PT. Indofarma Botol @ 60 ml
632 Setirizin tablet 10 mg n/a PT. Pertiwi Agung Box, 10 strips @ 10 capsules

633 Setuksimab infus 5 mg/ml (Skema Risk Sharing sesuai Kepmenkes RI Nomor Erbitux PT. Merck Tbk Dus, 1 vial @ 20 ml
HK.02.02/Menkes/223/2014)
634 Sevofluran ih, btl Sojourn PT. Pratapa Nirmala tabung/botol
635 Sianokobalamin (vitamin B12) injeksi 500 mcg n/a PT. Lucas Djaja 100 ampul @ 1 ml
636 Sianokobalamin (vitamin B12) tablet/kapsul/kaplet 50 mcg n/a PT. Afifarma Dus, 10 Strip @ 10 tablet
637 Siklofosfamid serbuk injeksi i.v. 1000 mg Cyclovid 1000 mg PT. Novell vial
638 Siklofosfamid serbuk injeksi i.v. 200 mg Cyclovid 200 mg PT. Novell vial
639 Siklofosfamid serbuk injeksi i.v. 500 mg CYCLOVID 500 PT. Novell Vial
640 Siklosporin kaps 100 mg Sandimmun Neoral 100mg Kap PT. Novartis Dus, 10 blister @ 5 kapsul lu
641 Siklosporin kapsul lunak 25 mg Sandimmun Neoral 25mg Kap PT. Novartis Dus, 10 blister @ 5 kapsul lu
642 Simvastatin scored tablet 10 mg n/a PT. Natura Dus, 3 Strip @ 10 Kaplet salu
643 Simvastatin tablet 20 mg n/a PT. Natura Dus, 3 Strip @ 10 Kaplet salu
644 Siprofloksasin infus 2% n/a PT. Dexa Medica Vial 200 ml
645 Siprofloksasin tablet 500 mg (sebagai HCl) n/a PT. Bernofarm Dus, 10 blister @ 10 tab ss
646 Sisplatin serbuk injeksi 10 mg Cisplatin PT Kalbe Farma vial
647 Sisplatin serbuk injeksi 50 mg Cisplatin PT Kalbe Farma vial
648 Sitarabin serbuk injeksi i.m./i.v./s.k. 1gr/10ml DBL Cytarabun PT. Tempo dus, 1 vial @ 10 ml
649 Spiramisin tablet 500 mg n/a PT. Indofarma Dus, 5 strip @ 10 tablet
650 Spironolakton tablet 100 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
651 Spironolakton tablet 25 mg n/a PT. Dexa Medica Dus, 10 Strip @ 10 tablet
652 Stavudin tablet/kapsul/kaplet 30 mg n/a PT. Kimia Farma Botol @ 60 tablet
653 Streptokinase injeksi 1,5 juta UI/vial Streptase PT. Dexa Medica Vial
654 Streptomisin serbuk injeksi i.v 1000 mg/ml n/a PT. Phapros, Tbk Dus @ 56 Vial
Sufentanyl Injeksi iv.Epidural 5 PT. Kimia Farma
655 Sufentanil injeksi iv, epidural 5 mcg/ml dus 5 amp @ dus 10
mcg / ml
656 Sukralfat susp 500 mg/5 mL Ulsafate PT. Combiphar Botol, 100 ml
657 Sukralfat tab 500 mg ULSIDEX PT. Dexa Medica DUS, 10 STRIP @ 10 TAB
658 Takrolimus kaps 0.5 mg Prograf PT. Combiphar Pounch @ 5 blister @ 10 cap
659 Takrolimus kaps 1 mg Prograf PT. Combiphar Dus, 1 pouch @5 blister@10
660 Tamsulosin tab 0,2 mg Harnal ® D 0.2 mg Disp. Tablet PT. Combiphar Box/ 2 blister @ 14 tablet
661 Tamsulosin tab 0,2 mg Harnal D PT. Combiphar Box @ 2 blister @ 14 tablet
662 Tamsulosin tab SR 0,4 mg Harnal ® OCAS 0.4 mg Tablet PT. Combiphar Box/ 3 blister @ 10 Tablet
663 Telbivudin tab 600 mg Sebivo 600 mg Tab PT. Novartis Dus, 2 blister @ 14 tablet
664 Telmisartan tab 40mg Micardis 40mg PT. Boehringer Dus, 2 alu-blister @10 tablet
665 Telmisartan tab 80 mg Micardis 80mg PT. Boehringer Box, 2 blisters @10 tablets
666 Temozolamid kaps 100 mg Temodal PT. Merck Dus, 5 sachet @ 1 kapsul
667 Temozolamid kaps 20 mg Temodal PT. Merck Dus, 5 sachet @ 1 kapsul
668 Tenofovir tab 300 mg n/a PT. Kimia Farma Botol 30 tab
669 Teofilin tab SR 300 mg Rethapyl PT. Kimia Farma Dus 10-s @ 10 Kaptab
670 Teofilin tablet 150 mg Bronsolvan PT Kalbe Farma strip
671 Terazosin HCl tablet/kapsul/kaplet 1 mg HYTROZ 1MG PT. Dexa Medica DUS, 10 BLISTER @ 10 TAB
672 Terazosin HCl tablet/kapsul/kaplet 2 mg HYTROZ 3MG PT. Dexa Medica DUS, 10 BLISTER @ 10 TAB
673 Terbutalin cairan ih 2,5 mg/mL Bricasma Respules PT. Astra Dus, 2 pak @ 5 respules
674 Terbutalin tablet 2,5 mg Molasma Tablet PT. Molex Ayus Box 50's
675 Terbutalin turbu (serbuk ih) 0,50 mg Bricasma Turbuhaler 0,5 mg PT. Astra Dus, 1 Turbuhaler @ 200 dos
676 Testoteron soft capsul 40 mg Andriol Testocaps PT. Merck Dus, 6 blister @ 10 kapsul lu
677 Tetrakain HCl tetes mata 0,5% Pantocain 0.5% PT. Cendo botol 5 ml
678 Tetrasiklin kapsul/kaplet 250 mg n/a PT. Holi Pharma Dus, 10 strip @ 10 kapsul
679 Tetrasiklin tablet/kapsul/kaplet 500 mg n/a PT. Afifarma DUS,10 STRIP @ 10 KAPSUL
680 Tiamazol tab 10 mg Thyrozol 10 PT. Merck Tbk Dus, 10 blister @ 10 tablet
681 Tiamazol tab 5 mg Thyrozol 5 PT. Merck Tbk Dus, 10 blister @ 10 tablet
682 Timolol tetes mata 0,25% Isotic Adretor 0,25% PT. Pratapa Nirmala Dus, Botol Plastik @ 5ml
683 Timolol tetes mata 0,5% Isotic Adretor 0,5% PT. Pratapa Nirmala Dus, Botol Plastik @ 5ml
Spiriva powder for inhalation
684 Tiotropium 18 mcg refill PT. Boehringer Box, 3 blisters @10 capsules
18mcg 30s
685 Tiotropium kaps 18 mcg + handihaller Spiriva 10s + Handihaler PT. Boehringer Dus, 1 blister @10 kapsul +
686 Tramadol injeksi 50 mg/ml n/a PT. Natura Dus, 10 Ampul @ 2 ml
687 Trastuzumab serbuk injeksi 440 mg/vial (Skema Risk Sharing sesuai Kepmenkes Herceptin PT. Boehringer Dus, 1 vial @ 440 mg + 1 via
RI Nomor HK.02.02/Menkes/223/2014)
688 Travoprost tetes mata 0,004% Travatan PT. Tempo botol, tetes mata 2,5 ml
689 Triamsinolon asetonid nasal spray 55 mcg/puff Nasacort AQ PT. Aventis Pharma Dus, botol plastik 120 dosis
690 Trifluoperazin tablet 5 mg n/a PT. Darya Varia strip
691 Tropikamid tetes mata 1% Cendo Mydriatil 1% PT. Cendo Botol 5ml
692 Urea krim 10% Soft U Derm PT. Galenium tube
693 Vaksin polio inj (Vaksin Poliomyelitis yang diinaktifkan) Imovax Polio PT. Aventis Pharma 1 vial of 10ml (10 d's)
694 Vaksin rabies, untuk manusia serbuk injeksi s.k./i.k. + booster RABIPUR PT. Novartis Dus, 1 vial serbuk + 1 ampul
695 Valgansiklovir tab 450 mg Valcyte PT. Boehringer Boks, 60 tablet
696 Valproat sirup 250 mg/5 ml Ikalep PT. Ikapharmindo Botol 120 ml
697 Valproat tab SR 250 mg Depakote ER 250 mg PT. Abbott Indonesia Tablet
698 Valproat tab SR 500 mg Depakote ER 500 mg PT. Abbott Indonesia Tablet
699 Valproat tablet salut 250 mg Depakote Tab 250 mg PT. Abbott Indonesia Tablet salut 250 mg
700 Valsartan tab 80 mg Diovan 80mg Tab PT. Novartis DUS, 3 ALU-ALU STRIP @ 10 ta
701 Valsartan tab 160 mg DIOVAN 160 MG PT. Novartis DUS, 3 ALU-ALU STRIP @ 10 ta
702 Vankomisin serbuk injeksi 500 mg/vial Vancep PT. Pratapa Nirmala Box @ 2 vial
703 Verapamil tab 240 mg Isoptin 240 mg PT. Abbott Indonesia Tablet
704 Verapamil tablet 80 mg (HCl) n/a PT. Kimia Farma Ktk 10X10 TAB
705 Vinblastin serbuk injeksi 10 mg Vinblastine PT. Combiphar Vial 10mg/10ml
706 Vinkristin serb inj i.v 2 mg/vial Vincristine Kalbe PT Kalbe Farma vial @ 2 ml
707 Vinkristin serbuk injeksi i.v. 1 mg Vincristine Kalbe PT Kalbe Farma vial @ 1 ml
708 Vinorelbin inj. 10 mg/ml Navelbine injeksi 10 PT. Mugi Laboratories Dus, 1 vial @ 1 ml
709 Vitamin B Kompleks tablet n/a PT. Kimia Farma Dus 10 strip x 10 tab
710 Zidofudin 100 mg n/a PT. Kimia Farma Botol 60 Kapsul
711 Zidovudin 300 mg + Lamivudine 150 mg n/a PT. Kimia Farma Botol 60 tablet
712 Zinc drop 10 mg/mL Zincpro Drops PT. Combiphar Drops 10 mg/ml, Botol @15
713 Zinc sir 20 mg/5 Ml Zircum Kid Sirup PT. Meprofarm Dus, botol 60 ml
714 Zinc tablet dispersible20 mg n/a PT. Indofarma Dus, 10 strip @ 10 tablet dis
 1,375.00
27,500.00
7,500.00
1,397.00
950
3,849.00
344
750,000.00
345,000.00
321,552.00
732,727.00
900,000.00
283,000.00
86
199.5
380
214
233
3,800,000.00
18,500.00
50,500.00
3,822.00
80
80
12,480.00
1,200.00
112
330
187
211
261
 4,070.00
2,445.00
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85,000.00

106,000.00

97,500.00

200,000.00

85,345.00

79,165.00

79,167.00

32,000.00

72

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2,516.00
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135
1,500.00
22,000.00
116
148
159
95
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48
2,209,000.00
112
 1,815.00
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24,750.00
237
336
1,039,500.00
190
700
20,000.00
74
13,500.00
13,500.00
34,400.00
4,500.00
3,333.00
1,250.00
9,800.00
13,400.00
3,200,000.00
3,600.00
1,520.00
25,106.00

4,803,697.00

72,400.00
45,000.00
6,045.00
4,990.00
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 304,000.00
247,089.00
93,000.00
106,000.00
8,900.00
117,600.00
110,500.00
25,600.00
30,800.00
12,936.00
12,936.00
305,000.00
275,000.00
76,000.00
150,000.00
2,600,000.00
25,300.00
112,000.00
1,580.00
62
70,000.00
5,700.00
9,983.00
11,525.00
16,748.00
45
1,050.00
22,000.00
97
134
127,667.00
 46,667.00
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104
37,500.00
124,955.00
26,700.00
3,480.00
5,480.00
270
55,500.00
258,000.00
3,333.00
167
15,600.00
9,840.00
970,200.00

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7,100.00
6,375.00
12,990.00
42,600.00
40,740.00
71,875.00
100,000.00
8,100.00
500,000.00
128,000.00
650
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497
 930
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275,000.00
133,875.00
128,000.00
139,500.00
314
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2,500.00
1,360.00
128,779.00
100,000.00
16,667.00
11,813.00
23,250.00

4,400,000.00

9,200,000.00
1,133,000.00
990,000.00
2,150,000.00
20,250.00
133
20,250.00
1,800.00
1,075.00
1,375.00
290
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72,900.00
117,500.00
 128,000.00
33,914.00
80,000.00
153,000.00
285,000.00
375,000.00
2,950.00
630
3,417.00
1,248,319.00
275,000.00
55,000.00
47,550.00
4,862.00
22,000.00
419
432
30,493.00
24,500.00
33,000.00
2,400.00
93,333.00
12,917.00
241,667.00
972,000.00
1,829.00
85
275,000.00
412,500.00
2,570,000.00
399,500.00
 288
295,000.00
289
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1,098,900.00
330,000.00
3,399.00
2,600.00
3,194.00
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430
3,207.00
3,000.00
1,493.00
2,171.00
1,500.00
5,333.00
5,700.00
5,200.00
2,300,000.00
840,000.00
209
83,333.00
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59
 96
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126
16,500.00
641,500.00
42,900.00
1,328,000.00
2,570.00
2,798.00
5,400.00
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18,000.00

138,000.00

138,000.00

72,000.00

76,125.00

76,125.00

75,000.00

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138,000.00

138,000.00

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 75,000.00

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138,000.00

138,000.00

72,000.00

170,000.00
3,499.00
4,499.00
110
150
1,329,163.00

211,000.00

3,908.00
2,120.00
350,000.00
122,000.00
166,000.00
369,000.00
147,000.00
199,000.00
245,000.00
123,200.00
299,000.00
150,300.00
80,000.00
90,000.00
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 2,470.00
510,000.00
270,000.00
65
158
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88
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1,580.00
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7,800.00
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3,100.00
27,500.00
140
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2,042.00
190,000.00
408,000.00
1,360.00
110,000.00
60,300.00
4,700.00
 2,850.00
2,569.00
28,000.00
300
2,722.00
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3,200.00
361
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900
30,600.00
184
3,400.00
249
1,600.00
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1,100.00
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144
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 50

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138
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540
2,000.00
1,400.00
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473
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 36,667.00

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295,240.00

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8,000.00
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37,500.00

210,000.00

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6,917.00

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 7,700.00

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10,000.00

105,500.00
60,500.00
210,000.00

591,000.00

511,000.00

358,000.00

89,800.00

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127,000.00
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2,700,000.00
500,000.00
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142,000.00
600
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89
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1,341.00
52,000.00
62,000.00
1,200.00
3,276.00
473,000.00
7,140.00
6,125.00
12,210.00
54,000.00
44,960.00
74,998.00
254,100.00
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108
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3,220.00
110
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1,925,000.00
1,237,500.00
6,000.00
12,060.00
260,000.00
16,000.00
3,000.00
697,000.00
72,000.00
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15,620.00
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176
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3,500.00
110
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480
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1,199,990.00
214,900.00
160,000.00
288,199.00
171,195.00
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400
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27,550.00
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36,000.00
211
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1,189.00
1,902,240.00
219,540.00

5,522,580.00

984,000.00
3,000,000.00
274,560.00
5,200.00
1,438.00
79
6,730.00
1,077,815.00
1,248,220.00
973,500.00
1,135,000.00
915,000.00
915,810.00
23,000.00
2,420.00
11,475.00
14,500.00
3,120.00
4,525.00
8,360.00
298
208
1,000.00
17,393.00
37,109.00
2,163.00
14,203.00
5,998.00
7,200.00
11,268.00
2,300.00
114
1,650.00
7,190.00
65
319
15,642.00
107
17,391.00
19,500.00
23,185.00
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 1,013.00
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120
260
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609
5,200.00
1,200.00
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3,164,805.00

23,500.00
23,500.00
23,500.00
5,248.00
6,275.00
7,383.00
6,600.00
63,750.00
431
5,867.00
59
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4,896.00
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 859
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3,700.00
16,000.00
3,300.00
4,752.00
7,200.00
3,300.00
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181

3,650,000.00

1,320,000.00
1,078.00
57
256,000.00
82,000.00
120,000.00
43,000.00
12,000.00
169
391
13,000.00
255
22,000.00
93,000.00
575,000.00
1,499.00
 900
315
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3,290,000.00
3,650.00
127,000.00
13,425.00
424
11,167.00
21,500.00
5,800.00
5,800.00
6,800.00
28,500.00
3,900.00
6,500.00
1,120,000.00
223,000.00
8,100.00
1,050.00
250
1,669.00
2,949.00
6,250.00
99
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6,200.00
11,500.00
149
300
1,135.00
 563
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13,867.27
152,543.00
2,395.00
19,608,034.00
115,000.00
90,000.00
405
36,500.00
6,400.00
285,000.00
78,500.00
170,000.00
40,000.00
2,793.00
5,450.00
1,680.00
3,900.00
6,500.00
122,000.00
6,200.00
234
210,000.00
78,000.00
46,000.00
1,229,998.00
107
1,575.00
 3,429.00
12,840.00
7,400.00
474