TANGGAL PEMBUATAN LAPORAN

LAPORAN PEMAKAIAN BULAN

PERMINTAAN OBAT BULAN

HARGA
NO NAMA OBAT SATUAN
SATUAN

1 2 WAY FOLEY CATHETER NO.16 PCS Rp 8,107

2 2 WAY FOLEY CATHETER NO.18 PCS Rp 7,999
3 2 WAY FOLEY CATHETER NO.20 PCS Rp 8,000
4 ALAT SUNTIK SEKALI PAKAI 1 ML PCS Rp 990
6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS Rp 1,302
5 ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS Rp 825
7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS Rp 1,500
8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS Rp 792
9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS Rp 979
10 ALAT SUNTIK SEKALI PAKAI 50 ML PCS Rp 3,400
11 ALAT SUNTIK SEKALI PAKAI IX 0,5 ML PCS Rp 1,195
12 ALLOPURINOL TABLET 100 MG TABLET Rp 89
13 ALPRAZOLAM 1 MG TABLET TABLET Rp 162
14 AMBROXOL SIRUP 5MG/ML BOTOL Rp 4,400
15 AMBROXOL TABLET 30 MG TABLET Rp 187
16 AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL Rp 3,345
17 AMINOPHYLLINE TABLET 200 MG TABLET Rp 91
18 AMITRIPTYLLINE HCL TABLET 25 MG TABLET Rp 143
19 AMLODIPINE TABLET 10 MG TABLET Rp 93
20 AMLODIPINE TABLET 5 MG TABLET Rp 105
21 AMOKSILLIN SERBUK INJEKSI 1.000 MG VIAL Rp 14,850
22 AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL Rp 2,090
23 AMOKSISILIN TABLET 500 MG KAPLET Rp 232
24 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL Rp 8,470
25 ANTALGIN INJEKSI 250 MG/ML 2 ML AMPUL Rp 1,980
26 ANTALGIN TABLET 500 MG TABLET Rp 255

LPLPO Hal. 1
27 ANTASIDA DOEN TABLET KOMBINASI TABLET Rp 62
28 ANTASIDA SUSPENSI 60 ML BOTOL Rp 1,923
29 ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT Rp 2,924
30 ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT Rp 4,158
31 ANTI HAEMOROID DOEN KOMBINASI SUPP. Rp 3,045
32 ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET Rp 990
33 ANTI INFLUENZA (SOLAFLUZ) KOMBINASI SYRUP BOTOL Rp 6,600
34 ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET Rp 167
35 ANTI SPASMODIK TABLET (DORMICOMP) TABLET Rp 3,080
36 ANTITUSSIVE KOMBINASI TABLET TABLET Rp 440
37 AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL Rp 2,000
38 ARTEMETHER INJEKSI 80 MG AMPUL Rp 25,490
39 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET Rp 114
40 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET Rp 104
41 ASAM FOLAT 1MG TABLET TABLET Rp 63
42 ASAM FUSIDAT KRIM 20MG/ GRAM TUBE Rp 5,997
43 ASAM MEFENAMAT TABLET 500 MG TABLET Rp 106
44 ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL Rp 2,190
45 ASAM TRANEKSAMAT 500 MG TABLET TABLET Rp 1,540
46 ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET Rp 2,945
47 ASEPTAN 500CC + PUMP BOTOL Rp 34,496
48 ASEPTIC GEL 500CC + DISPENSER BOTOL Rp 22,000
49 ASERING (ASETAT RINGER) SOFT BAG BOTOL Rp 9,275
50 ASETOSAL TABLET 100 (80) MG TABLET Rp 92
51 ASIKLOVIR KREAM 5 % 5 GR TUBE Rp 3,160
52 ASIKLOVIR TABLET 400 MG TABLET Rp 349
53 ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL Rp 1,540
54 ATROPIN SULFAT TABLET 0,5 MG TABLET Rp 75
55 ATROPIN SULFAT TETES MATA 0,5 % 5 ML BOTOL Rp 13,500
56 ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET Rp 140
57 BETAHISTINMESILAT 6 MG TABLET TABLET Rp 149
58 BETAMETHASONE CREAM 0,1 % 5 GR TUBE Rp 1,349
59 BISAKODIL ( BICOLAX ) TABLET 5 MG TABLET Rp 300
60 BISAKODIL SUPPOSITORIA 10 MG SUPP. Rp 5,900

LPLPO Hal. 2
61 BISAKODIL SUPPOSITORIA 5 MG SUPP. Rp 6,000
62 BISOPROLOL 5 MG TABLET TABLET Rp 645
63 BROMHEXINE SIRUP (HUSTAB) BOTOL Rp 11,550
64 CAT GUT NO.2/0 CHROMIC + JARUM 1/2 GT 35 MM PCS Rp 5,583
65 CAT GUT NO.2/0-3/0 PLAIN & CHROMIC PCS Rp 5,583
66 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL Rp 16,390
67 COMBIVENT UDV INHALASI VIAL Rp 4,550
68 DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL Rp 1,097
69 DEKSAMETHASONE TABLET 0,5 MG TABLET Rp 32
70 DEVITALISASI PASTA ( NON ARSEN ) POT Rp 223,300
71 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL Rp 1,735
72 DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE Rp 12,573
73 DIAZEPAM TABLET 2 MG TABLET Rp 45
74 DIAZEPAM TABLET 5 MG TABLET Rp 109
75 DIETILKARBAMAZIN SITRAT TABLET 100 MG TABLET Rp 119
76 DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL Rp 1,175
77 DIGOXIN TABLET 0,25 MG TABLET Rp 105
78 DIMENHYDRINATE TABLET 50 MG TABLET Rp 99
79 DOKSISIKLIN TABLET 100 MG KAPSUL Rp 269
80 DOMPERIDON SUSPENSI 5MG/ML BOTOL Rp 3,000
81 DOMPERIDON TABLET 10 MG TABLET Rp 118
82 EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE Rp 18,150
83 EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL Rp 1,749
84 ERITROMISIN 200 MG/5-ML SIRUP KERING BOTOL Rp 6,090
85 ERITROMISIN KAPSUL 250 MG KAPSUL Rp 566
86 ERITROMISIN TABLET 500 MG KAPSUL Rp 730
87 ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 ML BOTOL Rp 3,000
88 ETANOL (ALKOHOL) 70 % 1000 ML BOTOL Rp 21,500
89 ETANOL [ ALKOHOL ] 70 % 300 ML BOTOL Rp 7,500
90 ETHAMBUTOL HCL TABLET 250 MG TABLET Rp -
91 ETHAMBUTOL HCL TABLET 500 MG TABLET Rp -
92 ETIL KLORIDA SEMPROT 100 ML BOTOL Rp 138,930
93 EUGENOL CAIRAN 10 ML BOTOL Rp 18,824
94 FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL Rp 7,980

LPLPO Hal. 3
 95 FENITOIN NATRIUM TABLET 100 MG KAPSUL Rp 154
96 FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL Rp 1,969
97 FENOBARBITAL TABLET 100 MG TABLET Rp -
98 FENOBARBITAL TABLET 30 MG TABLET Rp 171
99 FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL Rp 2,500
100 FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1 ML AMPUL Rp 3,682
101 FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET Rp 691
102 FITOMENADION INFANT INJ. 2MG/ML AMPUL Rp 3,550
103 FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL Rp 57,500
104 FRADIOMISIN + GRAMISIDIN TABLET [ FG TROCHES ] TABLET Rp -
105 FUROSEMID INJEKSI IV/ IM 10 MG/ ML AMPUL Rp 1,895
106 FUROSEMID TABLET 40 MG TABLET Rp 77
107 GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE Rp 12,155
108 GEMFIBROZIL 300 MG KAPSUL KAPSUL Rp 380
109 GENTAMISIN INJEKSI 80 MG/2 ML VIAL Rp 3,083
110 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE Rp 3,520
111 GENTAMISIN SALEP MATA 0,3% TUBE Rp 2,830
112 GENTAMISIN TETES MATA 0,3% BOTOL Rp 4,000
113 GENTIAN VIOLET LARUTAN 1 % BOTOL Rp 700
114 GLASS IONOMER CEMENT ( GC IX ) BOTOL Rp 861,300
115 GLIBENCLAMIDE TABLET 5 MG TABLET Rp 119
116 GLICERIL GUAIACOLAT TABLET 100 MG TABLET Rp 121
117 GLIMEPIRIDE 2 MG TABLET TABLET Rp 289
118 GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL Rp 7,500
119 GLUKOSA LARUTAN INFUS 40 % STERIL 25 ML BOTOL Rp 7,920
120 GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL Rp 6,900
121 GRISEOFULVIN TABLET 125 MG TABLET Rp 210
122 HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL Rp 4,974
123 HALOPERIDOL TABLET 1,5 MG TABLET Rp 66
124 HALOPERIDOL TABLET 5 MG TABLET Rp 75
HEPARIN SODIUM 200 UI/GRAM-GELL
125 TUBE Rp 46,200
(THROMBOFLASH)
HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS
126 BOTOL Rp 21,780
500 ML
127 HIDROCHLOROTIAZIDE (H.C.T) TABLET 25 MG TABLET Rp -
128 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE Rp 2,650

LPLPO Hal. 4
129 HYOCINE N BUTILBROMIDE 10 MG TABLET TABLET Rp 1,694
HYOSIN N BUTILBROMID ( ANTI SPASMODIK-SPASI)
130 AMPUL Rp 10,890
INJEKSI
131 I.V CATHETER NO.16 WITH INJECTION PORT PCS Rp 12,100
132 I.V CATHETER NO.18 WITH INJECTION PORT PCS Rp 11,000
133 I.V CATHETER NO.20 WITH INJECTION PORT PCS Rp 11,000
134 I.V CATHETER NO.22 WITH INJECTION PORT PCS Rp 11,000
135 I.V CATHETER NO.24 WITH INJECTION PORT PCS Rp 11,000
136 IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL Rp 2,475
137 IBUPROFEN TABLET 200 MG TABLET Rp 105
138 IBUPROFEN TABLET 400 MG TABLET Rp 127
139 INFUSION SET ANAK PCS Rp 6,400
140 INFUSION SET DEWASA PCS Rp 3,200
141 ISONIAZIDA (INH) 100 MG TABLET TABLET Rp 72
142 ISONIAZIDA (INH) 300 MG TABLET TABLET Rp 173
143 ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET Rp 88
144 KAEN 3B BOTOL Rp 10,050
145 KALIUM DIKLOFENAK 50 MG TABLET TABLET Rp 682
146 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL Rp 9,955
147 KALSIUM HIDROKSIDA PASTA POT Rp -
148 KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET Rp 63
149 KANTONG URINE DEWASA PCS Rp 3,000
150 KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL Rp 7,700
151 KAPAS BERLEMAK 500 GR BKS Rp 16,500
152 KAPAS PEMBALUT/ABSORBEN 250 GR BKS Rp 12,496
153 KAPTOPRIL TABLET 25 MG TABLET Rp 68
154 KARBAMAZEPIN TABLET 200 MG TABLET Rp 270
KARBAZOKHROME SODIUM SULFONATE INJEKSI 5
155 AMPUL Rp 13,200
MG/ML 10 ML (SALDONA)
156 KASA KOMPRES 40/40 STERIL BKS Rp 1,595
157 KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL Rp 5,800
158 KASA PEMBALUT HIDROFIL 18 X 22 CM STERIL ROL Rp 5,900
159 KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL Rp 7,700
160 KASA PEMBALUT HIDROFIL 3 M X 80 CM ROL Rp 7,700
161 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL Rp 1,500
162 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL Rp 2,100

LPLPO Hal. 5
163 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL Rp 590
164 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL Rp 750
165 KASA STERIL (DARYAN TOLLE)YG DIRESAPI FRAMISETIN PCS Rp 8,990
166 KETOKONAZOLE TABLET 200 MG TABLET Rp 280
167 KETOPROFEN 100 MG SUPPOSITORIA SUPP. Rp 2,640
168 KLINDAMISIN KAPSUL 300 MG KAPSUL Rp 578
169 KLOBAZAM 10 MG TABLET TABLET Rp 739
170 KLORAMFENIKOL INJEKSI 1.000 MG/VIAL VIAL Rp 7,954
171 KLORAMFENIKOL KAPSUL 500 MG KAPSUL Rp 1,048
172 KLORAMFENIKOL SALEP KULIT 2 % TUBE Rp 3,008
173 KLORAMFENIKOL SALEP MATA 1 % TUBE Rp 1,798
174 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL Rp 4,700
175 KLORAMFENIKOL TETES MATA 0,5 % 10 ML BOTOL Rp 6,050
176 KLORAMFENIKOL TETES TELINGA 3 % BOTOL Rp 6,600
177 KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET Rp 42
178 KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL Rp 1,240
179 KLORPROMAZIN HCL INJEKSI 5 MG/ML 1 ML AMPUL Rp 1,412
180 KLORPROMAZIN HCL TABLET 100 MG TABLET Rp 162
181 KLORPROMAZIN HCL TABLET 25 MG TABLET Rp -
182 KLOZAPIN 100 MG TABLET TABLET Rp 3,288
183 KODEIN HCL TABLET 10 MG TABLET Rp 550
184 KOTRIMOKSAZOL DEWASA TABLET TABLET Rp 151
185 KOTRIMOKSAZOL PEDIATRIK TABLET TABLET Rp 151
186 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL Rp 2,140
187 LEVOFLOXACIN TABLET 500 MG TABLET Rp 495
188 LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL Rp 1,937
189 LIDOCAIN Hcl INJEKSI 2 % AMPUL Rp 1,149
190 LISOL CONCENTRATE 1000 ML BOTOL Rp 41,000
191 LOPERAMIDE TABLET 2 MG TABLET Rp 85
192 LORATADIN TABLET 10 MG TABLET Rp 134
193 MAGNESIUM SULFAT INJEKSI (IV) 20 % 25 ML AMPUL Rp 3,200
194 MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL Rp 3,796
195 MASKER KERTAS 3 PLY EAR LOOP PCS Rp 440
196 MASKER KERTAS 3 PLY TIE ON PCS Rp 330

LPLPO Hal. 6
197 MASKER N9 PCS Rp 8,875
198 MELOKSIKAM TABLET 7,5 MG TABLET Rp 407
199 METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL Rp 9,185
200 METFORMIN TABLET 500 MG TABLET Rp 100
201 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL Rp 2,684
202 METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET Rp 210
203 METILPREDNISOLON TABLET 4 MG TABLET Rp 194
204 METOKLOPRAMIDE 10 MG TABLET TABLET Rp 115
METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2
205 AMPUL Rp 4,620
ML
206 METRONIDAZOL TABLET 250 MG TABLET Rp 94
207 METRONIDAZOL TABLET 500 MG TABLET Rp 133
208 METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL Rp 9,950
METRONIDAZOLE+NYSTATIN 100.000 UI (PROVAGIN)
209 SUPP. Rp 15,615
VAG.SUPP.
210 MIKONAZOL KREAM 10 GR TUBE Rp 3,250
211 MINERAL MIX SACHET Rp 2,920
212 MONOKLORKAMFER MENTOL CAIRAN (CHKM) BOTOL Rp -
213 MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL Rp 24,200
MULTIVITAMIN (MALTIRON PLUS) KOMBINASI
214 TABLET Rp 1,430
TABLET
215 MUMMIFYING PASTA BOTOL Rp -
216 NATRIUM DIKLOFENAK TABLET 50 MG TABLET Rp 159
217 NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL Rp 6,410
218 NEUROTROPIK (IKANEURON) INJEKSI AMPUL Rp 4,180
219 NEUROTROPIK KOMBINASI (IKANEURON) TABLET TABLET Rp 1,210
220 NEVIRAPINE TABLET 200 MG TABLET Rp 2,940
221 NIFEDIPINE TABLET 10 MG TABLET Rp 104
222 NISTATIN TABLET 500.000 UI TABLET Rp 790
223 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB Rp 523
224 OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL Rp 5,500
225 OKSIGEN NASAL CANNULA ADULT PCS Rp 5,082
226 OKSIGEN NASAL CANNULA INFANT PCS Rp 5,082
227 OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE Rp 2,261
228 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE Rp 2,500
229 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL Rp 1,199
230 OMEPRAZOLE TABLET 20 MG KAPSUL Rp 160

LPLPO Hal. 7
231 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL Rp 1,255
232 PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL Rp 1,010
233 PARACETAMOL TABLET 100 MG TABLET Rp 94
234 PARACETAMOL TABLET 500 MG TABLET Rp 53
235 PARACETAMOL TETES 100 MG/ML 15 ML BOTOL Rp 6,649
236 PERAK SULFADIAZIN KRIM 1 % TUBE Rp 20,700
237 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL Rp 24,200
238 PIRACETAM TABLET 800 MG TABLET Rp 964
239 PIRANTEL PAMOAT TABLET 125 MG TABLET Rp 291
240 PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET Rp 45
241 PIRIDOKSIN HCL (VIT B6) TABLET 25 MG TABLET Rp 60
242 PIROKSIKAM KAPSUL 10 MG KAPSUL Rp 127
243 PLESTER 5 YARD X 2 INCI ROL Rp 32,450
244 PREDNISON TABLET 5 MG TABLET Rp 96
245 PROPANOLOL HCL TABLET 40 MG TABLET Rp 76
246 PROPILTHIOURACIL TABLET 100 MG TABLET Rp 279
247 RANITIDIN INJEKSI 25 MG/ ML AMPUL Rp 1,390
248 RANITIDIN TABLET 150 MG TABLET Rp 105
249 RESPERIDON 2 MG TABLET TABLET Rp 273
250 RINGER LAKTATE LARUTAN INFUS STERIL BOTOL Rp 7,150
251 SALBUTAMOL TABLET 2 MG TABLET Rp 66
252 SALBUTAMOL TABLET 4 MG TABLET Rp 83
253 SALEP 2-4 KOMBINASI 30 GR POT Rp 2,429
254 SALICYL BEDAK 2 % KOTAK Rp 1,020
255 SARUNG TANGAM NON STERIL L PCS Rp 583
256 SARUNG TANGAN NON STERIL M PCS Rp 356
257 SARUNG TANGAN NON STERIL S PCS Rp 356
258 SARUNG TANGAN OBGYN PSG Rp 19,360
259 SARUNG TANGAN STERIL NO 6 PSG Rp 4,180
260 SARUNG TANGAN STERIL NO. 8 PSG Rp 4,180
261 SARUNG TANGAN STERILE NO.6,5 PSG Rp 4,180
262 SARUNG TANGAN STERILE NO.7 PSG Rp 5,863
263 SEFADROKSIL KAPSUL 500 MG KAPSUL Rp 516
264 SEFIKSIM KAPSUL 100 MG KAPSUL Rp 590

LPLPO Hal. 8
265 SEFOTAKSIM INJEKSI 1.000 MG VIAL Rp 4,898
266 SEMEN SENG FOSFAT SERBUK DAN CAIRAN 30 GR BOTOL Rp 112,200
267 SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL Rp 462,000
268 SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL Rp 126,500
269 SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) VIAL Rp 126,500
270 SETIRIZINE TABLET 10 MG TABLET Rp 90
SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1
271 AMPUL Rp 1,087
ML
272 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET Rp 51
273 SILK (BENANG BEDAH SUTERA) NO.3/0 PCS Rp 3,055
274 SILVER AMALGAM SERBUK 65-75 % BOTOL Rp -
275 SIMETIDINE TABLET 200 MG TABLET Rp 242
276 SIMVASTATIN TABLET 10 MG TABLET Rp 131
277 SIPROFLOXACIN INFUS 2% BOTOL Rp 11,489
278 SIPROFLOXACIN TABLET 500 MG TABLET Rp 281
279 SIPROHEPTADINE 4 MG TABLET (PRONICY) TABLET Rp 275
280 SPONS GELATIN CUBICLES 1x1x1 CM POT Rp 9,240
281 SULFADOXINE - PYRIMETHAMINE 525 MG TABLET Rp 616
282 SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL Rp 35,614
283 TABLET TAMBAH DARAH TABLET Rp 354
TEMPORARY CAVITY SEALER [TUMPATAN
284 POT Rp 133,650
SEMENTARA] (CAVIT G) FLECHTER SERBUK DAN
TEMPORARY STOPPING
285 BOTOL Rp 35,200
CAIRAN
286 TETRAKAIN HCL TETES MATA 5 ML BOTOL Rp 14,300
287 TETRASIKLIN HCL TABLET 500 MG KAPSUL Rp 310
288 THIAMFENIKOL SIRUP 60 ML BOTOL Rp 6,600
289 THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL Rp 1,320
290 THIAMIN HCL MONONITRAT (VIT B1) TABLET 100 MG TABLET Rp 200
291 THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET Rp 86
292 TRAMADOL INJEKSI 50 MG/ML AMPUL Rp 1,710
293 TRANFUSION SET ADULT WITH Y INJECTION PCS Rp 14,300
TRIAMSINOLON ACETONIDE (BUFACOMB) 1MG/GR
294 TUBE Rp 16,500
SALEP
295 TRIFLOUPERASIN TABLET 5 MG TABLET Rp 296
296 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET Rp 88
297 TRIKRESOL FORMALIN (PENGANTI TKF) BOTOL Rp 40,000
298 TRIPROLIDINE|PSEUDOEPHEDRINE (ZENTRA) TABLET Rp 99

LPLPO Hal. 9
299VIKIA HIV 1/2/0 RAPID TEST STRIPS STRIP Rp 19,480
300VITAMIN B COMPLEX TABLET TABLET Rp 83
301YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL Rp 2,900
302YODIUM POVIDON LARUTAN 10% 1000 ML BOTOL Rp 42,500
303YODIUM POVIDON LARUTAN 10% 300 ML ML BOTOL Rp 18,000
304YODIUM POVIDON LARUTAN 10% 60 ML BOTOL Rp 3,700
305ZINK 20 MG TABLET TABLET Rp 514
JUMLAH OBAT PKD
JUMLAH OBAT PKD HARGA
NO SATUAN
DAFTAR OBAT PROGRAM / HIBAH SATUAN
1 ALAT SUNTIK 0,5 ML ONEJECT KTK100'S Rp 1,195
2 ALAT SUNTIK 0,05 ML ONEJECT KTK100'S Rp 1,590
3 ALAT SUNTIK 5 ML KTK100'S Rp 1,640
4 ALBENDAZOL TABLET 400 MG KTK30'S Rp 231
5 EFAFIRENZ (EKV) 200 MG TABLET BTL90'S Rp 410
6 EFAFIRENZ (EFV) 600 MG TABLET BTL30'S Rp 6,375
7 GARAM ORALIT UNTUK 200 ML AIR KTK 100'S Rp 264
8 IODINE TES SET-6 BTL Rp 5,275
9 LAMIVUDIN 150 MG TABLET BTL60'S Rp 1,500
10 NEVIRAPINE (NVP) 200 MG TABLET BTL60'S Rp 2,800
11 OBAT ANTI TUBERKULOSIS KATAGORI 1 PAKET Rp 359,985
12 OBAT ANTI TUBERKULOSIS KATAGORI 2 PAKET ###
13 OBAT ANTI TUBERKULOSIS UNTUK ANAK PAKET Rp 203,259
14 OAT KOMBIPAK KATEGORI I PAKET Rp 288,199
15 REAGEN I (STANDART DIAGNOSTIC/SD) PCS Rp 13,340
16 REAGEN III (BIOMERIEUX/VIKIA HIV 1/2 PCS Rp 19,839
17 REAGEN HIV (FOKUS) TEST PCS Rp 14,470
18 REAGEN HIV+THA/SYPHILIS/HUMAN HEXAGON PCS Rp 26,671
19 REAGEN RDT DBD COMBO PCS Rp 110,089
20 REAGEN I (INTEC ONE STEP ANN HIV 1&2) PCS Rp 22,396
21 REAGEN II (CONCOPROBE/IR-100 C) PCS Rp 23,386
BOTOL
22 RETINOL ( VIT A ) KAPSUL 100.000 IU Rp 284
100'S
BOTOL
23 RETINOL ( VIT A ) KAPSUL 200.000 IU Rp 520
100'S
24 SAFETY BOX PCS Rp 16,268

LPLPO Hal. 10
25 TDC+3TC+EFV (300/300/600) TABLET BTL30'S Rp 11,895
26 TENOKOVIR 300 MG (TDF) BTL30'S Rp 8,100
ZIDOVUDINE (CDZ) 300 MG + LAMIVUDIN (3TC) 150
27 BTL60'S Rp 3,700
MG
28 ZIDOVUDINE SYRUP 240 ML BTL Rp 28,281
ZIDOVUDIN 60MG+LAMIVUDIN 30MG+NEVIRAPINE
29 BTL60'S Rp 721
50MG(TRIPLE FDC) ANAK

HARGA
NO DAFTAR OBAT TAMBAHAN SATUAN
SATUAN
1 AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL Rp 8,237
2 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL Rp 1,735
3 FITOMENADION ( VIT K1 ) INFANT INJEKSI 2 MG/ML AMPUL Rp 3,682
4 GENTAMISIN INJEKSI 80 MG/ 2 ML AMPUL Rp 3,083
5 KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL Rp 9,955
6 LEVOTHYROXINE SODIUM TABET TABLET Rp 735
7 METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL Rp 2,684
8 OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE Rp 2,500
9 ZINK SIRUP BOTOL Rp -
10 ZINK SIRUP BOTOL Rp -
11 0 0 Rp -
12 0 0 Rp -
13 0 0 Rp -
14 0 0 Rp -
15 0 0 Rp -
16 0 0 Rp -
17 0 0 Rp -
18 0 0 Rp -
19 0 0 Rp -
20 0 0 Rp -

LPLPO Hal. 11
 DATA CEK KESESUAIAN OBAT YANG TERSEDIA DENGAN FORNAS

KETERANGAN :
BKN (BUKAN FORNAS)
TK 1 (UTK FK TINGKAT 1)
TK 2 (UTK FK TINGKAT 2)
TK 3 (UTK FK TINGKAT 3)

SATUAN KESESUAIAN FORNAS

2 WAY FOLEY CATHETER NO.16 PCS BKN

2 WAY FOLEY CATHETER NO.18 PCS BKN
2 WAY FOLEY CATHETER NO.20 PCS BKN
ALAT SUNTIK SEKALI PAKAI 1 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 10 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 20 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 3 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 5 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI 50 ML PCS BKN
ALAT SUNTIK SEKALI PAKAI IX 0,5 ML PCS BKN
ALLOPURINOL TABLET 100 MG TABLET BKN
ALPRAZOLAM 1 MG TABLET TABLET BKN
AMBROXOL SIRUP 5MG/ML BOTOL BKN
AMBROXOL TABLET 30 MG TABLET BKN
AMINOPHYLLINE INJEKSI 24 MG/ML 10 ML AMPUL TK 1
AMINOPHYLLINE TABLET 200 MG TABLET TK 1
AMITRIPTYLLINE HCL TABLET 25 MG TABLET TK 1
AMLODIPINE TABLET 10 MG TABLET TK 1
AMLODIPINE TABLET 5 MG TABLET TK 1
AMOKSILLIN SERBUK INJEKSI 1.000 MG VIAL BKN
AMOKSISILIN DRY SYRUP 125 MG/5 ML 60 ML BOTOL TK 2 TK 3
AMOKSISILIN TABLET 500 MG KAPLET TK 1
AMPICILLIN SERBUK INJEKSI 1.000 MG MG/VIAL VIAL TK 1
ANTALGIN INJEKSI 250 MG/ML 2 ML AMPUL BKN
ANTALGIN TABLET 500 MG TABLET BKN
ANTASIDA DOEN TABLET KOMBINASI TABLET TK 1
ANTASIDA SUSPENSI 60 ML BOTOL TK 1
ANTI BAKTERI DOEN SALEP KOMBINASI 5 GR POT BKN
ANTI FUNGI DOEN SALEP KOMBINASI 30 GR POT BKN
ANTI HAEMOROID DOEN KOMBINASI SUPP. TK 1
ANTI INFLUENZA (EMFLU) KOMBINASI TAB TABLET BKN
ANTI INFLUENZA (SOLAFLUZ) KOMBINASI SYRUP BOTOL BKN
ANTI MIGRAIN DOEN TABLET KOMBINASI TABLET TK 1

LPLPO Hal. 12
 SATUAN KESESUAIAN FORNAS

ANTI SPASMODIK TABLET (DORMICOMP) TABLET TK 1

ANTITUSSIVE KOMBINASI TABLET TABLET BKN
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML BOTOL TK 1
ARTEMETHER INJEKSI 80 MG AMPUL BKN
ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET TK 1
ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET TK 1
ASAM FOLAT 1MG TABLET TABLET TK 1
ASAM FUSIDAT KRIM 20MG/ GRAM TUBE TK 1
ASAM MEFENAMAT TABLET 500 MG TABLET TK 1
ASAM TRANEKSAMAT 100 MG/ML INJEKSI AMPUL TK 2 TK 3
ASAM TRANEKSAMAT 500 MG TABLET TABLET TK 2 TK 3
ASAM VALPROAT 250 MG TABLET / DEPAKOTE ER TABLET TK 1
ASEPTAN 500CC + PUMP BOTOL BKN
ASEPTIC GEL 500CC + DISPENSER BOTOL BKN
ASERING (ASETAT RINGER) SOFT BAG BOTOL BKN
ASETOSAL TABLET 100 (80) MG TABLET TK 1
ASIKLOVIR KREAM 5 % 5 GR TUBE BKN
ASIKLOVIR TABLET 400 MG TABLET TK 1
ATROPIN SULFAT INJEKSI 0,25 MG/ML 1 ML AMPUL TK 1
ATROPIN SULFAT TABLET 0,5 MG TABLET TK 1
ATROPIN SULFAT TETES MATA 0,5 % 5 ML BOTOL TK 2 TK 3
ATTAPULGIT + PECTIN ( NEO DIASTOP ) TABLET TABLET TK 1
BETAHISTINMESILAT 6 MG TABLET TABLET TK 2 TK 3
BETAMETHASONE CREAM 0,1 % 5 GR TUBE TK 1
BISAKODIL ( BICOLAX ) TABLET 5 MG TABLET TK 1
BISAKODIL SUPPOSITORIA 10 MG SUPP. TK 1
BISAKODIL SUPPOSITORIA 5 MG SUPP. TK 1
BISOPROLOL 5 MG TABLET TABLET TK 2 TK 3
BROMHEXINE SIRUP (HUSTAB) BOTOL BKN
CAT GUT NO.2/0 CHROMIC + JARUM 1/2 GT 35 MM PCS BKN
CAT GUT NO.2/0-3/0 PLAIN & CHROMIC PCS BKN
CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL BKN
COMBIVENT UDV INHALASI VIAL BKN
DEKSAMETHASONE INJEKSI 5 MG/ML 1 ML AMPUL TK 1
DEKSAMETHASONE TABLET 0,5 MG TABLET TK 1
DEVITALISASI PASTA ( NON ARSEN ) POT TK 1
DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL TK 1

DIAZEPAM LARUTAN RECTAL 5MG/ 2,5ML-STESOLID TUBE TK 1

DIAZEPAM TABLET 2 MG TABLET TK 1

DIAZEPAM TABLET 5 MG TABLET TK 1
DIETILKARBAMAZIN SITRAT TABLET 100 MG TABLET TK 1
DIFENHIDRAMINE HCL INJEKSI 10 MG/ML 1 ML AMPUL TK 1
DIGOXIN TABLET 0,25 MG TABLET TK 1
DIMENHYDRINATE TABLET 50 MG TABLET TK 1
DOKSISIKLIN TABLET 100 MG KAPSUL TK 1
DOMPERIDON SUSPENSI 5MG/ML BOTOL TK 1
DOMPERIDON TABLET 10 MG TABLET TK 1

LPLPO Hal. 13
 SATUAN KESESUAIAN FORNAS

EKSTRACT PLASENTA + NEOMYSIN SALEP 15 GR TUBE BKN

EPINEFRIN (ADRENALIN) HCL INJ.0,1 % 1 ML AMPUL TK 1
ERITROMISIN 200 MG/5-ML SIRUP KERING BOTOL TK 1
ERITROMISIN KAPSUL 250 MG KAPSUL TK 1
ERITROMISIN TABLET 500 MG KAPSUL TK 2 TK 3
ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 % 300 ML BOTOL BKN
ETANOL (ALKOHOL) 70 % 1000 ML BOTOL TK 1
ETANOL [ ALKOHOL ] 70 % 300 ML BOTOL TK 1
ETHAMBUTOL HCL TABLET 250 MG TABLET BKN
ETHAMBUTOL HCL TABLET 500 MG TABLET BKN
ETIL KLORIDA SEMPROT 100 ML BOTOL TK 1
EUGENOL CAIRAN 10 ML BOTOL BKN
FENITOIN NATRIUM INJEKSI 50 MG/ML 2 ML AMPUL TK 1
FENITOIN NATRIUM TABLET 100 MG KAPSUL TK 1
FENOBARBITAL INJEKSI 50 MG/ML 2 ML AMPUL TK 2 TK 3
FENOBARBITAL TABLET 100 MG TABLET TK 1
FENOBARBITAL TABLET 30 MG TABLET TK 1
FENOL GLISEROL TETES TELINGA 10 % 5 ML BOTOL BKN
FITOMENADION ( VIT K1 ) INJEKSI 10 MG/ML 1 ML AMPUL TK 1
FITOMENADION ( VIT K1 ) TABLET SALUT 10 MG TABLET TK 1
FITOMENADION INFANT INJ. 2MG/ML AMPUL TK 1
FLUPHENASINE DEKANOAT INJEKSI 25 MG 1 ML AMPUL BKN
FRADIOMISIN + GRAMISIDIN TABLET [ FG TROCHES ] TABLET BKN
FUROSEMID INJEKSI IV/ IM 10 MG/ ML AMPUL TK 2 TK 3
FUROSEMID TABLET 40 MG TABLET TK 1
GAMEKSAN (SCABICID)/PERMETRIN KRIM 1 % 10 GR TUBE BKN
GEMFIBROZIL 300 MG KAPSUL KAPSUL TK 2 TK 3
GENTAMISIN INJEKSI 80 MG/2 ML VIAL TK 2 TK 3
GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE TK 2 TK 3
GENTAMISIN SALEP MATA 0,3% TUBE TK 2 TK 3
GENTAMISIN TETES MATA 0,3% BOTOL TK 2 TK 3
GENTIAN VIOLET LARUTAN 1 % BOTOL BKN
GLASS IONOMER CEMENT ( GC IX ) BOTOL TK 1
GLIBENCLAMIDE TABLET 5 MG TABLET TK 1
GLICERIL GUAIACOLAT TABLET 100 MG TABLET BKN
GLIMEPIRIDE 2 MG TABLET TABLET TK 1
GLUKOSA LARUTAN INFUS 10 % STERIL BOTOL TK 1
GLUKOSA LARUTAN INFUS 40 % STERIL 25 ML BOTOL TK 1
GLUKOSA LARUTAN INFUS 5 % STERIL BOTOL TK 1
GRISEOFULVIN TABLET 125 MG TABLET TK 1
HALOPERIDOL INJ. 5 MG/ML (LODOMER) AMPUL TK 1
HALOPERIDOL TABLET 1,5 MG TABLET TK 1
HALOPERIDOL TABLET 5 MG TABLET TK 1
HEPARIN SODIUM 200 UI/GRAM-GELL (THROMBOFLASH) TUBE BKN
HES-HYDROXYETHYL STARCH 6 %/VOLUVEN INFUS 500 ML BOTOL BKN
HIDROCHLOROTIAZIDE (H.C.T) TABLET 25 MG TABLET TK 1
HIDROCORTISONE CREAM 2,5 % 5 GR TUBE TK 1
HYOCINE N BUTILBROMIDE 10 MG TABLET TABLET TK 1

LPLPO Hal. 14
 SATUAN KESESUAIAN FORNAS

HYOSIN N BUTILBROMID ( ANTI SPASMODIK-SPASI) INJEKSI AMPUL TK 2 TK 3

I.V CATHETER NO.16 WITH INJECTION PORT PCS BKN
I.V CATHETER NO.18 WITH INJECTION PORT PCS BKN
I.V CATHETER NO.20 WITH INJECTION PORT PCS BKN
I.V CATHETER NO.22 WITH INJECTION PORT PCS BKN
I.V CATHETER NO.24 WITH INJECTION PORT PCS BKN
IBUPROFEN SUSPENSI 100 MG/5 ML 60 ML BOTOL TK 1
IBUPROFEN TABLET 200 MG TABLET TK 1
IBUPROFEN TABLET 400 MG TABLET TK 1
INFUSION SET ANAK PCS BKN
INFUSION SET DEWASA PCS BKN
ISONIAZIDA (INH) 100 MG TABLET TABLET TK 1
ISONIAZIDA (INH) 300 MG TABLET TABLET TK 1
ISOSORBIDE DINITRATE SUBLINGUAL 5 MG TABLET TK 1
KAEN 3B BOTOL BKN
KALIUM DIKLOFENAK 50 MG TABLET TABLET BKN
KALSIUM GLUCONAS INJEKSI 100 MG/ML 10 ML AMPUL TK 1
KALSIUM HIDROKSIDA PASTA POT TK 1
KALSIUM LAKTAT (KALK) TABLET 500 MG TABLET TK 1
KANTONG URINE DEWASA PCS BKN
KAOLIN PEKTIN (NOVADIAR) SUSPENSI BOTOL BKN
KAPAS BERLEMAK 500 GR BKS BKN
KAPAS PEMBALUT/ABSORBEN 250 GR BKS BKN
KAPTOPRIL TABLET 25 MG TABLET TK 1
KARBAMAZEPIN TABLET 200 MG TABLET TK 1
KARBAZOKHROME SODIUM SULFONATE INJEKSI 5 MG/ML 10 AMPUL BKN
ML (SALDONA)
KASA KOMPRES 40/40 STERIL BKS BKN
KASA PEMBALUT HIDROFIL 16 X 16 CM STRIL ROL BKN
KASA PEMBALUT HIDROFIL 18 X 22 CM STERIL ROL BKN
KASA PEMBALUT HIDROFIL 2 M X 80 CM ROL BKN
KASA PEMBALUT HIDROFIL 3 M X 80 CM ROL BKN
KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL BKN
KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL BKN
KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL BKN
KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL BKN
KASA STERIL (DARYAN TOLLE)YG DIRESAPI FRAMISETIN PCS BKN
KETOKONAZOLE TABLET 200 MG TABLET TK 1
KETOPROFEN 100 MG SUPPOSITORIA SUPP. TK 2 TK 3
KLINDAMISIN KAPSUL 300 MG KAPSUL TK 1
KLOBAZAM 10 MG TABLET TABLET TK 2 TK 3
KLORAMFENIKOL INJEKSI 1.000 MG/VIAL VIAL TK 1
KLORAMFENIKOL KAPSUL 500 MG KAPSUL TK 1
KLORAMFENIKOL SALEP KULIT 2 % TUBE TK 1
KLORAMFENIKOL SALEP MATA 1 % TUBE TK 1
KLORAMFENIKOL SUSPENSI 125 MG/5 ML BOTOL TK 1
KLORAMFENIKOL TETES MATA 0,5 % 10 ML BOTOL TK 1
KLORAMFENIKOL TETES TELINGA 3 % BOTOL TK 1
KLORFENIRAMINE MALEAT (CTM) TABLET 4 MG TABLET TK 1

LPLPO Hal. 15
 SATUAN KESESUAIAN FORNAS

KLORPROMAZIN HCL INJEKSI 25 MG/ML 1 ML AMPUL TK 2 TK 3

KLORPROMAZIN HCL INJEKSI 5 MG/ML 1 ML AMPUL TK 1
KLORPROMAZIN HCL TABLET 100 MG TABLET TK 1
KLORPROMAZIN HCL TABLET 25 MG TABLET BKN
KLOZAPIN 100 MG TABLET TABLET TK 2 TK 3
KODEIN HCL TABLET 10 MG TABLET TK 1
KOTRIMOKSAZOL DEWASA TABLET TABLET TK 1
KOTRIMOKSAZOL PEDIATRIK TABLET TABLET BKN
KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL TK 1
LEVOFLOXACIN TABLET 500 MG TABLET TK 2 TK 3
LIDOCAIN COMPOSITUM INJEKSI 2 ML AMPUL TK 1
LIDOCAIN Hcl INJEKSI 2 % AMPUL TK 1
LISOL CONCENTRATE 1000 ML BOTOL BKN
LOPERAMIDE TABLET 2 MG TABLET TK 2 TK 3
LORATADIN TABLET 10 MG TABLET TK 1
MAGNESIUM SULFAT INJEKSI (IV) 20 % 25 ML AMPUL TK 1
MAGNESIUM SULFAT INJEKSI (IV) 40 % 25 ML AMPUL TK 1
MASKER KERTAS 3 PLY EAR LOOP PCS BKN
MASKER KERTAS 3 PLY TIE ON PCS BKN
MASKER N9 PCS BKN
MELOKSIKAM TABLET 7,5 MG TABLET BKN
METAMIZOL (NORAGES) INJEKSI 500 MG/2ML AMPUL TK 2 TK 3
METFORMIN TABLET 500 MG TABLET TK 1
METILERGOMETRIN MALEAT INJEKSI 0,200 MG 1 ML AMPUL TK 1
METILERGOMETRIN MALEAT TABLET 0,125 MG TABLET TK 1
METILPREDNISOLON TABLET 4 MG TABLET TK 1
METOKLOPRAMIDE 10 MG TABLET TABLET TK 1
METOKLOPROMIDE (SOTATIC) INJEKSI 5 MG/ML 2 ML AMPUL BKN
METRONIDAZOL TABLET 250 MG TABLET TK 1
METRONIDAZOL TABLET 500 MG TABLET TK 1
METRONIDAZOLE INFUS 5 MG/ML 100 ML BOTOL TK 1
METRONIDAZOLE+NYSTATIN 100.000 UI (PROVAGIN) VAG.SUPP. SUPP. BKN
MIKONAZOL KREAM 10 GR TUBE TK 1
MINERAL MIX SACHET BKN
MONOKLORKAMFER MENTOL CAIRAN (CHKM) BOTOL TK 1
MULTIVITAMIN (LYSOVIT ) SYRUP 100 ML BOTOL BKN
MULTIVITAMIN (MALTIRON PLUS) KOMBINASI TABLET TABLET BKN
MUMMIFYING PASTA BOTOL BKN
NATRIUM DIKLOFENAK TABLET 50 MG TABLET TK 1
NATRIUM KLORIDA INFUS 0,9 % STERIL BOTOL BKN
NEUROTROPIK (IKANEURON) INJEKSI AMPUL BKN
NEUROTROPIK KOMBINASI (IKANEURON) TABLET TABLET BKN
NEVIRAPINE TABLET 200 MG TABLET TK 2 TK 3
NIFEDIPINE TABLET 10 MG TABLET TK 1
NISTATIN TABLET 500.000 UI TABLET TK 1
NISTATIN VAGINAL TABLET 100.000 UI VAGTAB TK 1
OBAT BATUK HITAM (OBH) CAIRAN 100 ML BOTOL BKN
OKSIGEN NASAL CANNULA ADULT PCS BKN

LPLPO Hal. 16
 SATUAN KESESUAIAN FORNAS

OKSIGEN NASAL CANNULA INFANT PCS BKN

OKSITETRACYCLIN SALEP KULIT 3 % 5 GR TUBE TK 1
OKSITETRACYCLIN SALEP MATA 1 % 3,5 GR TUBE TK 1
OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL TK 1
OMEPRAZOLE TABLET 20 MG KAPSUL TK 1
ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL TK 2 TK 3
PARACETAMOL SYRUP 120 MG/5 ML 60 ML BOTOL TK 1
PARACETAMOL TABLET 100 MG TABLET BKN
PARACETAMOL TABLET 500 MG TABLET TK 1
PARACETAMOL TETES 100 MG/ML 15 ML BOTOL TK 1
PERAK SULFADIAZIN KRIM 1 % TUBE TK 1
PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL BKN
PIRACETAM TABLET 800 MG TABLET BKN
PIRANTEL PAMOAT TABLET 125 MG TABLET TK 1
PIRIDOKSIN HCL (VIT B6) TABLET 10 MG TABLET TK 1
PIRIDOKSIN HCL (VIT B6) TABLET 25 MG TABLET TK 1
PIROKSIKAM KAPSUL 10 MG KAPSUL BKN
PLESTER 5 YARD X 2 INCI ROL BKN
PREDNISON TABLET 5 MG TABLET TK 1
PROPANOLOL HCL TABLET 40 MG TABLET TK 1
PROPILTHIOURACIL TABLET 100 MG TABLET TK 1
RANITIDIN INJEKSI 25 MG/ ML AMPUL TK 2 TK 3
RANITIDIN TABLET 150 MG TABLET TK 1
RESPERIDON 2 MG TABLET TABLET TK 1
RINGER LAKTATE LARUTAN INFUS STERIL BOTOL BKN
SALBUTAMOL TABLET 2 MG TABLET TK 1
SALBUTAMOL TABLET 4 MG TABLET TK 1
SALEP 2-4 KOMBINASI 30 GR POT BKN
SALICYL BEDAK 2 % KOTAK TK 1
SARUNG TANGAM NON STERIL L PCS BKN
SARUNG TANGAN NON STERIL M PCS BKN
SARUNG TANGAN NON STERIL S PCS BKN
SARUNG TANGAN OBGYN PSG BKN
SARUNG TANGAN STERIL NO 6 PSG BKN
SARUNG TANGAN STERIL NO. 8 PSG BKN
SARUNG TANGAN STERILE NO.6,5 PSG BKN
SARUNG TANGAN STERILE NO.7 PSG BKN
SEFADROKSIL KAPSUL 500 MG KAPSUL TK 1
SEFIKSIM KAPSUL 100 MG KAPSUL TK 2 TK 3
SEFOTAKSIM INJEKSI 1.000 MG VIAL TK 2 TK 3
SEMEN SENG FOSFAT SERBUK DAN CAIRAN 30 GR BOTOL BKN
SERUM ANTI BISA ULAR POLIVALEN INJ.5 ML (ABU I) VIAL TK 1
SERUM ANTI TETANUS INJEKSI 1.500 IU/AMP (ATS) VIAL TK 1
SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) VIAL TK 1
SETIRIZINE TABLET 10 MG TABLET TK 1
SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML 1 ML AMPUL BKN
SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET TK 1
SILK (BENANG BEDAH SUTERA) NO.3/0 PCS BKN

LPLPO Hal. 17
 SATUAN KESESUAIAN FORNAS

SILVER AMALGAM SERBUK 65-75 % BOTOL BKN

SIMETIDINE TABLET 200 MG TABLET BKN
SIMVASTATIN TABLET 10 MG TABLET TK 1
SIPROFLOXACIN INFUS 2% BOTOL TK 2 TK 3
SIPROFLOXACIN TABLET 500 MG TABLET TK 1
SIPROHEPTADINE 4 MG TABLET (PRONICY) TABLET BKN
SPONS GELATIN CUBICLES 1x1x1 CM POT BKN
SULFADOXINE - PYRIMETHAMINE 525 MG TABLET BKN
SULFASETAMID NATRIUM TETES MATA 15 % 5 ML BOTOL BKN
TABLET TAMBAH DARAH TABLET TK 1
TEMPORARY CAVITY SEALER [TUMPATAN SEMENTARA] (CAVIT POT TK 1
G)
TEMPORARY STOPPING FLECHTER SERBUK DAN CAIRAN BOTOL BKN
TETRAKAIN HCL TETES MATA 5 ML BOTOL TK 1
TETRASIKLIN HCL TABLET 500 MG KAPSUL TK 1
THIAMFENIKOL SIRUP 60 ML BOTOL TK 1
THIAMIN HCL (VIT B1) INJEKSI 100 MG/ML 1 ML AMPUL BKN
THIAMIN HCL MONONITRAT (VIT B1) TABLET 100 MG TABLET TK 1
THIAMIN HCL MONONITRAT (VIT B1) TABLET 50 MG TABLET TK 1
TRAMADOL INJEKSI 50 MG/ML AMPUL TK 2 TK 3
TRANFUSION SET ADULT WITH Y INJECTION PCS BKN
TRIAMSINOLON ACETONIDE (BUFACOMB) 1MG/GR SALEP TUBE TK 1
TRIFLOUPERASIN TABLET 5 MG TABLET TK 2 TK 3
TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG TABLET TK 1
TRIKRESOL FORMALIN (PENGANTI TKF) BOTOL BKN
TRIPROLIDINE|PSEUDOEPHEDRINE (ZENTRA) TABLET BKN
VIKIA HIV 1/2/0 RAPID TEST STRIPS STRIP BKN
VITAMIN B COMPLEX TABLET TABLET TK 1
YODIUM POVIDON LARUTAN 10 % 30 ML BOTOL BKN
YODIUM POVIDON LARUTAN 10% 1000 ML BOTOL BKN
YODIUM POVIDON LARUTAN 10% 300 ML ML BOTOL BKN
YODIUM POVIDON LARUTAN 10% 60 ML BOTOL BKN
ZINK 20 MG TABLET TABLET TK 1

JUMLAH 152

PERSENTASE KESESUAIAN FORNAS

LPLPO Hal. 18